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Clinical Breast Exam -goal, importance
For early detection of Breast CA
- Breast CA:
- Most common CA in USA women
- Lifetime chance of developing breast CA is 1 in 8 women
- Second leading cause of CA deaths in women
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Breast Exam -Risk Factors
- Personal Hx of Breast CA/conditions
- FH of Breast CA/conditions
- Age (advanced)
- Reproductive age
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Breast exam -Inspection
- Size
- Symmetry
- Contour
- Skin changes
- Venous patterns
- Dimpling
- Scars
- Nipple retraction
- Nipple deviation
- Positions:
- Sitting with arms down
- Sititng with arms on hips
- Arms on side of head
- Bending forward
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Breast exam -lymph glands exam
Position: sitting
- Axillary lymph nodes
- Supraclavicular nodes
- Infraclavicular nodes
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Breast exam
Position: Lying down on supine
- Areas of breast tissue:
- Midaxillary line to Lateral edge of sternum
- Clavicle to Inframmamory fold
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Breast -Palpation
- Use pads of three middle fingers with hand slightly bow
- Vary pressure as you palpate: superficial, medium, deep
- Slide hand over without lifting fingers
- Takes 2-5 mnts to palpate both breast
- Check for nipple d/c
- Special attention to sites:
- Most malignancies at Upper-Outer Quadrant
- 2nd most common site for malignancies at Subaureolar area
- Patterns of palpation:
- Vertical strip
- Radial
- Concentric circles
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Breast exam -description of mass
- Location
- Size (cm)
- Shape
- Consistency
- Mobility
- Skin changes
- Tenderness
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Breast lumps -DDx
- Fibroadenoma
- Benign
- SMOOTH, ROUND, WELL-defined, usually solitary
- "Slippery tumor" -VERY MOBILE
- PainLESS
- Does NOT change with cycles
- Fibrocystic changes
- 35-55yo
- S/S:
- Mastalgia, cyclic or NON-cyclic
- TENDER, swelling, LUMPY, varying with menses
- Nodularity predominates
- Gross cystic dz
- Most NOT associated with increased risk of breast CA -EXCEPT atypical hyperplasia
- Breast CA
- >50yo female (increased risk with age)
- BRCA1 and/or BRCA2
- 2 or more first degree relatives with Breast CA Dx at early age
- Personal Hx of Breast CA
- Obesity
- EtOH
- Jewish
- Hx of radiation to breast tissue
- Recent/Long-term use of HRT
- Reproductive risks:
- Early menarche (<12yo)
- Late age at first pregnancy (>30yo) or NO full-term pregnacies
- Never breast fed a child
- Late menopause >55yo
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Breast exam -Education
- Self-Breast exam:
- Do at same time of month
- Demonstrate what is nl for pt
- Explain what to look for -masses, skin changes
Recommend mammography if >40yo
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Breast CA -Palpation
- HARD, WOODY, STONY
- ILL-defined margins
- NON-mobile, fixed to surrounding tissues
- ENLARGE LYMPH nodes
- NIPPLE RETRACTION/DEVIATION
- SKIN CHANGES (DIMPLING, PUCKERING, RETRACTION, PEAU D'ORANGE, REDNESS, VENOUS PATTERNS)
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