Breast exam

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Author:
ysimon
ID:
184465
Filename:
Breast exam
Updated:
2012-11-19 15:04:30
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Breast exam
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Description:
Clinical Breast exam
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  1. 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 
  2. Breast Exam -Risk Factors
    • Personal Hx of Breast CA/conditions
    • FH of Breast CA/conditions
    • Age (advanced)
    • Reproductive age
  3. 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
  4. Breast exam -lymph glands exam
    Position: sitting

    • Axillary lymph nodes 
    • Supraclavicular nodes
    • Infraclavicular nodes
  5. Breast exam
    Position: Lying down on supine

    • Areas of breast tissue: 
    • Midaxillary line to Lateral edge of sternum
    • Clavicle to Inframmamory fold
  6. 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
  7. Breast exam -description of mass
    • Location 
    • Size (cm)
    • Shape 
    • Consistency
    • Mobility
    • Skin changes
    • Tenderness
  8. 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
  9. 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
  10. 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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