Breast lumpsBMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g5275 (Published 05 September 2014) Cite this as: BMJ 2014;349:g5275
- M Twoon, medical student1,
- N Y B Ng, medical student1,
- S E Thomson, specialist training year 4, plastic and reconstructive surgery2
- 1University of Aberdeen, Aberdeen, Scotland
- 2Plastic and Reconstructive Surgery Unit, Aberdeen Royal Infirmary, Aberdeen, Scotland
- Correspondence to:
- Accepted 25 July 2014
A 35 year old woman presents with a 1 cm hard lump in the upper outer quadrant of her right breast. She first noticed this when she was in the shower three months ago. She is worried that the lump might be malignant.
What you should cover
Breast lumps are common and have a variety of causes. Although most lumps are not malignant, any abnormal changes to the breasts need to be reviewed as soon as possible. Refer patients to a breast clinic where triple assessment can be performed and the lump fully investigated. It is often difficult to make a definitive diagnosis on clinical history and examination alone. Many patients who are referred for specialist assessment will be found not to have cancer.
Undertake a clinical breast examination, with consent and chaperone. People have different techniques and, although the following technique is recommended, it is by no means the only acceptable one.
Compare both sides, and include all four quadrants, the retro-areolar area, and axillary tail. Examine the axilla and supraclavicular areas for lymphadenopathy.
Note the location of lump; its consistency; tethering to overlying or underlying structures; and associated features of lymphadenopathy, skin changes (such as peau d’orange—skin with an “orange peel” appearance owing to invasion of the lymphatics by tumour cells, which causes obstruction and oedema), or nipple discharge.
If nipple discharge is clearly evident send a sample for microbiology and cytology.
An eczematous rash might represent Paget’s disease of the nipple and underlying cancer. Compare both nipples for evidence of eczema or Paget’s disease. Eczema …