At first

• discharge

• Duration

•Swelling

• Redness

•Pain

HISTORYHISTORY

• Change over the time

• General

• Drug history

• Family history

• Past medical history

• socioeconomic status

• Reproductive history

HISTORYHISTORY

• General

•Obesity•Age >50 years

HISTORYHISTORY

• Reproductive history

•Recent history of pregnancy •Nulliparity•First child after 30•lactation: Lack of breastfeeding•Age at menarche:Menarche<12yrs•Menstural irregularities•Age at menopause:Menopause>45yrs

HISTORYHISTORY

• Drug history

•Hormone therapy•Alcohol consumption

HISTORYHISTORY

• Family history

•Cancer of the breast and ovaries in primary relatives(parents,siblings,and offspring)

HISTORYHISTORY

• Past medical history

•Benign breast dz•Hx of breast cancer•Radiation exposure

HISTORYHISTORY

• socioeconomic status

•Higher socioeconomic status

HISTORYHISTORY

Inspection

Palpation

Inspection› Symmetry› Skin changes› Nipple discharge

Physical Exam

Breast palpation techniques

› Soft vs hard› Fixed vs mobile› Margins: well-defined vs poorly

defined› Tenderness› Temperature

•Sensitivity of CBE improved by :• Longer duration (5-10 min.)• Using systematic pattern

Uncontrollable risk factors

Controllable risk factors

Being female Age Mutations of Breast cancer

genes(BRCA 1 and BRCA 2) History of previous breast biopsy

which showed precancerous condition

Gynecological history

Obesity

Use of oral contraceptives for five years or longer or hormone replacement therapy

Having 1st child after 30

More than one alcoholic drink a day

FNA

ULTRASOUND

MAMMOGRAPHY

History&physical

examination

High risk Low risk Age >50 years Benign breast dz Radiation exposure First child after 30 Higher socioeconomic

status Hx of breast cancer Family hx of breast

cancer Hormone therapy Nulliparity Obesity Alcohol consumption Lack of breastfeeding Menarche <12 yrs Menopause >45 yrs BRCA mutation

History&physical

examination

High risk Low risk

< 30 years > 30 years

History&physical

examination

High risk Low risk

< 30 years > 30 years

FNA

History&physical

examination

High risk Low risk

< 30 years > 30 years

Cystsolid

History&physical

examination

Low risk

< 30 years > 30 years

High risk

Residual mass

present

Fluid grossly bloody

Reaccumulation of cyst

Cystsolid

BIOPSY

Residual mass

present

Fluid grossly bloody

Reaccumulation of cyst

benign malignancysuspicious

FNA Follow up

surgery

Cystsolid

High risk Low risk

< 30 years > 30 years

History&physical

examination

Evaluate specific lesion Occult disease in surrounding tissue Utilized spot compression and

magnification views Communicate with

radiologist!