History - Common complaints:
- Lump ( most common)
- Pain/ tenderness (Mastalgia)
- Change in the breast size
- Change in the nipple
- Discharge from the nipple
History taking follows the standard pattern
Detailed analysis of complaints
Important areas of history: menstrual & pregnancy.
- lactation,
- family & previous breast problems
Lump History
- When noticed (duration)?
- How noticed?
- Any change in the lump since first noticed?
- Any change in the breast/ nipple?
- Any associated symptom ? Pain, discharge
- Any relationship with menstrual cycle?
- Any history of trauma?
History of Pain
- Site
- Duration
- Onset and severity
- Relationship to menstrual cycle (cyclical or non-cyclical)
- Aggravating factors
- Relieving factors
History of Discharge
- Duration
- Colour of discharge: blood (red), serum (brown, green, straw coloured), pus, milky
- Spontaneous or on pressure
- Unilateral/ bilateral
- Any change in the nipple
- Other symptom (pain)
Past Medical/ Surgical History
- Breast problem
- Mammogram
- Breast biopsy
- Exposure to radiation (face, chest)- risk factor
- Other medical /surgical history
- Obesity (BMI >30) - risk factor
Menstrual History
- Age of menarche
- Age at menopause early menarche (<12 year) , late menopause (>55 year)- increases risk for carcinoma
- Last menstrual period
- Regularity of menstrual cycle
- Breast changes during menstrual cycle
History of Pregnancy
- Age at 1st pregnancy- younger age (<18) is protective - >30 years- increased risk
- Number of pregnancy- protective
- Lactational history- protective
Medications
- Oral contraceptives- not known risk
- Hormone replacement therapy- increased risk
- Other medications
Family History
- At least two generations
- Breast, gynecologic, colon, prostate, gastric, or pancreatic cancer
- Their Age at diagnosis of these tumours.