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At first HISTORY • discharge • Duration •Pain •Swelling • Redness • Change over the time HISTORY • General • Reproductive history • Drug history • Family history • Past medical history • socioeconomic status HISTORY • General •Obesity •Age >50 years HISTORY • 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 HISTORY • Drug history •Hormone therapy •Alcohol consumption HISTORY • Family history •Cancer of the breast and ovaries in primary relatives(parents,siblings,and offspring) HISTORY • Past medical history •Benign breast dz •Hx of breast cancer •Radiation exposure HISTORY • socioeconomic status •Higher socioeconomic status Inspection Palpation Physical Exam Inspection › Symmetry › Skin changes › Nipple discharge 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 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 Low risk History& physical examination Low risk High risk < 30 years > 30 years History& physical examination High risk Low risk < 30 years FNA > 30 years History& physical examination High risk Low risk < 30 years solid > 30 years Cyst History& physical examination High risk Low risk < 30 years > 30 years solid Cyst Residual mass present Reaccumulation of cyst BIOPSY Fluid grossly bloody solid Cyst Residual mass present suspicious FNA benign Follow up malignancy surgery Reaccumulation of cyst Fluid grossly bloody History& physical examination High risk Low risk < 30 years > 30 years Evaluate specific lesion Occult disease in surrounding tissue Utilized spot compression and magnification views Communicate with radiologist!
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