1. EILEEN HAWKINS, MSN, ARNP BREAST ASSESSMENT

2. Brief Anatomy Review Breast Location Landmarks Composition

3. Evaluation of Breast Complaints LMP, gravida, parity, breast feeding hx. Breast exams Mammography Medications, OTC, herbal PMH, F. Hx. Breast hx. Hormonal risk factors Thorough breast exam

4. Common Breast Complaints Nipple discharge Breast pain Breast mass

5. Nipple Discharge Duration, laterality Stimulation or spontaneous Lactation experience Color, consistency determine for occult blood Medications

6. Differential Dx. of Nipple Discharge Fibrocystic condition Intraductal papilloma Infection Galactorrhea Duct ectasia Concern: unilateral pink, bloody or nonmilky associated with a mass > age 60

7. Breast Pain History and Physical Exam Duration & location Trauma Previous OR Associated lumps or nipple discharge Differentiate fibrocystic thickening from discrete mass

8. Breast Pain Differentials Menstrually related Costochondral Trauma Unrelated causes Cancer

9. Breast Mass: History Age Menopausal status Duration Changes Previous masses & biopsies F. Hx. PE: location, shape, size, mobility

10. Breast Mass: Exam Inspection & palpation Soft, smooth, movable often benign Hard, rough-edged, immobile suspicious

11. Special Considerations Asymptomatic Women Premenopausal Women Lactating Women Mastectomy, augmentation, implant, reconstruction, lumpectomy Infants Adolescents

12. Patient Education Teach and reinforce SBE Recommendations for clinical breast exams Guidelines for mammography

13. A 62 year old woman presents with a breast lump. She had first felt the lump about 2 yrs. ago and was afraid of breast CA because her mother and an older sister both had mastectomies for cancer. She denied smoking, has never had children, menopause at age 52. On breast exam you noted asymmetry of the breasts with dimpling and palpated a lump. How would you state your objective findings? What will you consider in your differential diagnosis?

14. A 32 year old woman presents with nipple discharge for several months. What specific questions will you ask? What objective findings will be important to document? What will you consider in your differential diagnosis?