clinical breast examination
DESCRIPTION
CLINICAL BREAST EXAMINATION. Assist.Prof . Arzu Akalın M.D. CLINICAL BREAST EXAM. i ncludes; careful history-taking, visual inspection, palpation of both breasts, armpits and root of the neck educating women on breast self-examination and awareness, particularly on breast lumps. . - PowerPoint PPT PresentationTRANSCRIPT
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CLINICAL BREAST EXAMINATION
Assist.Prof. Arzu Akalın M.D.
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CLINICAL BREAST EXAM
includes;• careful history-taking, • visual inspection, • palpation of
– both breasts, – armpits and – root of the neck
• educating women on breast self-examination and awareness, particularly on breast lumps.
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Risk Factors • A familial history of breast cancer increases the risk by a factor of
two or three. • Some mutations, particularly in BRCA1, BRCA2 and p53 result in a
very high risk for breast cancer. • Prolonged exposure to endogenous estrogens, such as early
menarche, late menopause, late age at first childbirth • Oral contraceptive and hormone replacement therapy use• Alcohol use, • Overweight and obesity, • Physical inactivity
• Breastfeeding has a protective effect
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HISTORY TAKING
• age at menarche, • marital status, • parity, • age at first child birth, • history of lactation and breast-feeding, • age at menopause, • family history of breast and ovarian cancers in first degree
relatives (mother, sisters, aunts, grandmothers), • history and duration of oral contraceptive use, hormone
replacement therapy (HRT), treatment for infertility• tobacco and alcohol use.
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Breast Anatomy
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Breast Anatomy
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The breast is composed of 15-20 lobes
and contains • glandular, • ductal, • fibrous, and • fatty tissue.
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More lobes are present in the outer quadrants, especially the upper outer quadrants, Therefore many breast conditions (among them, breast cancer) occur more frequently in these regions
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Axillary tail of breast tissue
• An axillary tail of breast tissue extends toward the anterior axillary fold.
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Examination of the Breast(Inspection & Palpation)
The exam should be performed in a well-lit room and privacy is facilitated by draping parts of the body not being examined.
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Examination of the Breast(Inspection & Palpation)
INSPECTION• Occurs with the patient seated,
– Arms at side; – With hands on hips; and – With arms above the head.
• Changes in size, shape, symmetry, or texture are noted.
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INSPECTION
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Examination of the Breast(Inspection & Palpation)
PALPATION • Is performed with the
patient supine, arms flexed at a 90-degree angle at the sides.
• Palpation includes supraclavicular, infraclavicular, and axillary nodes.
• Compression may identify a mass and/or elicit a discharge.
• Nipples should be examined for deviation, retraction, skin changes, or discharge.
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Supraclavicular L N Infraclavicular LN
Axillar LNInternal Mammary LN
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Benign Breast Masses General Considerations
• Benign breast masses will often change with the menstrual cycle, while worrisome masses are persistent throughout.
• Greater than 90% of palpable breast masses in women between 20 and 55 are benign.
• Masses may be discrete or poorly defined, but differ from the surrounding breast tissue and the corresponding area in the contralateral breast.
• Cancer should be excluded in a woman who presents with a solid mass.
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Benign Breast Masses
• Breast cysts• Fibrocystic breast changes• Fibroadenoma• Ductal papilloma
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Nipple Discharge
• Categorized as 1. Physiologic2. Pathologic (nonphysiologic).
Physiologic Pathologic
Nonspontaneous Spontaneous
Bilateral Unilateral
Arising from multiple ducts
Arise from a single duct
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Carcinoma of the Breast
• Most common malignant tumor among women• 1/8 of women will develop breast cancer
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a. Slowly growing, painless mass
b. May demonstrate retracted nipple
c. May be bleeding from nipple
d. May be distorted areola, or breast contour
e. Skin dimpling* in more advanced stages with
retraction of Cooper’s ligaments
Physical Signs
Note skin dimpling in the 6 o'clock radius
*Dimple=Gamze
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f. Attachment of mass
g. Edema of skin 1)with “orange skin” appearance
(peau d’orange) due to blocked lymphatics
h. Enlarged axillary or deep cervical lymph nodes
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Breast Cancer Screening Guidelines of ACS* 2012
BSE ages ≥20 monthly or irregularCBE ages 20-30 part of periodic
examination at least every 3 year ages ≥40 annually
Mammography begin anuual mammography at age 40
* American Cancer Society