- Change in shape/skin
- Lumps, bumps and swellings
- Ulceration of the skin
NB: Patients may leave it a long time to present with a breast problem, either due to embarrassment or because they hope it will go away by itself. Take time to take a full history
- When did it start, what was it like and has it changed?
- Does it change with the menstrual cycle?
- If painful - remember SOCRATES
- Assess for signs of malignancy
- Unexplained Weight Loss
- Generalised Malaise
- Have they had any previous problems with their breasts?
- Any other medical conditions, currently or in the past?
- Any surgery or treatments (e.g. radiotherapy in the past)
- Any current medication, including contraception
- Any allergies
- History of breast problems in the family
- History of breast or ovarian cancer? Known genetic risk (BRAC1, BRAC2)?
- Any other familial conditions
- Smoking and Alcohol history
- Where do they live? Local?
- Who do they have at home?
- Can they manage okay and do they have/need any specialist adaptations?
- Do they have any dependent others?
Try to find any evidence of metastasis by doing a thorough systems enquiry and vaguely get an idea of their general fitness, (thinking about invasive treatments if it is breast cancer).
This is one of the histories where ICE can really be key to a good or bad history taking. Patients will have all kinds of ideas about what is going on, but they are likely to be very worried about breast cancer. Finding this out and addressing it will really help the history.