Page Contents
OVERVIEW
This page is dedicated to providing more information about how to collect a medical history for an adolescent female palpable breast mass.
WHAT ARE THE GOALS OF THE INTERVIEW?
It can be difficult to evaluate a patient effectively if the goals of the patient encounter are not clear to the interviewer. In the case of collecting the medical history for an adolescent female palpable breast mass, here are some general goals that can help direct the history taking.
- Is malignancy likely in this patient? When considering any breast mass the fear is that it might be cancerous. A portion of the medical interview will try and further investigate if malignancy in the adolescent should be seriously considered.
HISTORY OF PRESENT ILLNESS
In the setting of this specific chief complaint here are elements of the HPI that are especially important to explore:
Onset:
Appreciating the duration and nature of the onset of the breast mass can help point to a diagnosis. While many examples of this may exist, one such example is a patient who notices the breast mass after direct trauma to the breast (which might suggest the diagnosis of fat necrosis)
Changes in size:
Depending on the cause of the breast mass, it may either be stable in size or growing. One generally might associate a growing mass with more serious conditions (such as malignancy)
Similarity, fluctuations in size that follow a pattern (menstrual cycle) may point to a more benign condition such as fibrocystic changes. In many cases observing the nature of the mass throughout a few menstrual cycles can be very informative.
Is there pain?
Evaluating for pain can help further narrow the diagnosis, and may require management on its own.
Is there nipple discharge?
The topic of nipple discharge arguably should be broached with every patient that presents with a palpable breast mass. The spirit of this question is to discover more clues that might aid in making the diagnosis.
- Bloody discharge for example is pathological and often will require further investigation.
- Purulent discharge will be more suggestive of infectious causes of the breast mass
Are skin changes present?
Certain patterns of skin changes may point to particular diagnosis.
PAST MEDICAL HISTORY
While other aspects of the past medical history often will be explored, working up this particular chief complaint benefits from exploring risk factors associated with malignancy. In the adolescent population it is especially important to ask about the following risk factors:
Personal history of cancer: most often malignant breast masses in the adolescent population are caused by metastasis from a malignancy OTHER then primary breast cancer. Patients with a known history of cancer have a much lower threshold for obtaining imaging and very often any mass visualized on ultrasound will be biopsied to rule out the possibility of malignancy.
Radiation exposure: exposure to ionizing radiation (such as radiation therapy to structures in the chest) is a risk factor for secondary breast cancer in adolescents.
FAMILY HISTORY
Breast cancer risk is increased in patients with a family history of the condition. When evaluating patients with breast masses asking about family history of malignancy (specifically breast cancer) can be important to evaluate.
Page Updated: 01.04.2016