Algorithm for palpable breast mass

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Sandhya Pruthi. The discovery of a breast mass, either self-detected or identified by a clinician, is a common, often distressing occurrence for many women. Although most detected breast masses are benign, every woman presenting with a breast mass should be evaluated to exclude or establish a diagnosis of cancer.

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A Caucasian female aged 15 years, with no significant medical history, presented to a regional acute care centre for assessment of a self-detected tender mass in her left breast. The mass had been present for three weeks, and the patient reported no nipple discharge, menstrual abnormalities or constitutional symptoms. On examination, there was an isolated 4 cm solid, mobile mass palpable in the upper inner quadrant of her left breast.

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There are a number of benign conditions that can affect the breastsincluding congenital anomalies e. Fibrocystic changes result in the most common benign lesion of the breastand, like the rest of these lesions, primarily affect women between the third and fifth decades of life. Although benign breast conditions may cause symptoms that mimic breast cancerthe majority of these lesions do not increase the risk of malignant disease.

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Subcutaneous and retromammary fat surrounds the glandular tissue and constitutes most of the bulk of the breast. Hormonal changes associated with ovulation can stimulate the proliferation of glandular breast tissue, resulting in breast swelling during the luteal phase of the menstrual cycle. For most women, this causes minor discomfort. Typically, breast pain is categorized as cyclical, noncyclical, or musculoskeletal Table 1.

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A more recent article on common breast problems is available. Related Editorial. Patients should be evaluated initially with a detailed clinical history and physical examination.

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The majority of breast mass are benign. However, with an increasing incidence of breast cancer in Hong Kong, careful work up is important. The accurate diagnosis of breast mass relies on a concordant Triple Assessment approach; open excisional biopsy should be minimal.

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Long delays to diagnosis is a major cause of late presentation of breast diseases in sub-Saharan Africa. We designed and implemented a single-visit breast care algorithm that overcomes health system-related barriers to timely diagnosis of breast diseases. A multidisciplinary team of Zambian healthcare experts trained a team of mid- and high-level Zambian healthcare practitioners how to evaluate women for breast diseases, and train trainers to do likewise.

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Inflammatory syndrome is one of the rare emergency breast situations. Its etiology is benign, infectious in most cases. The clinical examination is often self-evident and suggests the diagnosis. But alone it is insufficient, and diagnostic tests are necessary to guide therapy.

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Characterized by "lumpy" breasts associated with pain and tenderness that fluctuate with the menstrual cycle. Diagnosis often involves exclusion of other significant breast diseases. Assessment of risk for the development of breast cancer is important and is useful in patient reassurance or to design risk reduction strategies.

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This is a corrected version of the article that appeared in print. A thorough clinical breast examination, imaging, and tissue sampling are needed for a definitive diagnosis. Fine-needle aspiration is fast, inexpensive, and accurate, and it can differentiate solid and cystic masses. However, physicians must have adequate training to perform this procedure.


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