History and Physical Examination In Breast Cancer

Because of the potential options for treatment of early stage breast cancer, careful patient selection and a multidisciplinary approach are necessary. Four critical elements in patient selection for breast conservation treatment are:

• History and physical examination.
• Breast imaging.
• Histological assessment of the resected breast specimen.
• Assessment of the patient's needs and expectations.

Much of the information needed to determine a patient’s suitability for breast conservation therapy can be obtained from a detailed history and physical examination. It is important to note that age per se, whether young or old, is not a contraindication to breast conservation. In the elderly, physiologic age and the presence of comorbid conditions should be the primary determinants of local therapy.

The elements of the Breast Cancer Specific History are :

• Family history relatives with breast cancer (age at diagnosis, laterality), ovarian carcinoma
• History of prior therapeutic irradiation involving breast region
• History of collagen vascular disease – type, documentation of diagnosis
• Presence of breast implants – submammary or subpectoral
• Date of last menstrual period/possibility of pregnancy
• Symptoms suggestive of metastasis

The elements of the Breast Physical Exam are :

• Tumor size (measured) and location
• Fixation to skin
• Ratio of breast size to tumor size
• Evidence of multiple primary tumors
• Axillary node status – size, mobility
• Supraclavicular nodes
• Evidence of locally advanced cancer
- skin ulceration, satellitosis
- peau d’orange
- inflammatory carcinoma
- fixed axillary nodes
- lymphedema of the ipsilateral arm

When evaluating the physical examination, it is important to note that skin, nipple, and breast parenchyma retraction are not signs of locally advanced breast cancer and do not represent contraindications to breast conservation.
Labels:breast cancer,physical examination,breast conservation treatment,breast imaging,histological assessment,breast cancer specific history,breast physical exam