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It is important for the examiner to determine the patient’s age

and obtain a reproductive history, including age at menarche,

age at menopause, and history of pregnancies, including age at

first full-term pregnancy. A previous history of breast biopsies

should be obtained, including the pathologic findings, especially

proliferative breast disease. If the patient has had a hysterectomy,

it is important to determine whether the ovaries were removed.

In premenopausal women, a recent history of pregnancy and

lactation should be noted. The history should include any use

of HRT or hormones used for contraception. The family history

should detail any cancer of the breast and ovaries and the menopausal

status of any affected relatives.

With respect to the specific breast complaint, questioning

should include history of a mass, breast pain, nipple discharge,

and any skin changes. If a mass is present, one should inquire

as to how long it has been present and whether it changes with

the menstrual cycle. If a cancer diagnosis is suspected, inquiry

about constitutional symptoms, bone pain, weight loss, respiratory

changes, and similar clinical indications can direct investigations

that could reveal evidence of metastatic disease.