sabiston
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.