ABSTRACT
Breast cancer prevalence, particularly that of in situ disease continues to increase, largely attributable to the increasing use of screening mammography for early detection. According to American Cancer Society Surveillance Research in 2005, a North American female has a 13% life-time risk of developing breast cancer. Furthermore, the incidence of disease differs among demographic groups, i.e. 141/100 000 white women versus 90/100 000 for Latina/Hispanic women. The manner in which women present can be as varied as these statistics, ranging from asymptomatic mammographic abnormalities to exophytic fungating chest wall masses. The focus of this chapter is to clearly define the principles involved with the evaluation and management of breast cancer when it presents in a symptomatic manner, from its initial presentation as a breast mass or nipple discharge to the presence of recurrent disease. Although most breast related symptoms and masses are not associated with the presence of cancer, any and all breast related complaints which bring a patient to the physician for assessment warrant thoughtful evaluation. The principles of this investigation may not differ across patient populations but the interpretation of findings must be put into appropriate patient related context. As such the evaluation of any breast complaint begins with a thorough breast cancer oriented history and physical examination. The history should focus on the following factors of risk assessment: patient gender; patient age; family history of breast or ovarian cancer; hormonal history (age of menarche, menopause, gravidy, and parity, use of exogenous hormones); personal history of breast disease; and prior breast biopsies or procedures with relevant pathology. With a specific focus on the current breast issue at hand, information regarding the duration of symptoms, size or nature of any perceived masses, new or persistent tenderness, associated skin or nipple changes, ameliorating or worsening factors, and any associated trauma need to be ascertained.
