Red flags

  • Hard and irregular lump

  • skin dimpling and puckering

  • skin oedema (peau d’orange)

  • Nipple discharge

    • Blood stained (intraduct papilloma)

    • Green grey (mammary dysplasia)

    • Yellow (mammary dysplasia)

    • Milky white (galactorrhoea)

  • Nipple distortion

  • Nipple eczema

Cancer

  • fixed

  • discrete

  • hard

  • withor without skin tethering

  • spontaneous bloody discharge = indication for urgent referral

  • rare under 30yo

    • lump that enlarges

    • other features

      • fixed / hdard

    • other reasons for concern

  • up to 5% familial - most being autosomal dominant

men

  • urgen referral in any man ≥50yo with

    • unilateral

    • firm

    • subareolar mass

    • with or without nipple distorition or associated skin changes

investigations:

  • triple assessment

    • clincial

    • imaging

      • mammography +/- uss

    • needle biopsy

      • core biopsy/fine needle aspiration cytology

Ductal carcinoma in sity

  • non invasive abnormal proliferation of milk duct epithelial cells within the ductal-lobular system

  • precursor lesion for invasive breast cancer

  • may present with:

    • palpable mass

    • nipple discharge

    • Paget disease of nipple +/- mass

Fibroadenoma

  • mobile lump

  • occur in young women

  • round rubbery mass

  • common

  • refer non urgently

Fat necrosis

  • post trauma

  • should refer urgently - especially if nipple/skin changes

Fibrocystic disease of breast

  • mammary dysplasia aka

  • most common women 30-50yo

  • pain, tenderness, swelling

  • premenstrual discomfort or pain

  • fluctuation in size of mass

  • usually settle after period

  • unilateral/bilateral

  • nodularity +/- discrete mass

  • Ace may extend down inner aspect of upper arm

  • nipple discharge may occur

Paget’s disease of nipple

  • unilateral eczematous changes to skin of the breast that do not respond to topical treatment

  • recent distortion of nipple