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Breast lump (What are your DDx? (<30yo: physiologically lumpy breast,…

- - - - Breast lump - characterise
      - Associated breast symptoms
        
        pain/ulceration/bleeding/nipple discharge
        
        cyclical changes with menstrual cycle
        
        rash/pruritis
      - Any cancer
        
        Constitutional
        
        Metastatic (bone pain, dyspnoea)
    - - History
        
        Personal history of breast cancer or proliferative breast changes, gynaecological cancers (ovarian, endometrial), bowel cancer
        
        Family history
        
        BRCA1, 2 genes
        
        Without genetic mutations:
        Low-risk susceptibility genes + shared environmental factors
      - Chest wall irradiation e.g. HL
      - Estrogen exposure
        
        Early menarche, late menopause, nulliparity, 1st child after 30, not breastfeeding
        
        HRT, OCP
        
        Obesity
    - - Previous investigation results (mammogram, breast ultrasound)
- - - - Hx & Ex
    - - <35: ultrasound (dense breast)
      - over 35: ultrasound + mammogram
      - What imaging findings suggest cancer?
        
        spiculated mass
        
        irregular margins
        
        increased density
        
        clustered microcalcifications
    - - FNA
        
        Inconclusive → LA open biopsy
      - Core biopsy
        
        Nonpalpable
        
        ultrasound-guided
        
        stereotactic
        
        Palpable
        
        just do straightaway?