Breasts and Axillae

Chapter 19

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 Health History: Risk Factors,
Breast Cancer

As you conduct a health history related to

the breasts, it is important to consider
common risk factors associated with
breast cancer and follow up with additional
questions should they exist

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 Health History: Risk Factors,
Breast Cancer
• General
– Gender: females account for 99% of breast cancer
cases
– Age: risk increases with age
– Race/ethnicity: white women have highest incidence
of breast cancer
– Genetic: 10% of breast cancer cases associated with
a genetic mutation of BRCA-1 or BRCA-2
– Family history: breast cancer in a first-degree family
relative (on either maternal or paternal side)
especially before age 50 increases risk; risk highest if
relative is mother or sister
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 Health History: Risk Factors,
Breast Cancer
• Personal medical history
– History of breast cancer increases risk of
subsequent episodes
– History of proliferative breast disease with a
biopsy-confirmed atypical hyperplasia
increases risk
– Exposure to ionizing radiation to chest area as
child or young adult (for treatment of other
cancer such as Hodgkin’s disease) increases
risk
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Health History: Risk Factors, Breast
Cancer

• Reproductive history
– Long menstrual history (menarche before age
12; menopause after age 50) increases risk
– Nulliparity increases risk
– First full-term pregnancy after age 30
increases risk

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 Health History: Risk Factors,
Breast Cancer
• Estrogen replacement: hormone replacement
therapy for more than 5 years after menopause
increases risk
• Alcohol intake: increased alcohol intake (2 to 5
drinks a day) associated with increased risk
• Obesity: especially after age 50, or increased
weight gain as an adult increases risk
• Physical activity: Strenuous activity in youth may
provide lifelong protection; moderate physical
activity as adult may reduce risk

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 Health History:
Present Health Status
• Do you perform breast self-examination (BSE)? How
often? If not, ask if client interested in learning how
– Evaluating self-care behaviors encourages health-
enhancing behaviors. Beginning in late 20s, women
should be told of benefits & limitations of BSE
• Regular breast examination by a health care professional?
• Have you ever had a mammogram? When? How often?
• What medications do you take?
• How much chocolate and caffeine do you consume each
day or each week? Do you take vitamin supplements?
Which vitamins?
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 Health History: Past Health History
• Breast problems: fibrocystic breast changes,
fibroadenomas, or breast cancer? Describe. When? How
was it diagnosed? Treatment?
• History of ovarian cancer, endometrial cancer, or colon
cancer?
• Surgery on a breast (biopsy, mastectomy, lumpectomy,
breast reduction or augmentation)? When, and what for?
• How old when you began menstruating? How old were
you at menopause (if appropriate)?
• Pregnancy? At what age?

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 Health History: Family History
• History of breast cancer or breast disease
in family? If so, in whom?
• What age did this relative have breast
cancer or disease?
• Affect one or both breasts?
• Treatment?

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 Health History:
Problem-Based History
Breast lump
• When did you first notice lump in your breast? Where is
the lump?
• Is lump always present, or come and go? If always
present, does it change in size related to menstrual
cycle? If it comes and goes, does lump appear related to
your menstrual cycle?
• Is lump tender? Does severity of tenderness change
related to menstruation?
• Recent injury to breasts? If yes, did lump develop after
the injury?
• Other symptoms? Redness, swelling, or dimpling
associated with this lump?
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 Health History:
Problem-Based History
Nipple discharge
• When did you first notice discharge from nipple? Ever
noticed before? One or both nipples?
• Describe discharge. Color? Thick or thin? Odor? Occur
at specific times? Before menstrual period or with breast
manipulation?
• Occur spontaneously or only when expressed?
• Other symptoms? Breast pain or breast lump?
Headaches or changes in vision?
• Taking medications? What and for how long?

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 Health History:
Problem-Based History

Breast skin characteristics

• Notice changes to skin? When, where, extent,
one or both breasts, anywhere else?
• Other symptoms? Itching, bleeding, rash?
• Change in any household or personal lotions or
liquids
• Treatment? Result?

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 Health History:
Problem-Based History
Axilla characteristics
• When did you first notice lumps or tenderness under your
arms?
• Where is lump or tenderness located? One arm or both?
Come and go, or constant? Has tenderness or lump
gotten worse?
• Shave underarms? How often? Relationship to shaving
and tenderness? Use deodorant or antiperspirant?
• What have you done to treat this? Explore self-care
practices because it may be helpful to guide future
treatment strategies

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 Examination

Male breasts: as part of a comprehensive

examination, it is essential to examine the male
client’s breasts. Inspect the male breast while
the client is seated with his arms at his sides
• Inspect the breasts and nipples
• Palpate the breasts and nipples. Note evidence of
tenderness, unilateral enlargement, or masses
• Palpate axilla

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 Age-Related Variations:
Older Adults

Examination and findings

• Postmenopausal women should continue to
have regular breast examinations
– Techniques are same as for younger women
• Older men should also have a periodic breast
examination
– Techniques are same as for younger men

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 Examination Summary
Female
• Inspect breasts: size, shape, symmetry
• Inspect skin: appearance, color, vascularity,
pigmentation, surface characteristics, lesions
• Inspect aureola: color, characteristics
• Inspect nipples: position/symmetry,
intactness, scaling/lesions/bleeding/discharge
• Inspect breast (positions): pulling, symmetry,
contour
• Inspect/palpate axillae: rash, lesions, masses
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 Examination Summary
Female (cont.)
• Palpate breasts and axillae; note tissue
characteristics, masses, nodules, tenderness
• Palpate nipples for surface characteristics,
discharge
• Teach BSE
Male
• Inspect and palpate breasts and nipples
• Palpate axillae

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 Health Promotion:
Breast Cancer Prevention and
Screening
• Leading cause of death in women

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 Health Promotion:
BSE and CBE
• BSE for women older than 40
– Only 15% to 40% perform BSE
• Examined same time each month
– 4th to 14th day of period when breasts are
less congested
• CBE for women older than 40
– Every 1 to 3 years annually at same time as
mammogram
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 Health Promotion:
Mammogram

• Baseline between 35 and 40 years

• 40 to 50: every 1 to 2 years (depending on
risk factors)
• Older than 50: annually every 1 to 2 years
• ACS: annually older than 40

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