Palpation

1. The breasts should be palpated while the patient is sitting and then supine with the ipsilateral arm extended. The entire breast should be palpated systematically. The mass should be evaluated for size, shape, texture, tenderness, fixation to skin or chest wall.

2. A mass that is suspicious for breast cancer is usually solitary, discrete and hard. In some instances, it is fixed to the skin or the muscle. A suspicious mass is usually unilateral and nontender. Sometimes, an area of thickening may represent cancer. Breast cancer is rarely bilateral. The nipples should be expressed for discharge.

3. The axillae should be palpated for adenopathy, with an assessment of size of the lymph nodes, number, and fixation.

IV. Mammography. Screening mammograms are recommended every year for asymptomatic women 40 years and older. Unfortunately, only 60 percent of cancers are diagnosed at a local stage.

Screening for Breast Cancer in Women

Age

American Cancer Society guidelines

20 to 39 years

Clinical breast examination every three years

Monthly self-examination of breasts

Age 40 years and older

Annual mammogram

Annual clinical breast examination

Monthly self-examination of breasts

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