History and physical examination

A. In the woman with a suspicious breast mass, risk factors and a family history of breast cancers should be assessed. A personal history of radiation to the chest or breast, breast masses, biopsies, history of collagen vascular disease, and menstrual and gynecologic history are also important.

Symptoms of nipple discharge, pain, skin changes, or rashes may occur.

B. On physical examination, the breast mass should be palpated for size, position, adherence of the tumor to the skin or chest wall, density, fluctuance, and tenderness. In addition, both breasts and axillae should be examined for other tumors and any lymph nodes. A search for supraclavicular lymph nodes should also be conducted.

C. Any evidence of skin changes, ulceration, peau d'orange (thickening of skin to resemble an orange skin), or lymphedema is suspicious for locally advanced cancer.

D. Immediate mammography should be obtained. A white blood count, hematocrit, and erythrocyte sedimentation rate may be needed if cancer is found.

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