A

• Asymmetry

  • Definition: Difference in size or shape between the two breasts.

  • Clinical significance: May be normal, but sudden or new asymmetry could indicate a mass or malignancy.

• Axillary Symptoms

  • History: Presence of lumps, swelling, pain, or skin changes in the armpit area.

  • Significance: May indicate lymphadenopathy due to infection, inflammation, or breast cancer metastasis.

B

• Breast Lump

  • Description: Patient’s complaint of a palpable mass or thickening.

  • History details: Location, size, consistency, mobility, duration, associated skin changes or nipple discharge.

  • Red flags: Fixed, hard, irregular lumps with skin or nipple changes.

• Breast Pain (Mastalgia)

  • Types: Cyclical (linked to menstrual cycle) vs non-cyclical.

  • Assessment: Onset, location (unilateral vs bilateral), intensity, relation to menses or trauma, associated systemic symptoms.

• Breast Swelling

  • History: Sudden or gradual swelling, associated redness, warmth (suggestive of mastitis or inflammatory carcinoma).

C

• Changes in Skin

  • Types: Dimpling (peau d’orange), redness, thickening, ulceration, rash.

  • Clinical importance: May indicate underlying malignancy or inflammatory breast disease.

• Change in Breast Size

  • History: Rapid increase or decrease, unilateral or bilateral.

• Changes in Nipple

  • Types: Inversion (new or longstanding), retraction, eczema-like changes (Paget’s disease).

  • Important: New inversion or retraction should raise suspicion of malignancy.

D

• Discharge from Nipple

  • Description: Color, consistency (serous, bloody, purulent), unilateral vs bilateral, spontaneous vs expressed.

  • Common causes: Benign duct ectasia, intraductal papilloma, malignancy.

  • Red flags: Bloody or serous unilateral discharge.

• Duration

  • Importance: How long symptoms have been present; sudden changes are more concerning.

E

• Enlarged Lymph Nodes

  • Location: Axillary, supraclavicular, infraclavicular.

  • History: Pain, duration, progression, systemic symptoms like fever or weight loss.

• Exacerbating Factors

  • History: Hormonal influences (menstrual cycle, pregnancy), trauma, medications.

F

• Family History of Breast Disease

  • Details: Breast cancer, ovarian cancer, age of onset in relatives.

  • Significance: Important for risk assessment and genetic counseling.

G

• Gynecomastia (in males)

  • History: Onset, associated pain, unilateral or bilateral, medication history (e.g., spironolactone, steroids), systemic symptoms.

H

• Hormonal History

  • Details: Menstrual history, pregnancies, breastfeeding, use of hormonal contraceptives or hormone replacement therapy (HRT).

  • Importance: Hormonal factors influence breast symptoms and cancer risk.

• History of Breast Surgery or Biopsy

  • Details: Dates, indications, outcomes.

I

• Inflammation Signs

  • History: Redness, tenderness, fever, warmth—suggestive of mastitis or breast abscess.

• Injury or Trauma

  • History: Recent trauma to the breast; may cause hematoma or fat necrosis mimicking a lump.

L

• Lactation

  • Details: Breastfeeding history, problems with milk production, nipple pain, cracks or fissures.

• Lifestyle Factors

  • History: Alcohol intake, smoking, diet, exercise.

M

• Menstrual History

  • Details: Age at menarche, regularity, menopausal status.

  • Relation: Cyclical mastalgia often correlates with menstrual cycle.

• Mass Characteristics (from patient perspective)

  • Details: Size, growth rate, associated symptoms.

N

• Nipple Changes

  • Additional: Discoloration, scaling, itching.

• Nipple Discharge

  • Further details: Number of ducts involved, spontaneous vs expressed.

P

• Pain Radiation

  • History: Radiation of breast pain to the axilla, arm, or chest.

• Previous Breast Cancer or Other Cancers

  • History: Treatment, remission status.

R

• Risk Factors for Breast Cancer

  • History: Early menarche, late menopause, nulliparity, obesity, alcohol use.

• Recurrent Breast Symptoms

  • History: Previous episodes of mastitis, cysts, or benign lumps.

S

• Skin Texture Changes

  • Description: Peau d’orange (orange peel appearance) indicating lymphatic obstruction.

• Systemic Symptoms

  • History: Weight loss, fever, night sweats (may indicate malignancy or systemic illness).

T

• Trauma

  • See Injury.

• Tenderness

  • History: Localized vs diffuse, relation to menstrual cycle or trauma.

U

• Ulceration

  • History: Presence of ulcers on nipple or breast skin.

  • Clinical importance: May indicate advanced malignancy or infection.

V

• Visual Changes

  • Observation: Any visible lumps, asymmetry, skin changes noted by the patient or family.

Additional History Tips

• Chronology: Onset, duration, progression, and whether symptoms are persistent or intermittent.

• Associated systemic or constitutional symptoms: Such as fever, weight loss, night sweats.

• Impact on daily life: Discomfort, anxiety, and functional limitations.