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Clinical investigations from the RACP

Investigating a woman with a breast lump

Eva Segelov

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Abstract

Investigating a woman with a breast lump is a common problem in general practice. It is important to investigate each case thoroughly, with the bottom line being not to miss breast cancer. This is axiomatic as early diagnosis is the most significant factor in reducing mortality. Generally, triple assessment of any breast lump is required: clinical, radiological and pathological. The pathways described below can also be used to investigate other breast symptoms such as thickening, pain, asymmetry or nipple discharge.

Key Points

  • Early diagnosis is the most significant factor in reducing deaths from breast cancer. Therefore, it is important to investigate thoroughly each patient presenting with a breast lump. The lump could be a cyst, a fibroadenoma, carcinoma or ductal carcinoma in situ.
  • Triple assessment is required – clinical, radiological and pathological. Even in younger patients, clinical investigation alone is insufficient to label a breast lesion benign. Radiological imaging (by mammography and/or ultrasound), then fine needle aspiration cytology (FNAC), should follow.
  • Where there is suspicion of malignancy on clinical or radiological grounds, surgical biopsy is required, even if FNAC shows benign cells.
  • Refer a woman with a suspicious lump to a breast surgeon or multidisciplinary breast clinic.

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