The presenting complaint is likely to be pain, lump or discharge. For the sake of this guide, will will use a lump as an example, but consultation
should cover all three anyway.
- Wash your hands and introduce yourself
- Check the patient’s name and DOB
- Ask if it’s okay to have a chat before the patient sees the doctor
History of presenting complaint
- ‘What has brought you in today?’
- ‘Tell me more about the lump’
- ‘How long have you had the lump?’
- Did it come on suddenly, or gradually?
- Did anything precipitate it?
- When/how did you notice it?
- Is it painful?
- If yes, follow SOCRATES pain mnemonic
- Is it associated with your period (if appropriate)?
- Do they have any associated symptoms?
- Nipple discharge
- Nipple inversion
- Skin changes
- Ask if the patient has had these symptoms before
- Ask about cancer red flags
- Weight loss
- New onset fatigue
- Pain anywhere else, eg back pain or abdomen
- Enlarged lymph nodes
Age for mammogram screening
50 - 70
47 – 73 in some areas
Past medical history
- Ask when the patient last had a mammogram, if relevant
- Does the patient still have periods?
- At what age was the menopause?
- What age did they start their periods?
- How many times have they been pregnant?
- How many children they have
- Did they breastfeed?
- Have they ever taken the contraceptive pill or had hormonal treatment?
- How long for?
- Over the age of 35?
- Have they had any breast problems/cancer before?
- Do they have any medical problems?
- Have they ever had cancer?
- Recent breast trauma?
- Previous surgery?
- Have any members of the patient’s family had breast cancer?
- If yes, who? And at what ages? Was their cancer treated?
- Have any members of their close family had any other kind of cancer?
- Who? What type? What age? Cured?
- Are they taking any regular medication?
- Anything over the counter?
- Any supplements?
- Do they have any allergies?
- If yes, to what? What happens?
- With whom/where they live (especially for older patients)
- Ask if the patient has any questions or anything they’re concerned about
- Ask if there’s anything else that you haven’t asked
- Summarise again if necessary
- Thank the patient for talking to you
- Referral to triple-stop breast clinic
- Imaging (ultrasound if <40, mammogram if >40)
- Biopsy if necessary