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Breast health in the women's health clinic

Gynaecology

The lump, the pain, the discharge and the screening question, at the depth the clinic that sees her first needs: what is benign, what is referred, and how the diagnosis is made.

Three presentations

  • Triple assessment makes the diagnosis: clinical examination, imaging (ultrasound under 40, mammography and ultrasound over 40), and a core biopsy of anything solid or suspicious. A normal examination alone does not exclude cancer.
  • Inflammatory signs in a non-lactating breast that do not settle with a course of antibiotics are inflammatory cancer until biopsied.
PresentationUsuallyRefer when
A lumpFibroadenoma in the young, cyst in the 30s to 50s, fibrocystic changeAny discrete new lump, a lump persisting after a period, a lump over 30, skin or nipple change, an axillary node
PainCyclical mastalgia (bilateral, premenstrual, resolves); non-cyclical from the chest wallFocal persistent pain with a mass or in a postmenopausal woman
Nipple dischargePhysiological (bilateral, multiduct, on expression), duct ectasia, prolactinoma if milky and bilateral (check prolactin, medicines)Spontaneous, single-duct, bloody or clear, or with a mass: papilloma or, less often, cancer

Screening and risk

  • Average risk: screening mammography every 2 to 3 years from 50 to 74 in Canadian Task Force guidance, with shared decision-making from 40 and where provincial programmes now start at 40; other countries differ, so name the programme you practise in.
  • Breast self-examination and routine clinical breast examination are not recommended as screening in average-risk women; breast awareness (knowing what is normal for her and reporting change) is.
  • High risk: a known BRCA1 or BRCA2 or other pathogenic variant, a first-degree relative with a variant, prior chest radiotherapy before 30, or a calculated lifetime risk of 25 percent or more: annual MRI with mammography from 25 to 30, genetics referral, and a conversation about risk-reducing options.
  • Refer to genetics for: breast cancer under 50 in a first-degree relative, two or more relatives on one side, male breast cancer, ovarian cancer, Ashkenazi Jewish ancestry with breast or ovarian cancer, or a known family variant.
  • Density: dense breasts lower the sensitivity of mammography and raise risk modestly; supplemental imaging is by programme and shared decision.

Ovarian cancer and hereditary risk

Check

A 27-year-old has a smooth, mobile, painless 2 cm lump she noticed a month ago. What next?

Frameworks and sources

  • Canadian Task Force on Preventive Health Care: Recommendations on screening for breast cancer in women aged 40 to 74 who are not at increased risk (2018). The Task Force recommendations and provincial programmes differ on starting at 40; the module teaches shared decision-making and tells the learner to name their programme.

Content reviewed 2026-09. Teaching material for students, not clinical decision support; check the current edition of the guideline your unit uses.