What history questions should be asked during a breast exam?

Essential History Questions During a Breast Exam

A comprehensive breast examination should include a thorough clinical history that identifies personal and family health history to assess breast cancer risk, as this information can direct attention to potentially relevant symptoms and provide important context for interpreting findings. 1

Clinical History Components

Screening History

• Identify previous breast health screening practices and their results 1:
  • Prior breast self-examinations (BSE) and frequency
  • Previous clinical breast examinations (CBE) and when last performed
  • Prior screening and diagnostic mammograms with dates and results
  • Any other breast imaging (ultrasound, MRI) with dates and results

Breast Changes and Symptoms

• Ask about any breast changes and how they were identified 1:
  • Changes in appearance of skin or nipples
  • Presence of lumps or masses
  • Pain (distinguish between focal vs. general and constant vs. cyclic)
  • Itching
  • Nipple discharge (including color, consistency, and whether spontaneous)
  • Staining of garments or bed sheets

Risk Assessment

• Assess breast cancer risk by asking about 1:
  • Age (particularly important as risk increases with age)
  • Personal history of:
    • Benign breast disease
    • Previous breast biopsies and results
    • Previous breast cancer
    • Cosmetic or other breast surgery
  • Hormonal history:
    • Current or past hormonal therapy
    • Oral contraceptive use
    • Age at menarche and menopause
    • Menopausal status 1
  • Obstetric history:
    • Number of pregnancies
    • Age at first full-term pregnancy
    • Breastfeeding history and duration
  • Family history:
    • Breast and ovarian cancers in first-degree and second-degree relatives
    • Age at diagnosis of affected relatives
    • Both maternal and paternal sides of the family 1
    • Known genetic mutations (BRCA1/2, PALB2, TP53, etc.) 1
  • Ethnicity (particularly Ashkenazi Jewish ancestry) 1
  • Health promotion habits:
    • Exercise
    • Nutrition
    • Alcohol consumption
    • Smoking status

Special Considerations

Genetic Risk Assessment

• For patients with concerning family history, consider more detailed questioning about 1:
  • Triple-negative breast cancer in family members
  • Male breast cancer in family
  • Multiple primary cancers in single individuals
  • Pattern of cancer across generations

Previous Breast Cancer History

• For patients with a personal history of breast cancer, additional questions should include 1:
  • Age at diagnosis
  • Type of cancer (particularly triple-negative)
  • Treatment received
  • Time since diagnosis
  • Follow-up care and surveillance

Clinical Pearls and Pitfalls

Common Pitfalls

• Failing to ask about breast symptoms directly, as some women will not report symptoms until specifically asked 1
• Overlooking family history on the paternal side 1
• Not updating family history regularly, as new cancer diagnoses in the family may change risk assessment 1
• Neglecting to ask about lifestyle factors that may modify risk

Best Practices

• Begin collecting family history information in a patient's 20s and update regularly 1
• Use the clinical history to explain the benefits, limitations, and elements of the breast examination 1
• Document alcohol consumption and exercise behavior thoroughly, as these are often incompletely captured in medical records 2
• Use the history to determine whether genetic counseling referral is appropriate 1
• Explain that the clinical breast exam is part of a comprehensive approach to breast health that may include imaging based on age, risk factors, and symptoms 3

By systematically collecting this history information before performing the physical examination, clinicians can better focus their exam, identify high-risk patients who may need additional screening or genetic testing, and provide appropriate patient education about breast health.