Key Questions to Ask

1. Lump Characteristics (SOCRATES approach – focused)

Site: "Where exactly is the lump?" (Ask patient to point)

Onset: "When did you first notice it?" (Duration)

Change over time: "Has it grown, shrunk, or stayed the same?"

Consistency: "Is it hard or soft?"

Pain: "Is it painful or painless?" (Malignant lumps are often painless, but not always)

2. Associated Breast Symptoms (Red Flags)

Skin changes: "Any dimpling, redness, or ulceration?" (Peau d’orange?)

Any recent trauma to the breast?

Nipple changes: "Any nipple discharge (bloody/clear)? Retraction?"

Axillary symptoms: "Any lumps in the armpit?" (Lymphadenopathy)

3. Risk Factors for Breast Cancer (Quick Screening)

Family history: "Any breast/ovarian cancer in close relatives?" (1st degree?)

DESA

Previous breast disease: "Ever had a breast biopsy or lump before?"

Hormonal factors:

"Age at first period & menopause?" (Early menarche/late menopause → ↑risk)

"Any hormonal therapy (HRT/OCP) use?"

Reproductive history: "Any children? Did you breastfeed?" (Nulliparity → ↑risk)

Past Medical Hx: Ongoing medical conditions, surgery and hospitalisations.

4. Systemic Symptoms (Metastatic Red Flags)

• "Any unexplained weight loss, bone pain, or shortness of breath?"

5. Patient Concerns & Screening History

• "Have you ever had a mammogram?" (If yes, "When & any results?")

• "What are your main worries about this lump?" (Address anxiety)

Mammogram:

"You’ll likely have a mammogram, which is a special type of X-ray that takes a detailed picture of your breast tissues."

Ultrasound:

"They might also do an ultrasound scan — that's where they use sound waves to create a picture of what's inside the breast, similar to the scans used during pregnancy."

Biopsy (if needed):

"If they see anything that needs a closer look, they may take a tiny sample of tissue with a fine needle — this is called a biopsy. It helps them check the cells under a microscope

Safety Netting:

"If you don't hear from the breast clinic within two weeks, please contact our surgery immediately."

"Also, if you notice any changes like the lump growing quickly, new pain, skin dimpling, nipple changes, or new lumps in the armpit, please come back straight away."

Leaflet:

Provide:

Breast clinic 2WW referral information leaflet Breast lump awareness leaflet

Reassure. Educate the woman about breast awareness. Consider reviewing in 6wk

 Found on Examination

1. Reassure kindly:

"I have carefully examined your breasts today, and I haven't found any lumps or anything concerning."

2. Acknowledge patient's feelings:

"It's completely normal to feel worried when you notice a change, and you've done exactly the right thing by coming in to get it checked."

3. Breast self-awareness education:

"It’s important to continue being breast aware. That means checking your breasts regularly, about once a month, ideally after your period if you're still having them."

4. Teach signs to watch for:

"When you check, you're looking for things like: New lumps

Changes in size or shape

Skin changes like dimpling or redness

Nipple changes like inversion or new discharge"

5. Explain routine screening:

"Because you’re over 50, you’re eligible for regular mammograms every three years through the national breast screening programme."

"Mammograms are like a special X-ray of the breast tissue that helps detect very small changes before they become noticeable."

6. Safety netting:

"If you notice any new changes in your breasts before your next routine check, please don't wait — come back and see us straight away."

7. Leaflet:

Provide:

Breast self-examination leaflet

Routine breast screening program leaflet