Breast Cancer Examination


  • Candidate Instructions
  • Actor Instructions
  • Mark Sheet
  • Score

Location: You are an FY1 doctor in General Practice

Patient: Mrs Summer, a 45 year old, has come to clinic after noticing a lump in her left breast

Task:

– Perform a breast examination

– After 6 minutes you will be asked questions by the examiner.

– Answer any questions that the patient may have

Note to actor:Try to restrain yourself from volunteering too much information – you may do so when prompted (that is, by a specific question, not a general one). If a student is on the wrong line of clinical reasoning do not fuel this line of thinking, state no to the question as being ambiguous may prompt further questioning and does not allow the student to be appropriately tested. The aim of the exercise is to take a focused history; short answers are required.

You are Mrs Summer, a 45 year old, who has come into clinic after feeling a lump in your left breast. You are happy to be examined and you do not have any questions.

If the candidate appears to have finished early remind them how long is left at the station and enquire if there is anything else they would like to ask, or whether they have finished. If they have finished, please remain silent and allow the candidate that time for reflection.

Category Question
Done
Excellent
Introduction Candidate appropriately introduced themselves with:
Full name
Role
Clarifies who they are talking to
Asks patient for preferred name


Examination basics Examination basics
Washes hands
Appropriately exposes patient
Chaperone present


Inspection Inspection
Compare breasts directly
Hands by side
Hands on hips
Raising hands above head


Inspection Inspection
Lumps
Skin changes
Scars
Nipples (inversion, discharge)


Palpation Palpation
Patient laying at 45 degrees, hands behind head
Palpates all four quadrants, starting with asymptomatic breast (i.e. right side in this case) – in a “clockwise manor”


Palpation Palpation
Palpates axillary tail
Palpates axilla for lymphadenopathy
Assesses whether there is nipple discharge
Palpates supraclavicular fossa for lymphadenopathy


Palpation Other breast
Repeats the above for other breast


Finishing Finishing remarks
Invites patient to dress again
Re-washes hands


Question
After the candidate has finished inspection please present the following image and state “please review the following image and comment on any features you can see”

Inverted nipple
Lump
Skin dimpling


Question What is the likely diagnosis
Breast Cancer


Question How would you describe a breast lump?
Size (measured in mm)
Site
Consistency (Soft; firm; hard)
Margins (discrete vs diffuse)
Surface (smooth vs irregular)
Mobility from skin and underlying structures


Question In a patient with a lump, what investigations would you request?
Imaging – ultrasound / mammography
Fine needle aspiration / core biopsy


Question What are the risk factors for developing breast cancer?
Increasing age
Previous history of breast cancer / DCIS
Family history or breast or ovarian cancer
Early menarche & late menopause
Current or past use of HRT or oral contraceptives
Nulliparity or late first child
Smoking
Obesity
Alcohol excess
Radiation exposure



Score