Questionnaire/history: Lump? - When first noticed? - Changed in size or in any other way? - Any changes noted through the menstrual cycle? Pain? - Onset? - Severity? - Location? - Radiation? - Duration? - Relationship to menstrual cycle, physical activity or recent trauma? Skin changes? Nipple changes? Menstrual history? Past medical history? Family history (eg breast cancer or other cancers) Current medication? Drug allergies? Examination: Explanations given ('The examination will involve me first inspecting the breasts, then placing a hand on the breasts to assess the breast tissue. Finally, I’ll examine the glands of your neck and armpit. One of the female ward staff members will be present throughout the examination, acting as a chaperone, would that be ok? Does everything I’ve said make sense? Do you feel you understand what the examination will involve? Do you have any questions?)? Consent obtained ('Are you happy for me to carry out the breast examination?')? Instructions given (Asked patient to undress down to the waist to adequately expose their breasts for the examination, provided patient with privacy to get undressed and offered a paper roll cover to allow exposure only when required. With the patient sitting on the side of the bed asked them to place hands on thighs to relax the pectoral muscles, then to press hands into hips to contract the pectoralis muscles and finally to place hands behind head and lean forward so that the breasts are pendulous.)?

Inspection - Scars? - Asymmetry (normal in most women)? - Masses? - Nipple abnormalities (eg discharge, inversion)? - Skin changes (eg scaling, erythema, puckering, dimpling/Peau D’Orange)? Palpation Breast Adjusted head of the bed to 45° and asked patient to lie down, asked patient to place the hand on the side being examined behind head to fully expose the breast, warmed hands before touching the patient, used flats of middle three fingers to compress the breast tissue against the chest wall as to feel for any masses, began with asymptomatic breast. - Clock face method (each “hour” of the breast)? - Spiral method (start at the nipple and work outwards in a concentric circular motion)? - Quadrants method? Findings?

Masses? - Position: - Which quadrant? - What “hour”? - How far away from the nipple? - Size (approximate dimensions of the mass (cm x cm))? - Shape (eg spherical, elongated, irregular? - Consistency (eg smooth, firm, stony rubbery)? - Overlying skin changes (eg erythema, puckering)? - Mobility (moves freely, moves with the overlying skin, moves with the prectorcal contraction (tense chest muscles))? - Fluctuance (mass fluid filled with holding the mass by its sides and then applying pressure with another finger to the centre of the mass sides bulging outwards?) Axillary tail

Findings? Nipple-areolar complex (Palpated using the flats of middle three fingers to compress the areolar tissue towards the nipple.) History of nipple discharge, but none is visible? Asked patient to attempt to express discharge from the nipple (if comfortable to do so)? Findings? Discharge? - Colour (eg milky; green, yellow, brown; blood-stained)? - Consistency (eg thick, watery)? - Volume? Elevation of breast Pathology visible? Lymph nodes Axillary (pectoral (anterior), subscapular (posterior), humoral (lateral), central (medial) and apical groups (palpated by holding the patient’s forearm in other hand and instructed to relax it completely, allowing to support the weigh)? Cervical? Supraclavicular? Infraclavicular? Parasternal? Diagnosis: No breast lump found? Bening breast lump? Suspected benign breast lump? Suspicious breast lump? Management: Findings explained to patient? Reassured? Advice for breast awareness given (including weblinks NHS Health A to Z and NHS England)? Advised to return in 2 weeks for re-examination? Non-urgent referral to breast clinic? 2 week wait referral to breast clinic? Other? Resource(s): Geeky Medics: Breast Examination – OSCE Guide NICE CKS: Breast cancer - recognition and referral

Information for patient/carer(s):

NHS England: Keep Yourself healthy. A guide to examining your breasts

NHS Heath A to Z: How should I check my breasts?