The examiner should take a focused history of breast problems and risk factors for breast cancer befroe performing the clinical breast examination. The assessment of breast problems should include duration and onset of signs and symptoms (such as lump, skin changes, spontaneous nipple discharge, or breast pain), menstrual and reproductive history, hormone use, and dietary habits. The examiner should ask about factors that increase the risk of breast cancer including the following (American College of Obstetricians and Gynecologists):

• Increased age
• Previous history of breast cancer
• Nulliparity
• Delayed childbearing (over age 30)
• Early menarche (before age 12)
• Late menopause (after age 53)
• Family history of breast cancer (primarily in first-degree relatives)
• Biopsy-proven ductal or lobular hyperplasia
• Higher socioeconomic status
• Obesity

Approximately 80% of women found to have breast cancer have no identifiable risk factors. The history should also include details of previous imaging studies (mammography, ultrasonography, magnetic resonance imaging, etc.) and previous breast aspirations, biopsies, and surgeries. During the history is an excellent time to teach patients how to perform breast self-examination and reinforce its importance.

Contraindications to Breast Examination

There are no clear contraindications to clinical breast examination. However, if a woman refuses the examination, the examiner should stress its importance and try to understand her reasons for refusing. If the examiner is male, he should offer to have a female nurse act as chaperone during the examination.