Diagnosis FAM

A.
Diagnosis
1. History taking 1,2,3
There are several things that need to be questioned to the patient who
has Fibroadenoma mammae. Mostly patient who has Fibroadenoma
mammae said that they have:
a. Palpable mass that are typically unilateral, painless, firm, solitary,
mobile, and slowly growing lump. We must asking about the length
of time present and speed of growth (hormonally responsive, grows
during pregnancy and late luteal phase, regresses after menopause).
Sometimes other symptoms such as pain, nipple discharge, and skin
changes (dimpling or inflammation, nipple inversion) can be
present.
b. Family history of breast or ovarian disease (benign or malignant).
Female patients who have first-degree relatives with breast or
ovarian cancer should be monitored and observed more carefully for
malignant features than patients without this family history.
c. Age of at onset of menstrual cycle (early menarche <12 years),
obstetrical parity (nulliparity), and late menopause (age >55 years).
2. Physical Examination1,2,3
On physical examination, it has the following features:
a. Fibroadenoma most commonly occurs in the upper outer quadrant
of the breast.
b. Rapidly growing solid lump (with variable shape and size) with
rubbery consistency, regular borders. The mass is mobile and soliter.
c. Most are painless or non-tender. But, may have associated pain with
palpation, especially right before your period, when it may swell due
to hormonal changes.
3. Breast Self-Exam4
Breast self-exam or regularly (every 1 week after the first day of last
menstrual period) examining your breasts on your own, can be an
important way to find a breast cancer early, when it’s more likely to be
treated successfully. Breast self-exam is a convenient, no-cost tool that
you can use on a regular basis and at any age. How to do a breast self-
exam:
a. Step 1: Begin by looking at your breasts in the mirror with your
shoulders straight and your arms on your hips.
Here's what you should look for:
1) Breasts that are their usual size, shape, and color;
2) Breasts that are evenly shaped without visible distortion or
swelling.
If you see any of the following changes, bring them to your doctor's
attention:
1) Dimpling, puckering, or bulging of the skin;
2) A nipple that has changed position or an inverted nipple
(pushed inward instead of sticking out);
3) Redness, soreness, rash, or swelling.
b. Step 2: Raise your arms and look for the same changes.
c. Step 3: While you're at the mirror, look for any signs of fluid
coming out of one or both nipples (this could be a watery, milky,
or yellow fluid or blood).
d. Step 4: Feel your breasts while lying down, using your right hand
to feel your left breast and then your left hand to feel your right
breast. Use a firm, smooth touch with the first few finger pads of
your hand, keeping the fingers flat and together. Use a circular
motion, about the size of a quarter. Cover the entire breast from top
to bottom, side to side from your collarbone to the top of your
abdomen, and from your armpit to your cleavage. Follow a pattern
to be sure that you cover the whole breast. You can begin at the
nipple, moving in larger and larger circles until you reach the outer
edge of the breast. You can also move your fingers up and down
vertically, in rows, as if you were mowing a lawn. This up-and-
down approach seems to work best for most women. Be sure to feel
all the tissue from the front to the back of your breasts: for the skin
and tissue just beneath, use light pressure; use medium pressure for
tissue in the middle of your breasts; use firm pressure for the deep
tissue in the back. When you've reached the deep tissue, you should
be able to feel down to your ribcage.
e. Step 5: feel your breasts while you are standing or sitting. Many
women find that the easiest way to feel their breasts is when their
skin is wet and slippery, so they like to do this step in the shower.
Cover your entire breast, using the same hand movements
described in step 4.
1. Jingmei L, Keith H, Peh JH, Mikael E, Eva DR, Linda SL, Per H, Kamila.
Family History, Reproductive, and Lifestyle Risk Factors for Fibroadenoma
and Breast Cancer. JNCI Cancer Spectru; 2(3):1-7.
2. Woodard S, Schetter S, Millington K. 2018. Diagnosis and imaging
characteristics of a juvenile fibroadenoma in a 2-year-old patient: a case
report. Radiol Case Rep;13(1):6-10.
3. Ajmal M & Van Fossen K. 2019. Breast Fibroadenoma. Treasure Island
(FL): StatPearls Publishing.
4. Boraas M & Gupta S. 2019. Breast Self-Exam. Breastcancer.org.
https://www.breastcancer.org/symptoms/testing/types/self_exam. accessed
August 2019.

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