No symptom or sign frightens a woman more than a problem with a breast. Physicians should be aware that most breast lesions are benign rather than malignant, and they should transmit this fact to the patient at the start of the consultation. The patient will then be more comfortable and able to focus on the problem that brought her to the consultation.

THE CLINICAL HISTORY

Presenting Symptoms and Age

The most common reasons for which a woman consults a physician or breast surgery specialist are

• a tumor on the breast,

• breast pain (mastodynia),

• nipple discharge,

• nipple or skin changes in the breast, or

• a mammography finding of a lump or calcifications.

The physician should note the patient's age. Knowing which breast lesions most commonly cause the presenting symptoms, and the median ages at which those lesions most commonly occur is extremely important.

The most common breast lesions are fibrocystic changes, cancer, fibroadenoma, intraductal papilloma, and duct ectasia.

Each of those conditions usually presents itself in certain age groups:

• Fibrocystic changes are more common at age 20–45.

• Cancer is more prevalent at age 40–45, with a slight decline until the age of 50, and a progressive increase after that age.

• Fibroadenoma is seen at age 20–30.

• Intraductal papilloma is more common at the age of 35–45.

• Duct ectasia occurs for the most part in premenopause.