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history taking in breast mass

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MSt MRCGP.

Posted: 5 November 2026Updated: 5 November 2026 Guideline-Aligned (High Confidence) Clinically Reviewed

Focus the history on the breast lump, associated nipple or skin changes, and age-related referral criteria .

  • Establish the patient’s age and whether the lump is unexplained, as these determine the recommended referral pathway .
  • Ask about pain associated with the lump, but do not use pain to exclude malignancy: malignant lumps are usually painless, although pain can occur .
  • Ask about nipple symptoms, including discharge or bleeding, retraction, and changes in shape, and establish whether these affect one nipple only .
  • Ask about skin changes, particularly tethering or an orange-peel appearance (peau d’orange) .
  • Ask about an associated unexplained axillary lump, which is another feature relevant to suspected breast cancer referral .

Use the history to guide referral: refer through the suspected cancer pathway for an unexplained breast lump, with or without pain, in patients aged 30 years or over; consider non-urgent referral in those under 30 1. Consider a suspected cancer pathway referral for suspicious skin changes or an unexplained axillary lump in someone aged 30 years or over . Unilateral nipple discharge, retraction, or other concerning nipple changes in someone aged 50 years or over also warrant suspected cancer pathway referral .

The supplied breast guideline excerpts establish these symptom and referral priorities but do not provide a comprehensive history-taking checklist .

Educational content only. Always verify information and use clinical judgement.