Swelling of the breast tissue in a male is an embarrassing symptom, often presented behind the facade of a ‘calling card’. The following differential diagnosis does not include other causes of breast swelling, which are referred to in the Top Tips at the end of this section. In true breast swelling, glandular tissue is palpable behind the areola and is usually bilateral.
The discovery of a lump in a woman’s breast will usually create a lot of anxiety. She will probably have found it herself and with the high public awareness of breast cancer, will want reassurance or rapid action. If within your scope of practice, a careful examination of both breasts and associated lymph nodes is mandatory. Otherwise make an immediate referral to a GP.
Breast pain has a variety of innocent causes: The commonest are puberty and pregnancy. It can be a troublesome recurrent problem for women with cyclical mastalgia. Cancer is very likely to be a major concern: this is an uncommon cause and pain is an unfortunately late sign of the disease.
Nipple discharge has a number of disparate causes, from the first outward sign of a previously unrecognised pregnancy, to a late sign of an advanced carcinoma. It can cause embarrassment and concern in equally large amounts. Compared with breast pain and lumps, it is a relatively rare presenting symptom. Take it seriously assess carefully and refer quickly – investigation will often be needed.