Examqo › Examqo library › Family medicine › Women's and men's health · IMLE
Breast complaints in primary care: lump, pain and nipple discharge
Every breast lump is assessed by "triple assessment" — examination, imaging and biopsy as needed; cyclical pain in both breasts is almost always benign, and discharge that is unilateral, spontaneous, from one duct or bloody needs imaging.
Why it matters in the exam
The exam presents a young woman with a mobile lump (ultrasound first), a 46-year-old with brown discharge from one nipple, a young woman with premenstrual breast pain, and a boy with swelling of both breasts at puberty. It asks for the first test and the next step.
The key point: under 30 start with ultrasound, from 30 with mammography and ultrasound; a suspicious finding needs a needle biopsy even when imaging is "equivocal".
Most breast complaints are benign, but they cause great anxiety; an orderly, prompt work-up reassures most women and identifies the few who need a biopsy.
During breastfeeding a painful lump with redness and fever is usually mastitis or an abscess — breastfeeding continues and an ultrasound is done if there is no improvement. A lump that persists after lactation is investigated like any other lump, because breast cancer can appear in this period too. Other questions deal with early-detection recommendations without risk factors — mammography every 2 years at 50–74 — and with a young woman who asks for a "reassurance test" without a complaint.
Key points
- Lump — triple assessment: examination, imaging, biopsy.
- Under 30 — ultrasound; from 30 — mammography and ultrasound.
- Bilateral cyclical pain — benign; reassurance.
- Unilateral, spontaneous or bloody discharge — imaging; usually an intraductal papilloma.
- Galactorrhoea — pregnancy, prolactin, TSH and drugs.
Summary table
| Complaint | Features | Work-up | Exam note |
|---|---|---|---|
| Breast lump under 30 | Usually a fibroadenoma or a cyst | Ultrasound first | Suspicious finding — needle biopsy |
| Breast lump from 30 | Any new lump | Mammography and ultrasound, and biopsy according to the finding | Normal imaging does not exclude a lump that feels suspicious |
| Cyclical pain | Bilateral, premenstrual | Reassurance, supportive bra, topical NSAIDs | No imaging beyond age-appropriate screening |
| Pathological discharge | Unilateral, spontaneous, from one duct, bloody or clear | Mammography and ultrasound | The common cause of bloody discharge: an intraductal papilloma |
| Galactorrhoea | Milky, bilateral | Pregnancy test, prolactin, TSH, drug review | Antipsychotics and metoclopramide raise prolactin |
| Gynaecomastia | Boy at puberty: bilateral and tender; adult: drugs, liver, testis | In a boy — follow-up; in an adult — work-up by cause | In a boy it usually resolves within 1–2 years |
In the full version for subscribers
- A simple algorithm
- Memory aid
- Exam traps
- 5 review cards
- Enough for IMLE
The full version is open to subscribers of: Family medicine, Medical licensing exam (IMLE), General surgery, Obstetrics and gynecology.
Subscriber? Read the full topic Plans and prices 25 free questions
Sources
- American College of Radiology Appropriateness Criteria, 2022–2023 — Palpable breast masses; Evaluation of nipple discharge; Breast pain
- Goroll AH, Mulley AG. Primary Care Medicine, 8th edition (2020) — Evaluation of breast masses, nipple discharge and breast pain
- Salzman B et al., American Family Physician, 2019 — Common breast problems
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.