Discomfort in the breast (eg. As masses, nipple discharge, pain) are common and are annually in the US for> 15 million visits to the doctor in charge. Although> 90% of the complaints have a benign cause, breast cancer remains a differential diagnosis. Because breast cancer is common and can see many benign diseases similar, should be excluded a carcinoma in the clarification of all complaints and abnormalities in the mammary gland or confirmed. Clarification history The Anamnes includes the following: duration of symptoms relation of symptoms to menstruation and pregnancy presence and type of pain, vaginal discharge and skin changes taking drugs, including hormonal therapy breast cancer in their own or family history date and results of the last mammogram breast examination Basically the breast examination by doctor and patient alike. The breasts are first inspected; Care is taken to asymmetry of the mold, collection of the nipple, the protrusions and depressions (for the usual examination of the breast examination positions A and B). Even if a difference in size between the breasts is common, each breast should have a regular contour. Sometimes a deeper tumor is characterized discovered that you press the patient’s both hands against the hips or both palms can be compressed prior to the end (examination of the breast C and D). In these positions, the pectoralis muscle is tensed, and there may be a slight indentation of the skin are visible when a growing tumor has fixed the Cooper’sche ligament. The nipples are squeezed to check for secretion and determine where it comes from (for example, whether it emerges from several milk ducts). Breast examination The examination positions are the following: sitting or standing patient (A) with the arms on the side; (B) over the head arms raised and thus raised pektoraler fascia and mom; (C) the hands are pressed firmly against the hips; or (D) the palms are pressed together in front of the end so that the pectoralis muscle is strained. (E) palpation of the axilla: The arm is held as shown to relax the pectoralis muscle. (F) The patient is examined in supine position with a pillow under the shoulder and on the side to be examined over the head arm raised. (G) palpation of the breast in a circular pattern from the nipple to the outside. The axillary and supraclavicular lymph nodes are most easily studied in the sitting or standing patient (examination of the breast E). Holding the patient’s arm during the examination of the axilla allows a complete relaxation of the arm, so that deep axillary nodes can be palpated. The breast is initially keyed to the seated patient, then again in supine position with the ipsilateral arm over his head and a pillow under the ipsilateral shoulder (examination of the breast F). The latter position is also used for self-examination; The patient examining her breast with the contralateral hand. A lateral support, so that the breast on the examination side falls medially, can help to distinguish one tenderness of the mammary gland of a tenderness of the chest wall, since then the chest wall can be investigated separately from the mammary gland tissue. The mammary gland should be scanned with the palmar surface of the 2nd, 3rd and 4th finger systematically in an up to reaching the outer edges of the nipple circular pattern (examination of the breast G). The exact location and size (measured with calipers) of each striking findings should be noted on a sketch of the chest, the part of the patient record. Furthermore, the consistency of the findings should be described and noted how good or bad it can be separated from the surrounding tissue. The detection of abnormalities on physical examination, may mean that a biopsy is necessary, even if the imaging no pathological findings ergibt.Diagnostische process imaging examination are used for screening: testing of asymptomatic women to detect early cancer diagnosis: evaluation of breast abnormalities (eg. as masses, nipple discharge) All women should be tested for breast cancer. All societies and groups agree with this concept, even though they have different opinions when it comes to the recommended age by the screening should be started and as to the exact frequency of screening. ie recommendations for mammography screening vary for women at average risk, but in general, screening starts at age 40 or 50 years and is repeated until the age of 75 every year or every two years, or until the life expectancy <10 is years (breast cancer: screening recommendations for breast cancer screening mammography in women at average risk). Mammography is effective in older women because fibroglanduläres breast tissue is replaced by fat with age and this is more easily distinguished from abnormal tissue. Mammography is less sensitive in women with dense breast tissue; some states mandate that patients be informed that they have dense breast tissue when it is discovered by mammography screening. Recommendations for breast cancer screening mammography in women at average risk recommendations USPSTF ACS ACP AAFP ACOG ACR NCCN initiation age (years) 50 45 50 * 50 * 40 40 40 Frequency (Year e) 2 annually until age 54, then every 2 years 1-2 2 1 1 1 final age (years) 75 If the life expectancy <10 years 75 75 75 75 75 * Women aged 40 to 50: Consulting the risks and benefits of mammography is recommended, and the investigation can Basier take place end at the risk and patient preferences. women aged ? 75: Screening can be performed when the life expectancy is good or the patient requests it. AAFP = American Academy of Family Physicians; ACOG = American College of Obstetricians and Gynecologists of; ACP = American College of Physicians; ACR = American College of Radiology; ACS = American Cancer Society; NCCN = National Comprehensive Cancer Network; USPSTF = US Preventive Services Task Force. In the low-dose mammography X-ray images of both breasts in soft Beam Technology in 1 (oblique) or 2 layers are created (at an angle and craniocaudal). Only about 10 to 15% of the relevant properties have their origin in a malignancy. The significance of a mammogram depends in part on the techniques used and the experience of Befunders from; more than 15% of the findings can be false-negative. To support the diagnosis, some centers cost digital mammography images from a computer. Such systems are not recommended as the sole method of diagnosis, but they seem the sensitivity for detection of small cancers by radiologists to increase. A breast tomosynthesis (3-dimensional mammography), carried out with digital mammography, the rate of cancer detection slightly increases and decreases the rate of "Recall Imaging"; this study is helpful for women with dense breast tissue. However, the test women is almost twice as high radiation as a conventional mammogram. A diagnostic mammogram is used for the following:. Clarification of nodes, pain and nipple discharge Determine the size and location of a lesion and make images of the surrounding tissue and lymph nodes represent guide biopsy Customize after surgery, a recording of the breast and cut to Rumforderung to determine whether the excision was complete. In diagnostic mammography display in more levels than is necessary for the screening. Among the photographs are enlargements, and dot print images that provide better visualization of suspicious areas. Ultrasound can be used to check the following: Diagnose breast abnormalities Determine abnormal axillary lymph nodes that might make a punch biopsy required breast cancer stage review discovered by MRI or mammogram abnormalities (make, for example, whether they have solid or cystic. ) MRI is used to: diagnose breast abnormalities Before the operation, accurate determination of tumor size and the chest wall involvement and existing multiple tumors. Identify abnormal axillary lymph nodes (to help classify the stage of breast cancer). In women at high risk for breast cancer (z. B. with a BRCA gene mutation or a calculated lifetime risk of breast cancer of ? 15 to 20%), the screening should contain in addition to clinical breast examination and mammography an MRI. For screening for women with average or only slightly elevated risk of breast cancer, MRI is considered inappropriate.