Breast surgery
Breast lumps, breast pain, nipple discharge, infection and breast cancer. The key concept is triple assessment.
High-yield points
Triple assessment for a breast lump: clinical examination, imaging and needle biopsy (core biopsy preferred); all three must be concordant.
Imaging: ultrasound first under about 35 years; mammography plus ultrasound in older women.
Fibroadenoma is the most common lump in young women: smooth, mobile, 'breast mouse'.
Lactational mastitis: continue breastfeeding or expressing; flucloxacillin or cefalexin if bacterial; drain an abscess.
Bloody single-duct nipple discharge needs imaging and referral (intraductal papilloma or cancer).
Strong family history or known BRCA1/2 mutation: refer to a familial cancer service (eviQ guidelines).
Male breast lump: most are gynaecomastia (review drugs, liver, testes), but cancer must be excluded.
India vs Australia
Where the answer the AMC marks correct differs from what’s usually taught in Indian MBBS.
| Aspect | India (MBBS)What you learn in MBBS | Australia (AMC)What the exam marks as correct |
|---|---|---|
| Screening | No organised program; clinical breast examination is promoted. | BreastScreen Australia: free 2-yearly mammograms for women 50-74 (from 40 on request), no GP referral needed. |
| Breast lump | Triple assessment. | Largely the same: triple assessment (clinical, imaging, biopsy). A normal mammogram alone doesn't exclude cancer. |
| Typical presentation | Younger women and later, often locally advanced disease. | Many cancers are screen-detected and early; breast-conserving surgery with radiotherapy is common. |
| Family history | Genetic testing limited by cost. | Assess familial risk category; refer to familial cancer services; BRCA testing is Medicare-funded for eligible people. |
Screening
India (MBBS)
No organised program; clinical breast examination is promoted.
Australia (AMC): what the exam expects
BreastScreen Australia: free 2-yearly mammograms for women 50-74 (from 40 on request), no GP referral needed.
Breast lump
India (MBBS)
Triple assessment.
Australia (AMC): what the exam expects
Largely the same: triple assessment (clinical, imaging, biopsy). A normal mammogram alone doesn't exclude cancer.
Typical presentation
India (MBBS)
Younger women and later, often locally advanced disease.
Australia (AMC): what the exam expects
Many cancers are screen-detected and early; breast-conserving surgery with radiotherapy is common.
Family history
India (MBBS)
Genetic testing limited by cost.
Australia (AMC): what the exam expects
Assess familial risk category; refer to familial cancer services; BRCA testing is Medicare-funded for eligible people.
The Australian context
BreastScreen Australia offers free 2-yearly mammograms to women aged 50-74, and women 40 and over can also attend. No GP referral is needed. Breast cancer is the most common cancer in Australian women.