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GP CCE Caseswomens-health

GP CCE Cases · womens-health

The lump her mother found — CCE clinical encounter

CCE-style clinical encounter: a 41-year-old woman attends with a lump she found in the shower, terrified after her mother's breast cancer death. The candidate must examine properly, refer through the right pathway, and handle the fear without dismissing it.

clinical encounter with role-player (CCE format)2 min readVerification in progress

Target exams

RACGP CCEFRACGP oralsCFPC SOOs
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Study tools

Target exams

RACGP CCEFRACGP oralsCFPC SOOs
Prompt
A 41-year-old teacher attends saying she found 'something' in her right breast in the shower two weeks ago but 'it's probably nothing'. Her mother died of breast cancer at 58. She has not examined herself since finding it. On your examination there is a firm, discrete, non-tender 2 cm lump in the right upper outer quadrant. No skin or nipple change. She asks you twice whether you think it's 'just a cyst'.

Objectives

  1. Take a focused history including the family history and its weight. [18]
  2. Examine both breasts and regional nodes properly, with her own finding demonstrated. [7]
  3. Deliver the honest working diagnosis: a discrete lump over 30 goes to triple assessment — clinical benignity never discharges the referral. [9] [15]
  4. Explain the pathway concretely (what happens, when, what the tests are) — the triple assessment with its measured accuracy. [21]
  5. Manage the fear as part of the clinical problem, with a definite follow-up plan. [3]
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References28ShowHide
  1. [1]Khawaja AR, Allan SM Has the breast cancer 'two week wait' guarantee for assessment made any difference? Eur J Surg Oncol, 2000.PMID 11034802
  2. [2]Clarke D, Sudhakaran N, Gateley CA Replace fine needle aspiration cytology with automated core biopsy in the triple assessment of breast cancer Ann R Coll Surg Engl, 2001.PMID 11320918
  3. [3]Meechan GT, et al. Who is not reassured following benign diagnosis of breast symptoms? Psychooncology, 2005.PMID 15386770
  4. [4]Mansel R, et al. A phase II trial of Afimoxifene (4-hydroxytamoxifen gel) for cyclical mastalgia in premenopausal women Breast Cancer Res Treat, 2007.PMID 17351746
  5. [5]Clegg-Lamptey JN, et al. Breast cancer risk in patients with breast pain in Accra, Ghana East Afr Med J, 2007.PMID 17892195
  6. [6]Ghimire B, et al. Accuracy of triple test score in the diagnosis of palpable breast lump JNMA J Nepal Med Assoc, 2008.PMID 19079392
  7. [7]Donnelly J Breast lump detection: who is more accurate, patients or their GPs? Int J Clin Pract, 2010.PMID 20015214
  8. [8]Goyal A Breast pain BMJ Clin Evid, 2011.PMID 21477394
  9. [9]Jan M, et al. Triple assessment in the diagnosis of breast cancer in Kashmir Indian J Surg, 2010.PMID 23133217
  10. [10]Kataria K, et al. A systematic review of current understanding and management of mastalgia Indian J Surg, 2014.PMID 25177120
  11. [11]Nakhlis F, et al. Papilloma on core biopsy: excision vs. observation Ann Surg Oncol, 2015.PMID 25361885
  12. [12]Saghafi N, et al. Effectiveness of Matricaria chamomilla (chamomile) extract on pain control of cyclic mastalgia: a double-blind randomised controlled trial J Obstet Gynaecol, 2018.PMID 29072514
  13. [13]Mišković J, et al. Diagnostic Value of Fine Needle Aspiration Cytology for Breast Tumors Acta Clin Croat, 2016.PMID 29117654
  14. [14]Zhou Y, et al. Variation in 'fast-track' referrals for suspected cancer by patient characteristic and cancer diagnosis: evidence from 670 000 patients with cancers of 35 different sites Br J Cancer, 2018.PMID 29182609
  15. [15]Mazari FAK, et al. The need for triple assessment and predictors for diagnosis of breast cancer in patients <40 years of age Clin Radiol, 2018.PMID 29731127
  16. [16]Quinlan A, et al. Quantifying patient preferences for symptomatic breast clinic referral: a decision analysis study BMJ Open, 2018.PMID 29858402
  17. [17]Barakzai N, Mansoor E, Buccimazza I Is conservative management of fibroadenomas feasible? 5-year results from the Durban Breast Unit S Afr J Surg, 2021.PMID 34212569
  18. [18]Rai A, et al. Study of Diagnostic Delay among Symptomatic Breast Cancer Patients in Northern India: A Mixed-Methods Analysis from a Dedicated Breast Cancer Centre Asian Pac J Cancer Prev, 2022.PMID 35345361
  19. [19]Zhang M, et al. Imaging and Management of Fibroepithelial Lesions of the Breast: Radiologic-Pathologic Correlation Radiographics, 2023.PMID 37856317
  20. [20]Gil Quessep E, et al. Subgroups varying in risk and density highlight the potential for stratified breast cancer screening Eur J Cancer, 2025.PMID 39805236
  21. [21]More RS, Dumbre S, Dikle AM Efficacy of Modified Triple Assessment in Diagnosing Breast Lesions: A Prospective Observational Study Cureus, 2025.PMID 40314043
  22. [22]Ahire P, et al. Unraveling Benign Breast Conditions: A Comprehensive Study of Diagnosis, Treatment, and Care Cureus, 2025.PMID 40600088
  23. [23]Jansen C, et al. Surgical treatment of breast fibroadenomas Dan Med J, 2025.PMID 41069312
  24. [24]Moshina N, et al. Breast cancer mortality among women who have attended BreastScreen Norway, 1996-2023 Breast Cancer Res, 2026.PMID 41845512
  25. [25]Pestrin O, et al. A longitudinal observational study of male referrals and adherence to imaging guidelines: a single centre experience in 148 patients Front Oncol, 2026.PMID 42022318
  26. [26]Scardina L, et al. Management of lactational and non-lactational breast abscesses: an evidence-based framework to support breast surgeon decision-making Updates Surg, 2026.PMID 42334816
  27. [27]Zhong W, et al. Clinical factors of prolonged treatment duration in patients with non-puerperal mastitis Gland Surg, 2026.PMID 42445087
  28. [28]Boldrini C, et al. The Gems and Pitfalls of Inflammatory Breast Disease: An Illustrated Review of Mastitis. What the Radiologist Should Know Radiol Res Pract, 2026.PMID 42540206
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