The detection of a lump in the breast causes understandable fear of a cancer diagnosis. It is important in responding to this symptom and the inevitable underlying fear that a careful assessment is undertaken so that appropriate management can be organised in a timely and efficient way. Careful and meticulous examination will increase the chance of correct diagnosis. It is important that referrals are appropriate and that information and discussion accompany this assessment.rnrnrnrnEpidemiologyrnrnThe detection of a breast lump is a relatively common problem in general practice. Each year the average GP, with a patient list of 2,000 will see one or two new cases of breast cancer. The same GP will see many more patients with benign breast problems. An average breast unit serving a population of 300,000 will receive about 40 referrals from GPs and 2 from screening centres per week. On average 4 cases of breast cancer will be diagnosed from these referrals per week.rnrnIn line with good practice, explain to the patient what you intend to do and why, and consider using a chaperone.rnSome people advocate using the examination to teach the patient self-examination. It may seem logical that self-awareness should be beneficial but there is remarkably little evidence that self-examination is beneficial.rnrnrnInspect the breasts:rnInspect with the patient sitting and then with hands raised above headrnA lump may be visiblernLook for:rnVariations in breast size and contourrnIs there an inverted nipple (nipple retraction) and, if so, is it unilateral or bilateral?rnAny oedema (may be slight)rnRedness or retraction of the skinrnDimpling of the skin (called peau d’orange and is like orange peel because of inflamed tumour under the skin)rnThe peau d’orange appearance is of serious significance. The underlying tumour is likely to be aggressive and classified as stage IIIB.rnThe next stage is palpation, and a systematic search pattern improves the rate of detection. Different people have different techniques and whilst the following is recommended here, it is by no means the only acceptable technique: Less