The history of present illness should note the means of how the cancer was initially identified, such as a palpable mass, an abnormality identified on a screening mammogram, nipple discharge, or the development of focal pain. Of course, it is important to obtain all outside imaging studies, with a personal review of such studies by both the treating surgeon and institutional breast radiologist. Tumor characterization, overall diameter, and clinical stage should be documented, with further evaluation of other imaging abnormalities that may not have been identified on the initial studies.

A thorough physical exam of the breasts and regional nodal basins should be performed [7]. If possible, evaluation of the regional nodal basin with ultrasound has been found to be helpful in the identification of suspicious-appearing lymph nodes that may require further evaluation and possible ultrasound-guided biopsy. Such information has clinical implications on the role, or lack thereof, for performing a sentinel node biopsy in the face of known nodal metastases [8, 9]. Accurate past medical and surgical histories are also important to obtain beforehand, as part of the general well-being of the patient and associated comorbidities that may potentially affect (alter) surgical, radiation, and medical oncology recommendations. A few such examples may be a previous history of mantle radiation for lymphoma or radiation for lung cancer, history of scleroderma, or connective tissue disorder that may prohibit or limit the use of radiation therapy.

A comprehensive history of current medications, including supplements and herbal medications, should be documented. Ideally, patients should bring their medication to the initial visit to avoid errors in the names of the drug or dosage. Allergies should also be identified, not only to medications, but also food, topicals, latex, and environmental substances. The review of systems is particularly important to identify possible coexisting conditions, second primary cancers, and findings suspicious for distant disease. A thorough menstrual and reproductive history should be obtained along with a history of hormone use such as oral contraceptives, impregnated intrauterine devices, depot contraception, hormone replacement therapy, and fertility drugs. It is also important to remember that cast menstrual period (CMP) is not an accurate reflection of menopausal state if a woman has had a hysterectomy without oophorectomy or has undergone a uterine ablation procedure. Ovarian function dictates endocrine therapy choices in hormone receptor-positive tumors and should be evaluated with FSH levels if any question exists [10].

A thorough family history of cancer is necessary to assess the risk of developing a genetically associated breast cancer. All types of cancer should be included, along with age at diagnosis, bilateral disease (where appropriate), and whether the family member experienced a recurrence of their cancer. A history of cigarette use, alcohol consumption, and recreational drug use should also be documented. All imaging studies should undergo a second opinion by your own department of breast radiology. Changes in interpretation of imaging studies and pathology findings can result in significant changes in the overall treatment plan [1, 4, 11, 12]. All outside pathology should also be obtained for second opinion by your institute’s breast pathologists in order to insure that the pathologic diagnosis is accurate and that the receptors, ER/PR and HER2-neu, are assessed at a minimum [13].