12-17-2008, 07:15 AM
A 42-year-old woman is evaluated for a lump in her left breast she noticed several weeks ago. She thought the mass would resolve after her menstrual period, but it has persisted. She is otherwise healthy. She began menarche at age 10 years, had her first child at age 31 years, and did not breast-feed. She is sexually active and takes oral estrogen-progestin contraceptives. Results of mammography performed when she was ages 40 and 41 years were negative. Her mother was diagnosed with breast cancer at age 68 years.
On physical examination, a dominant 1 cm × 2-cm mass is palpated in the upper outer quadrant of the left breast. Examination of the right breast demonstrates glandular tissue similar to that of the left breast but no dominant mass. There is no axillary lymphadenopathy. Bilateral diagnostic mammography is performed, the results of which are interpreted as negative, with a Breast Imaging Reporting and Data System (BIRADS)-1 reading.
Which of the following is the most appropriate next step in the management of this patient?
A Repeated bilateral diagnostic mammography in 6 months
B Repeated clinical breast examination in 4 to 6 weeks, after a menstrual cycle
C Recommendation to avoid caffeine and repeated clinical breast examination in 3 months
D Fine-needle aspiration of the mass
E MRI of the left breast
On physical examination, a dominant 1 cm × 2-cm mass is palpated in the upper outer quadrant of the left breast. Examination of the right breast demonstrates glandular tissue similar to that of the left breast but no dominant mass. There is no axillary lymphadenopathy. Bilateral diagnostic mammography is performed, the results of which are interpreted as negative, with a Breast Imaging Reporting and Data System (BIRADS)-1 reading.
Which of the following is the most appropriate next step in the management of this patient?
A Repeated bilateral diagnostic mammography in 6 months
B Repeated clinical breast examination in 4 to 6 weeks, after a menstrual cycle
C Recommendation to avoid caffeine and repeated clinical breast examination in 3 months
D Fine-needle aspiration of the mass
E MRI of the left breast