Question

A 42-year-old woman presents to the office with a breast mass. She noticed a firm, slightly tender mass on her right breast during a self breast exam two months ago. She has not noticed nipple discharge or skin changes. It has not enlarged nor decreased in size. The review of systems is negative. She does not use tobacco, alcohol or drugs, and she drinks five cans of caffeinated soda per day. She has a maternal aunt with breast cancer who was diagnosed at age 50. On examination, the left breast is normal; right breast has a 1 cm x 2 cm rubbery mobile mass in the upper outer quadrant. There was no nipple discharge, no visible skin changes, and no axillary or supraclavicular lymphadenopathy. A mammogram three months ago was normal and showed dense breast tissue bilaterally. What is the best next step in the management of this patient to help determine her diagnosis?

A. Fine needle aspiration of the mass
B. Observation for six months and reexamine
C. Repeat mammogram
D. Excisional biopsy of the mass
E. Decrease caffeine intake and reexamine

Answer 1

An excisional biopsy is the best next step to diagnose the breast mass of the 42-year-old woman with a family history of breast cancer and a palpable mass, after a recent normal mammogram.

Step-by-step explanation:

The best next step in managing this patient's breast mass, given the normal mammogram three months ago and the current examination findings, would be to proceed with a diagnostic excisional biopsy of the mass (Option D). A fine needle aspiration (Option A) may not provide conclusive diagnostic information, and with a family history of breast cancer, more definitive diagnosis is needed.

Observation (Option B) might delay necessary intervention, a repeat mammogram (Option C) so soon after a normal one is less likely to be informative, and while decreasing caffeine intake (Option E) could be considered for breast tenderness, it is not adequate in this case where a definitive diagnosis is required.