Question

4. A 30 year old female presents to her physician with a breast mass. She first noted a small "lump" in her left breast while showering about six weeks ago. She has noted no change in the size of the mass since that time, and she denies pain or nipple discharge. Family history is significant for a paternal grandmother who had breast cancer at age 79. Physical examination reveals a soft, round, mobile 1cm mass in the lower outer quadrant of the left breast. No skin changes are noted. What is the most appropriate next step in the management of this patient?

A. Mammography
B. Refer patient for radical mastectomy
C. Begin levonrgestrel/etinyl estradiol
D. Genetic testing for BRCA1 and BRCA2
E. Ultrasound of breast mass

Answer 1

The most appropriate next step in the management of a 30-year-old female presenting with a breast mass is to perform an ultrasound of the breast mass, which is effective for detecting abnormalities, especially in younger women with denser breast tissue.

Step-by-step explanation:

A 30-year-old female presenting with a breast mass requires a careful evaluation due to the risk of breast cancer, even though her symptoms do not currently suggest a malignant process. Since she has no family history suggesting a high genetic risk based on the information given (e.g., multiple family members with breast cancer or diagnosis at an unusually young age), and considering the mass has not changed over six weeks, is not painful, and no nipple discharge is present, initial imaging rather than invasive procedures or genetic testing is most appropriate. Hence, the most appropriate next step in the management of this patient is E. Ultrasound of the breast mass. An ultrasound is particularly useful in younger women with denser breast tissue, where mammography may not provide as clear a contrast. If an ultrasound indicates a more suspicious finding, further diagnostic steps could include mammography or biopsy. This pathway aligns with the principles of early detection and minimally invasive diagnosis that are crucial in breast cancer management.