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Breast Mass
Diagnosis/Definition
A mass or thickening in the breast.
Initial Diagnosis and Management
- Breast tissue is inherently nodular and variable, depending on the individual and the phase of the menstrual cycle.
- However, all clear-cut masses, and any concerning possible mass or thickening should be carefully assessed and promptly referred for specialty opinion if spontaneous resolution does not take place within 3 weeks.
- In patients over age 30 with an abnormality on physical exam, a diagnostic mammogram and ultrasound should be obtained.
- In patients under age 30 with an abnormality on physical exam, breast-imaging decisions should be deferred until after specialty opinion.
- Breast cysts are common and easily treated by aspiration if large and symptomatic. However, attempted aspiration of suspected small or asymptomatic cysts at a primary care level is discouraged since such attempts are often unsuccessful, and may hinder specialty assessment.
Ongoing Management and Objectives
Well-woman breast health maintenance:
- Low-risk group women are advised to perform monthly self-exams, to have a yearly professional breast exam, and to obtain their initial screening mammogram sometime between the ages of 35-40.
- Subsequent screening mammograms are advised annually after age 40.
- Women with a positive family history should follow a similar plan, but should begin annual mammograms 10 years prior to the age that the mother or sister developed breast cancer.
- The primary determinants of high-risk for breast cancer are a prior personal history of breast cancer, a prior breast biopsy showing atypical hyperplasia or lobular carcinoma in situ (LCIS), or having a mother or sister with breast cancer diagnosed prior to age 50.
Indications for Specialty Care Referral
Any concerning breast mass that persists beyond one menstrual cycle should be referred for diagnostic mammography.
Spontaneous unilateral, bloody or clear nipple discharge should be referred for diagnostic mammography.
Nipple or skin inversion or retraction should be referred for diagnostic mammography.
Any mammographic concern for which specialty level assessment has been advised by the Radiologist should be referred.
Criteria for Return to Primary Care
Following specialty level assessment, patients are returned to primary care providers and should follow the follow-up plan as outlined in the consultation note if no biopsy has been advised or performed.
Patients who have had a specialty-level breast biopsy of any kind with benign outcome should have a follow-up unilateral mammogram 6 months post biopsy, then resume well-woman breast health surveillance (at the one year interval given age and risk factors) under the supervision of their primary care provider.
