A 37-year-old woman presents for evaluation of a self-discovered breast mass. There is no family history of breast cancer; she is otherwise healthy. Examination reveals a 1.5-cm area of firmness in the right upper outer quadrant. No skin changes are noted. You attempt to aspirate the mass, but no fluid is obtained; a mammogram is ordered and is normal.
Which of the following is the most appropriate next step in management?
A. Refer the patient for further evaluation to a surgeon or comprehensive breast radiologistA breast mass, even in a young woman, requires definitive evaluation. Although most such masses are benign, breast cancer is still the most common cause of cancer death in this age group. Risk factor assessment cannot provide sufficient reassurance. A negative mammogram never rules out breast cancer. Either excisional biopsy or, in selected hands, fine-needle aspiration with follow-up, will be needed to detect cases of breast cancer before metastases outside the breast have occurred. Reassurance and reevaluation in 6 months may lead to delay in diagnosis of breast cancer. Neither oral contraceptives nor tamoxifen are indicated prior to a definitive diagnosis.