Breast
Core concepts
Breast questions blend benign disease, breast cancer staging and biology, and the workup of a breast mass. Know the triple assessment (clinical exam, imaging, tissue sampling), the difference between screening and diagnostic mammography, and the receptor status implications (ER/PR, HER2). Understand that most breast masses in younger women are benign fibroadenomas, while a hard, fixed mass in an older woman raises malignancy concern.
Traps
- Age-based workup: a palpable mass in a woman under 30 is often evaluated first with ultrasound; in women 30 and older, diagnostic mammography plus ultrasound is typical. Don't apply screening logic to a symptomatic mass.
- Inflammatory breast cancer: presents with erythema, peau d'orange, and rapid enlargement-not a discrete mass-and is a clinical diagnosis requiring prompt biopsy, not antibiotics alone.
- Paget disease: eczematous nipple changes warrant biopsy to exclude underlying malignancy.
- Male breast cancer: rare but real; a unilateral subareolar mass in a man needs evaluation, not reassurance.
Rule of thumb
Any palpable breast mass should be evaluated with imaging and, if suspicious or persistent, tissue diagnosis. A negative mammogram does not exclude cancer in a palpable mass.
Worked example
A 55-year-old woman with a firm, immobile mass and skin dimpling: order diagnostic mammography and ultrasound, then core needle biopsy. Dimpling (tethering) and fixation suggest locally advanced disease; staging and multidisciplinary planning follow confirmation.