drduck
Forum Guru
Topics: 82
Posts: 535
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cutting short Q,
32 yr old, female.
mass 3cm, in upper outer quadrant of left breast, not fixed.
h/o Ca breast, mother when 40.
no h/o smoking, she uses OCP's.
no palpable lymphadenopathy....mass is not fixed, no discharge.
next best step........
-reassurance and NSAID's
-FNAC
-USG
-mammography
-excisional biopsy
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| neurom
Forum Senior
Topics: 2
Posts: 127
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USG
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"Nature magically suits a man to his fortunes, by making them the fruit of his character".
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| Ivonne
Going for step 3/99
Topics: 50
Posts: 1,397
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Since she is 32 ----------->USG 
If she would be 35 or more with +family h/o breast cancer-------->mammography
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If you beleive you can do it then you WILL DO IT!! (by Mymeghhi)
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| drduck
Forum Guru
Topics: 82
Posts: 535
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correct everyone......and thanks for replying to all my Queries.
but one thing creeping in my mind.......USG and mammogram done for what??
i thought these investigations are useful in cases where mass is not palpable....for example in obese 35+ woman, who have pendulous breasts, and so yearly mammogrm advised every year....cos palpation of mass very difficult in these situations.....
why shud one go for USG, if the mass is hard, and solid.......is it to rule out fibrocystic disease of breast or to look for more masses??
is it that every mass palpated in females upto 34 should be followed by USG and in those who are 35+ it shud be mammogram which is to be done next.
is that the protocol....for a breast mass.....
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| guangyu
Forum Elite
Topics: 28
Posts: 281
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single mass with family history, i would rather go to FNA
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| DrS
Forum Elite
Topics: 32
Posts: 338
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USG
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| WaqasQureshi
Forum Newbie
Topics: 2
Posts: 72
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I dunno drduck but what I think is that this should be MAMMOGRAPHY
the currrent recommendations from national cacner institute and american college of surgeons is annual screening mammography for women aged 40 and above
and for hereditary breast cancer with known BRCA mutation the annual mammography should start at 25-30 years of age. alongwith semiannual physical exams
for a strong family hisotry of undocumented genetic mutation, annual mammography and semiannual physical should start 10 years earlier to the age of youngest affected relative and no later than age 40 years
in this question, the patient's mother has it.
the first step in management here should be MAMMOGRAPHY.
Please note that ultrasonography has high false positve and negative rate. So this is used as an ADJUNCT not as a screening test. The indication is to check if the mass is solid or cystic. But it should be done after mammography. The cost of ultrasound is more than mammogram. So its not cost effective enough in this patient where you need a screening test.
ummm..what else...yes someone said FNA. FNA is defnitely a very sensitive test with >90% sensitivity but it would come after NON INVASIVE test that is mammography.
Please observe the usual sequence of recommendations
and yes, there is no age 35 CUT OFF in USA 
the usual cutt off is doctor's assessment of density and age of 20 years. When the breast is so DENSE that the mammogram is not sensitive enough to CATCH the disease. the other indication is when the female is lactating because al you will see is MILK on the radiogram.
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| WaqasQureshi
Forum Newbie
Topics: 2
Posts: 72
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as for drduck that why ULTRASOND be used for cystic masses.
SOME CYSTS ARE SO TENSE THAT THEY APPEAR SOLID. If we already know something is cystic, then whats the use of sonography?
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