|You are seeing a 53-year-old African American female for a lump she found in her right breast two weeks ago in the shower. Her last mammogram was three years ago and she was told it was “benign.” She had two breast biopsies at ages 32 and 34 in her right and left breasts, respectively. At both times she had surgery for removal of fibroadenomas. She does not routinely do breast self-exams. Her mother had a mastectomy for breast cancer at age 63, and she heard that a paternal aunt had a breast removed for cancer when she was in her forties. Both mother and aunt are alive and well today. It was discovered on postmortem exam that her grandfather had prostate cancer. Menarche was at age 15 and she is still having monthly menses. She is Gravida 4 Para 3104 with her first childbirth at age 31. She was on oral contraception for 10 years, has no history of fertility treatments, and had a bilateral tubal ligation after the birth of her last child at age 35. Past medical history is noncontributory. She wants to know how likely it is that she will get breast cancer. Physical exam reveals breasts are symmetrical with no dimpling, retractions, or rash. Her right breast has a 2 cm non-tender, hard, fixed mass at 3:00 6 cm from her nipple. Left breast is non-tender without masses. No nipple discharge bilaterally. No anterior cervical, infra- or supraclavicular, or axillary adenopathy.
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