Ms. White is a 28 yo F who is well-known to your practice. She presents to clinic today for breast pain and concern for possible breast cancer. She is very health-literate and always comes in with lots of questions for you. Today she states that she has been having breast pain "everywhere" for several months, that the pain radiates to both axillae and is worse in the 7-10 days before her menstrual period. She is not on any medications. She has never been diagnosed with a breast disorder. Her maternal grandmother has a history of invasive ductal carcinoma at age 59; no other known FMH of breast cancer. On physical exam, there are no palpable masses, and the pain is diffuse and bilateral. She is concerned about breast cancer given her grandmother's history, and has been reading that MRI is the most sensitive imaging modality to detect breast cancer. She requests breast MRI for "peace of mind" since worrying about possible breast cancer has been really bothering her recently.

Which of the following is the most appropriate next step in management?

A-reassurance

B-Breast MRI

C-Mammography

D-Breast Ultrasound

set up each as a link with answer A correct

A-reassurance:

Yes, reassurance is most appropriate next step in management of cyclic mastalgia. Even though she is very anxious about possibly having cancer and wants breast MRI, the likelihood of her having breast cancer is remarkably low given her age and lack of risk factors. MRI may actually be more anxiety-provoking than comforting for this patient (high false-positive rate, possible unecessary biopsies). If her pain persists, topical or oral NSAIDs and a well-fitting bra are the best recommendations.

FAMILY MEDICINE CASE 1