1. Although 90 percent or more of palpable breast masses in women in their 20s to early 50s are benign, excluding breast cancer is a crucial step in the evaluation. Mammography is recommended for any woman age 35 years or older who has a breast mass.

2. Mammography usually is not ordered routinely in women under age 35 years. The breast tissue in younger women is often too dense to evaluate the lump. Ultrasonography is useful in these women to evaluate lumps and to assess for cysts.

3. Round dense lesions on mammography often represent cystic fluid. Solid and cystic lesions can often be distinguished by ultrasonography and mammography, and needle aspiration under ultrasound guidance further documents the cystic nature of the lesion.

D. Breast pain. Women who present with breast pain as their only symptom often undergo mammography. Only 0.4 percent of women with breast pain have breast cancer. The vast majority of women have normal findings (87 percent); benign abnormalities are noted in 9 percent.

E. Ductal lavage. The cytologic detection of cellular atypia can identify women with a higher risk of developing breast cancer.

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