Women younger than age

1. Diagnostic mammography is usually not helpful in women under age 35 because the breast tissue is too dense. In a young woman with no physical findings indicating malignancy, the patient should return 3 to 10 days after the next menstruation begins to determine if the lump regresses.

2. FNAB can be performed if the lump remains easily palpable and feels cystic (round, smooth, and not hard). If fluid is obtained and is not bloody, the patient can be reassured and followed in four to six weeks to check for recurrence; a recurrence suggests the need for surgical referral. Bloody fluid should be sent for cytology.

3. If the lump does not feel cystic, the patient may be referred for ultrasound. If ultrasound shows a solid mass, the patient should undergo either FNAB, core-needle biopsy, or excisional biopsy. If a solid lump is small (<1 cm in size) and is not clinically suspicious (eg, is soft, not fixed, not new, and not changing), the lump is likely to be a fibroadenoma and the patient can be followed with physical examination every three to six months.

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