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Breast Masses in Biological Females

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

Palpable breast masses are common among biological females, including pregnant and lactating individuals. Although most palpable breast masses are benign, breast cancer is one of the most common cancers. In 2019, there were an estimated 3.7 million individuals living with female breast cancer in the United States.1 Therefore, it is important that clinicians have the knowledge to appropriately evaluate breast masses. Risk factors for female breast cancer include, but are not limited to, exposure to menopausal hormone therapy, personal or family history of breast cancer, gene variants, chest wall radiation, age of menarche younger than 12 years, obesity, and alcohol use.2 A systematic approach for breast mass evaluation can help clinicians identify clinical features that increase suspicion of malignancy. Physical examination, breast imaging, and tissue biopsy are key diagnostic tools. For individuals who are younger than 30 years, lactating, or pregnant, the initial evaluation includes ultrasound, whereas mammogram with ultrasound is recommended for individuals 30 years or older.3,4 Tissue biopsy is necessary to evaluate a clinically suspicious mass.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Corresponding Author: Monique Swain, MD, Obstetrics and Gynecology Department, Henry Ford Hospital/Michigan State University School of Medicine, 3031 W Grand Blvd, New Center One Building, Seventh Floor, Detroit, MI 48202 (mswain1@hfhs.org).

Published Online: June 30, 2022. doi:10.1001/jama.2022.9554

Conflict of Interest Disclosures: None reported.

References
1.
National Cancer Institute.  Surveillance, Epidemiology, and End Results Program website. Cancer stat facts: female breast cancer. Accessed April 23, 2022. https://www.seer.cancer.gov/statfacts/html/breast.html
2.
Centers for Disease Control and Prevention.  What are the risk factors for breast cancer? Accessed February 20, 2022. https://www.cdc.gov/cancer/breast/basic_info/risk_factors.htm
3.
National Comprehensive Cancer Network.  NCCN guideline version 1.2021. Diagnostic evaluation presenting signs and symptoms. Accessed February 20, 2022. https://www.nccn.org/professionals/physician_gls/pdf/breast-screening.pdf
4.
diFlorio-Alexander  RM , Slanetz  PJ , Moy  L ,  et al; Expert Panel on Breast Imaging.  ACR appropriateness criteria breast imaging of pregnant and lactating women.   J Am Coll Radiol. 2018;15(11S):S263-S275. doi:10.1016/j.jacr.2018.09.013PubMedGoogle ScholarCrossref
5.
American Cancer Society.  Understanding your mammogram report. What is a BI RADS assessment category? Accessed February 20, 2022. https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/mammograms/understanding-your-mammogram-report.html
6.
Sumkin  JH , Berg  WA , Carter  GJ ,  et al.  Diagnostic performance of MRI, molecular breast imaging, and contrast-enhanced mammography in women with newly diagnosed breast cancer.   Radiology. 2019;293(3):531-540. doi:10.1148/radiol.2019190887PubMedGoogle ScholarCrossref
7.
Yüzkan  S , Cengiz  D , Hekimsoy  I ,  et al.  Diagnostic performance of contrast-enhanced mammography: comparison with MRI and mammography.   J Breast Imaging. 2021;3(4):448-454. doi:10.1093/jbi/wbab028Google ScholarCrossref
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