Breast mass or pain are common patient presentations. Pain is always felt by the patient whereas the mass may be either felt by the patient, spouse, or clinician, or seen on an image. Probable diagnoses include differentials for mass, pain, or both mass and pain, such as intra-ductal papilloma, mammary duct ectasia, and fat necrosis. The duration of symptoms and the location of the mass provide helpful information for a clinician to narrow differential diagnoses.
Urgent/emergent situations include severe infection or advanced cancer/metastatic diseases resulting in hemodynamic instability. Although breast cancer is a serious disease, patients do not usually present with an advanced metastatic disease which could result in an immediately life-threatening situation in the short run. However, aggressive forms of breast cancer can pose an urgent/emergent situation, such that treatment delay of a few days can result in change in outcomes, and therefore a clinician should consider a patient’s demographics and the presence of risk factors when evaluating for urgent/emergent situations.
Weighing and removing anchor bias involves a clinician asking questions about risk factors associated with various pathologies and pertinent clinical features. A patient’s age, the association of symptoms with cycles, the characteristics of the mass, the presence of pain, weight loss, physical exam and, most importantly, risk factors provide valuable information for a clinician to arrive at the final diagnosis. Valuable diagnostic tests include imaging and biopsy.