Question of the Week # 436

436) A 24 year old woman returns to your office to discuss breast biopsy results. One week ago, she was evaluated your office for a palpable lump in her left breast of one week duration. She reported significant pain associated with this lump and it was also associated with pale yellow colored nipple discharge. She is physically very active and enjoys playing soccer. She does not smoke or drink. She has no other problems except for mild ankle sprain that she sustained during an  inter-collegiate match two weeks ago. Physical examination was positive for a tender left breast lump in the outer quadrant . She underwent ultrasound guided core needle biopsy . Image from pathology slides is shown below:

breast

Which of the following is the most appropriate recommendation for this patient?

A) Refer her for lumpectomy

B) Genetic testing for BRCA1/BRCA2

C) Reassurance and repeat in 6 months

D) Counsel regarding increased risk of subsequent breast cancer in this condition

E) Start Tamoxifen

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