skip to main content

Suspicious breast mass — MCCQE Part 1 MCQ

Instant feedback + full explanation. One question, done properly.

HardBreast LumpSuspicious breast massMCCQE Part 1

A 48-year-old woman has a 2.5 cm hard, irregular breast mass that is fixed to the overlying skin. She is afebrile, is not pregnant or lactating, and has no erythema or fluctuance. A screening mammogram 18 months ago was normal. Which diagnostic plan is most appropriate now?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Arrange diagnostic mammography with targeted ultrasound, then image-guided core biopsy of a suspicious correlate

This is a clinically suspicious symptomatic mass despite a previously normal screening study. Screening mammography is intended for people without breast symptoms and cannot replace diagnostic evaluation. The appropriate pathway is diagnostic mammography with targeted ultrasound, followed by image-guided core biopsy when the imaging or clinical correlate is suspicious; this integrates clinical assessment, imaging and tissue diagnosis. A recent normal screen does not exclude an interval cancer. Mastitis is unlikely without lactation, erythema, warmth or systemic illness, so an antibiotic-only trial would delay diagnosis. Fine-needle aspiration alone may not provide architecture or receptor information and cannot reliably close a discordant triple assessment. Definitive cancer surgery should not be undertaken before diagnostic imaging and tissue confirmation.

Reference: Ontario Health (Cancer Care Ontario), Guideline 1-25: https://www.cancercareontario.ca/en/file/81846/download?token=y6-fbl_N