Palpable mass / abnormal mammogram
Diagnose: Core biopsy (dx + ER/PR/HER2 status)
Then: Surgery ± sentinel node → adjuvant therapy
ER+ → tamoxifen (premenopausal) / aromatase inhibitor (postmenopausal). HER2+ → trastuzumab. Chemo/RT per stage. High-risk HR+/HER2−: add adjuvant CDK4/6 inhibitor — abemaciclib ×2 yr (monarchE) or ribociclib ×3 yr (NATALEE); extended endocrine therapy to 10 yr for high-risk ER+; gBRCA high-risk HER2− → adjuvant olaparib (OlympiA)
Order set
- Triple assessment (exam, imaging, core biopsy)
- Receptor status (ER/PR/HER2)
- Staging if indicated
Criteria
AdmitComplication (e.g., cord compression) or surgery
DischargeMDT plan, receptor status, surgical/oncology follow-up
Key
- Palpable mass with normal mammogram → still biopsy.
Clinical detail — differentials, red flags, pitfalls, disposition
Red flags
- Fixed mass
- Skin/nodal involvement
- Inflammatory changes
Differentials
- Fibroadenoma
- Cyst
- Fat necrosis
- Abscess
Common mistakes
- Reassuring on normal mammogram with palpable mass
- Skipping receptor status
Disposition & follow-up
MDT; surgery + adjuvant by receptor/stage.
Discharge package
MedicationsEndocrine therapy/HER2 therapy per receptors
Follow-upOncology MDT; surveillance
Warning symptomsNew lump, bone pain, breathlessness
💊 Treatment detail — doses & preparation
TamoxifenSERM
Dose20 mg OD ×5–10 yr (ER+ breast cancer, pre-menopausal)
Preparation10/20 mg tablets
MonitorVTE risk, endometrial cancer (bleeding → review), hot flushes
Anastrozolearomatase inhibitor
Dose1 mg OD ×5 yr (post-menopausal ER+ breast cancer)
Preparation1 mg tablets
MonitorBone density (osteoporosis), arthralgia; lipid profile
Trastuzumabanti-HER2
Dose8 mg/kg IV load then 6 mg/kg q3 wk (HER2+ breast)
PreparationReconstitute + dilute in 250 mL NS; observe first infusion
MonitorECHO/MUGA q3 mo (cardiotoxicity) — hold if EF falls
📖 NCCN / ASCO Breast CancerReviewed July 2026