Fibrocystic Changes of the Breast (American College of Physicians PIER)
All women with breast complaints should be evaluated carefully with a focused history and physical exam to determine the causes of breast pain, nipple discharge, and nodularity. The physical exam is directed at detecting any signs associated with a neoplasm and ruling out other causes of mastalgia. Use mammography to confirm the diagnosis and screen for neoplasm.

All patients with indeterminate lesions should be referred to a surgeon for evaluation. Note that indeterminate or suspicious findings, palpable solid masses, recurrent breast cysts, and bloody fluid or nipple discharge may require surgical or needle biopsy.

In follow-up, consider breast cancer in all patients with breast complaints even if there has been previous diagnosis of fibrocystic change.
• Examine women periodically with fibrocystic changes.
• Reexamine patients with palpable cystic masses that resolves after aspiration for recurrence.
• Screen all women over 40 for breast cancer.
• Screen women with a significant risk for breast cancer development at more frequent intervals than women with no associated risk factors.

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Screening for Breast Cancer (American College of Physicians PIER)
Recognize that breast cancer incidence and death rates increase most significantly with advancing age and that most cases of breast cancer occur in women aged 40 years and older with no known predisposition (average risk), which supports routine screening in this population.

The sensitivity of routine screening mammography ranges from 71% to 96% and varies by a number of patient, technical, and provider factors. Overall cancer detection rates for digital mammography are similar to those for traditional (film) mammography. Among high-risk women, the sensitivity of contrast-enhanced breast MRI is higher than that of standard mammography.

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