Guide for managing breast lumps
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* John G. Moffat

In response to the “Guidelines for the management of breast lumps” produced by surgeons in the Department of Surgery of the University of Toronto, and published in the December 1998 issue of the Journal (pages 476 and 477), I believe that generally guidelines are a good thing. In the case of breast lumps they can lead to more cost-effective management of patients with this condition.1

It is commendable in terms of cost containment and from the medicolegal standpoint that this stellar group of surgeons has recommended which cyst fluid should be sent for cytologic examination and which cyst fluid should be given the “sink test.”

The place where I find the guide ambiguous is in the “upper left hand corner” — the 45-year-old woman who presents because she thinks she has a breast lump, but no lump is detected on physical examination. Such a patient should be considered to have a breast lump until proven otherwise — and diagnostic mammography is essential. In addition, such a patient should be seen in follow-up on one occasion 4 to 6 months later.

## Reference

1.  Clinical practice guidelines for the care and treatment of breast cancer. CMAJ 1998;158 (Suppl 3).