Rule out malignant involvement. Reviewed observation with re-examination through full menstrual cycle vs. ultrasound with possible biopsy. Symptomatic treatments reviewed including caffeine reduction and hormonal stabilization with OCPs. Tripartite nature of breast cancer reviewed. Encouraged annual screening mammography and reviewed its diagnostic limitations.
Patient chooses ultrasound now.
Radiology appointment scheduled. She understands need for close follow up and states she'll keep appointments. Recheck in one week. Dictated in patient's presence. Consent and refusal are choices.