If a 35-year-old patient identifies a small discrete mass in one breast, what is the best initial evaluation step?

The most appropriate initial evaluation step when a patient identifies a small discrete mass in one breast is to ask whether the mass changes at the time of menses. This question is crucial as it can provide valuable information regarding the nature of the mass. Many breast masses are influenced by hormonal changes related to the menstrual cycle, which can help distinguish between benign conditions such as fibrocystic changes and more concerning issues.

Understanding the timing of the mass in relation to the menstrual cycle helps to assess whether the mass is more likely to be hormonal in nature. This initial inquiry aligns with the recommended approach of gathering the patient's history and understanding the context of the finding before proceeding to more invasive evaluations or referrals. It can guide the subsequent steps in management, ensuring a more informed approach to diagnosis.

In contrast, immediately performing an ultrasound, scheduling a biopsy, or referring to a specialist may be premature without first understanding the characteristics and history of the mass. This history-taking is essential in determining the need for further imaging or intervention.