A 60-year-old Black woman presents to her gynecologist reporting that she found a lump in her left breast during self-exam 1 month ago. She has not been for a screening mammogram in 2 years because she has been the primary caregiver for her older parents who passed away 3 months apart in the past year. She has also taken on extra evening shift work because her husband unexpectedly lost his job, and they are not yet financially ready to retire.

Physical exam reveals breast asymmetry, with architectural distortion of the left breast, and a firm, well-circumscribed, solid mass in the left upper outer quadrant on palpation. The patient appears tired. She has no family history of breast cancer and is otherwise healthy; she has mild hypertension, which is pharmacologically controlled. Blood pressure is unremarkable at 120/80 mm Hg; resting heart rate is 72 beats/min. Breath, heart, and bowel sounds are normal on auscultation. There is no evidence of lymphadenopathy in the cervical, axial, or mediastinal lymph nodes. The liver and spleen are normal on palpation. Laboratory testing is performed: complete blood count with differential and comprehensive metabolic panel, including liver function tests and alkaline phosphatase, are all within normal ranges and reveal nothing remarkable.