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January 3, 1996

A 47-Year-Old Woman With Ductal Carcinoma In Situ

JAMA. 1996;275(1):61-66. doi:10.1001/jama.1996.03530250065029

Dr Daley:  Mrs Y is a 47-year-old teacher. Married and the mother of two children, she lives in suburban Boston, Mass. She is covered by private health insurance through her husband's employer.The patient has been healthy, with no prior surgeries or hospitalizations other than childbirth. She has had no medical problems except for a left breast biopsy many years ago. She takes no medications. She is gravida 2, para 2, abortus 0, with regular menstrual periods. Her family history is significant for her mother, who was diagnosed with breast cancer at 61 years of age and died 4 years after her initial diagnosis with widespread metastases. Given her family history, Mrs Y has been conscientious about breast self-examination and undergoing screening mammography regularly.In June 1995, the patient had a screening mammogram that showed microcalcifications in the left breast. There was no palpable mass. After review, the mammographer recommended