Skill Checkup: A 64-Year-Old Woman With a Breast Mass and Back and Hip Pain

Maurie Markman, MD


September 08, 2021

The Skills Checkup series provides a quick, case-style interactive quiz highlighting key guidelines- and evidence-based information to inform clinical practice.


A 64-year-old woman presents for her well-woman examination. She has no children. She is obese and has type 2 diabetes that is well-controlled. She does not smoke. She reports that she generally feels well but has some back pain and occasional hip pain that have become increasingly bothersome.

On clinical workup, she has a laboratory analysis that evaluated complete blood count and complete metabolic profile. All of her laboratory values are normal, except for an alkaline phosphatase that was elevated, at 560 U/L (upper limit of normal in that laboratory, 140 U/L). Because of the elevated alkaline phosphatase level and bone pain, she is referred for mammography, which reveals an irregular-appearing mass in the left breast with suspicious axillary nodes.


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