Problem
As a primary care provider practicing in internal medicine, you have a new 87 year old female patient that is on your schedule. She is the mother of a patient that you have cared for past five years. She requested an appointed for her mother and was bringing her in today to see you for consultation regarding a breast mass. The daughter tells you that her mom mentioned the breast mass to her the other day, saying that it has been there for a long time, and maybe even a few years. There is no family history of breast cancer, but the daughter remains very concerned. She has not had a mammogram for over 10-15 years and informs you that she does not want one to evaluate the mass. She mentions that she is "too old" to get tests done and that her daughter was the one that recommended she come in to have it looked at. When you perform a clinical breast exam, you can locate the "marble sized" palpable mass that is described by the patient & daughter.
How do you approach this topic with the patient in terms of diagnostic testing, and what ethical principles are involved?