Please predict possible top 2 disease causes for this patient case, provide brief explanation, limit to <100 words.

The female patient was a Malay nullipara, a banker, with no known medical illness. She had menarche and menopause at the age of 12 and 55 years, respectively. She had no history of oral contraceptive pill usage or hormonal replacement therapy. There was no family history of breast or ovarian malignancy.

At 57 years old, she complained of a right breast lump. A mammogram was done at the National Cancer Society Center. She was informed that there were mammogram abnormalities in the right breast. However, she defaulted follow-up and sought alternative treatment instead.

Two years later, she presented to another hospital. The right breast lump had increased in size and she was found to have a contralateral breast lump. A mammogram with complementary breast and axillary ultrasound showed bilateral BI-RADS 5 lesions.

At 61 years old, the patient came to our hospital due to pain in the right breast lump. On clinical examination, there was a hard bosselated mass occupying the whole right breast measuring 12 cm × 13 m with a right axillary lymph node measuring 1.5 cm. On the contralateral breast, there was an upper inner quadrant mass measuring 4.5 cm × 6.8 cm with a left axillary lymph node measuring 1 cm.

A mammogram of the left breast showed a lobulated mass with clustered microcalcifications at the upper inner quadrant with associated architectural distortion. Core-needle biopsy was repeated for the left breast lump and reported to be a left invasive carcinoma, no special type, ER positive >95%, PR positive 30%, and HER2 negative 1+.

Based on the patient's history and clinical findings, I predict the top 2 disease causes for this patient case to be:

1. **Breast Cancer**: The patient's symptoms, mammogram abnormalities, and biopsy results (invasive carcinoma, ER positive, PR positive, and HER2 negative) strongly suggest breast cancer. The presence of bilateral breast lumps, axillary lymph node involvement, and architectural distortion on mammogram further support this diagnosis.
2. **Ductal Carcinoma In Situ (DCIS)**: Although the biopsy result only mentioned invasive carcinoma, the presence of clustered microcalcifications and architectural distortion on mammogram suggests the possibility of DCIS, a non-invasive form of breast cancer. DCIS can coexist with invasive carcinoma, and the patient's history of mammogram abnormalities and delayed follow-up increases the likelihood of DCIS.

Both diagnoses require further evaluation and management, including imaging studies, biopsy, and potentially surgery, chemotherapy, and hormone therapy.

Please predict possible top 2 disease causes for this patient case, provide brief explanation, limit to <100 words.

The female patient was a Malay nullipara, a banker, with no known medical illness. She had menarche and menopause at the age of 12 and 55 years, respectively. She had no history of oral contraceptive pill usage or hormonal replacement therapy. There was no family history of breast or ovarian malignancy.

At 57 years old, she complained of a right breast lump. A mammogram was done at the National Cancer Society Center. She was informed that there were mammogram abnormalities in the right breast. However, she defaulted follow-up and sought alternative treatment instead.

Two years later, she presented to another hospital. The right breast lump had increased in size and she was found to have a contralateral breast lump. A mammogram with complementary breast and axillary ultrasound showed bilateral BI-RADS 5 lesions.

Based on the patient's history and symptoms, I predict the top 2 disease causes as:

1. **Breast Cancer**: The patient's age, menopausal status, and presence of bilateral breast lumps with mammogram abnormalities (BI-RADS 5 lesions) strongly suggest breast cancer. The fact that the lump increased in size over 2 years and she has no family history of breast cancer suggests a possible sporadic case.
2. **Fibroadenoma**: Although less likely, fibroadenoma is a common benign breast tumor that can occur in postmenopausal women. The presence of bilateral lumps and mammogram abnormalities could be consistent with fibroadenoma, but the increasing size of the lump over time is less typical for this condition.

Note: BI-RADS 5 lesions have a high suspicion of malignancy, but a definitive diagnosis requires further evaluation, such as biopsy.

Please predict possible top 2 disease causes for this patient case, provide brief explanation, limit to <100 words.

The female patient was a Malay nullipara, a banker, with no known medical illness. She had menarche and menopause at the age of 12 and 55 years, respectively. She had no history of oral contraceptive pill usage or hormonal replacement therapy. There was no family history of breast or ovarian malignancy.

At 57 years old, she complained of a right breast lump. A mammogram was done at the National Cancer Society Center. She was informed that there were mammogram abnormalities in the right breast. However, she defaulted follow-up and sought alternative treatment instead.

Based on the patient's profile and symptoms, I predict the top 2 possible disease causes as:

1. **Breast Cancer**: The patient's age, menopausal status, and presence of a breast lump are risk factors for breast cancer. The mammogram abnormalities in the right breast further support this possibility.
2. **Fibroadenoma**: Although less likely, fibroadenoma is a common benign breast tumor that can occur in women of any age. The patient's lump and mammogram abnormalities could be indicative of a fibroadenoma, especially given her lack of family history of breast cancer.

Both possibilities require further evaluation and biopsy to confirm the diagnosis.