A 40 year-old female discovers a mass on mammography. What procedure is the next most appropriate step?

The most appropriate next step after discovering a mass on mammography is fine needle aspiration. This procedure is minimally invasive and is designed to obtain a sample of cells from the suspicious area for cytological analysis. It serves to determine whether the mass is benign or malignant, which is crucial for guiding further management. Early diagnosis through this method helps establish an effective treatment plan if needed.

In the context of managing breast masses, the decision to perform fine needle aspiration is often made after identifying a specific lesion via imaging, as it allows for quick results and can provide reassurance if the mass is benign. If the results indicate malignancy, additional diagnostic options, such as a biopsy or surgical intervention, may then be planned.

The other options are not suitable as the immediate next step in this context. Genetic testing for BRCA 1 and BRCA 2 would be appropriate in women with a strong family history of breast or ovarian cancer but is not a first step for evaluating a newly discovered mass. Serum CA-125 is primarily a tumor marker used in the context of ovarian cancer and is not applicable for breast masses. Radiation therapy is a treatment modality and is not a diagnostic step that follows the discovery of a breast mass.