Breast cancer in women under 35 years

Introduction

Breast cancer is rare in young women under 35 years; however, it can present a diagnostic challenge. This study was undertaken to determine the presentation of breast cancer in young women and the role of imaging including the predictive value in determining tumour size.

Methods

All breast cancer diagnoses in women aged ≤35 years from 2006 to 2014 were identified. Data were then extracted from PACS and EPR. Analysis was performed on Microsoft Excel. Paired t tests were used to assess the accuracy of imaging in predicting final pathological tumour size.

Results

Seventy patients with 74 presentations of carcinoma were included. Mean age 31 years (SD = 3.7). Of 73 examination scores (E): 7 % (5/73) were screen detected, 52 % (38/73) were E2−3 and 38 % (28/73) were suspected (E4−5). At ultrasound, 16 % (12/74) were U3 and 82 % (61/74) were suspected to be malignant (U4−5). Seventy-four per cent (51/69) had a mammogram score M4−M5. Seventy-five per cent (50/67) of patients were ACR density of 3−4. At MRI (42/70), tumour size correlated with final tumour size on pathology (N = 24, Pearson R 0.45). There was no significant difference between MR estimates of size and final tumour size (t = −0.88, p = 0.39). In contrast, there was a significant difference between US size estimates and final pathology (N = 43, t = −2.56, p <0.05).

Conclusion

Clinical examination has a low PPV in young women with ultrasound demonstrating a superior performance. However, 16 % of cancers were unsuspected at ultrasound. An important finding is the usefulness of MR in defining tumour size, suggesting it should be performed in all young patients.