Imaging the young breast

Abstract

Imaging the breast in young women is challenging for many reasons: This age group is not included in any screening programme, but mainly presents with symptoms, e.g. a lump. Although in most cases, a benign aetiology can be determined, the possibility of breast cancer should not be dismissed. Whereas a high percentage of young women presenting in a breast centre have a first-degree family history of breast cancer – likely to reflect both patient and referring doctor selection, Foxcroft et al. (2004) studied a population of women younger than 40 years with breast cancer, in which only 13.4% of patients had an affected first-degree relative, compared with 18.7% of women with breast cancer >40 years in the control group (the higher incidence in the control group can be explained by the fact that the younger women’s first-degree relatives may not yet have developed breast cancer). Therefore, the level of diagnostic suspicion should not be influenced by the absence of a family history in symptomatic younger women 1. Mammography is considered relatively insensitive and unspecific in young women for multiple reasons: most breasts in this age group are dense or even extremely dense (i.e. breast parenchyma density type III or IV according to the American College of Radiology – ACR – criteria 2), and thus the parenchyma might obscure an underlying mass (Fig. 1). Whereas in the screening population the false-negative rate of mammography was shown in the literature to be 8–10%, this figure is likely to be higher in young patients. Breast parenchyma that is inherently dense will compromise the ability to