What further evaluation is available for the younger symptomatic woman, less than 35 years old

High resolution ultrasound
Ultrasound is commonly used as the first line radiological investigation in the evaluation of the young woman’s breasts, especially if there is a lump. This is because the young breast normally has a high proportion of glandular tissue within, rendering it less suitable for mammography. In addition, one of the commonest lumps in the young woman is just the benign (harmless) fibroadenoma. Cancer is not common, especially if the patient is younger than 30 years. 

Ultrasound is relatively inexpensive, uses sound waves, is relatively safe, relatively “painless” and is excellent for differentiating between a solid and a fluid filled lump. However, it depends on the skill of the operator, your breast type and quality of the ultrasound machine. It is best used in focused evaluation of the breast symptom or sign and is very helpful in the young “dense” breast. However, it does not replace mammography as a screening tool for breast cancer if you have no signs and symptoms in your breast. 

In the younger woman, lumpy breasts are common, and sometimes, it is difficult for yourself or even your doctor to be sure, there is no true “lump” underlying the normal uneven lumpy texture of the breasts. Again, high-resolution ultrasound with a high frequency transducer (probe used in contact with your breast) is helpful to confirm the absence or presence of a true lump.  

Diagnostic Mammogram
Should the radiologist suspect the “lesion” in your breast could be cancer after the ultrasound examination, they normally recommend that you proceed to have a mammogram examination. This is the diagnostic mammogram as opposed to the screening mammogram. A screening mammogram is when a mammogram is done in the absence of any breast signs and symptoms in a patient. There is no true lower age limit to the diagnostic mammogram. 

What happens after the ultrasound or mammogram is found to be abnormal, is described in the article “ What happens if the Mammogram is abnormal?” Sometimes, depending on various factors, even if the lump is likely to be benign, your breast surgeon suggests it should be removed or it should be tested using needle biopsy techniques.  After that, there will be a period of follow up. 

Remember every person’s condition and factors influencing decisions are different. Having good communication with your doctor is essential.
 

Less than 35 years old: What if I have no breast symptoms, do I need any screening test other than SBE?

Generally, there is no need to go for screening mammograms or even screening ultrasounds if you are younger than 35 years and have no symptoms. Please see Myths and Barriers to Mammography – Why you may think you do not need a mammogram? 

Determine your risk profile: You need to find out if you are in the high-risk group
Ultrasound is not accurate enough to screen for breast cancer currently. The mammogram is only considered if you are in the high-risk group. Common factors placing you in the high-risk group includes previous breast cancer in one breast and immediate family history of young breast cancer. This means, if your sister or mother had breast cancer less than 40 years old, and especially under 35 years old, you may need to start screening for breast cancer earlier than 40 years old. Whenever in doubt, please consult your doctor to determine your risk profile. You can also read about this in Risk Factors for Breast Cancer in the Breast Health Info Centre.
 

35-39 years old: What about us if we have breast symptoms?

Basically, all that have been described in the sections for “ Less than 35 years old…” applies to this age group as well. The only difference is that, you may be assessed with a mammogram first. The ultrasound would almost always follow especially if the breasts are dense. In this case, the ultrasound is used to complement or as an adjunct to the mammogram. The ultrasound would be used to further evaluate any finding in the mammogram as well even if you happen to have a high proportion of fat compared to glandular tissue in your breasts. 
 

Take home points for the younger woman

• SBE should be performed monthly, after your menses/period is over
   
• If you do not find anything wrong with your breasts and do not belong to the high-risk group for breast cancer, regular SBE is adequate. An ultrasound or mammogram is not necessary.
   
• If you are 30-39 years old, in addition to SBE, a clinical breast examination by your regular doctor/healthcare provider is recommended at least once every 3 years. If you visit your doctor/family-planning clinic anyway for a Pap Smear, this is an opportunity for your breasts to be examined.
   
• At any time, if you find something “wrong” with your breasts, see your doctor/healthcare provider immediately.
   
• Do not worry, as very often (80-90% of the time), most of the findings in the breasts are not cancer.
   

Consult your
doctor if you suspect if there is something wrong

Lumpy breasts are common and may be your natural breast texture. Most lumps
are harmless, or benign.

In younger women, the breasts tend to have more glandular tissue (dense) and may benefit from ultrasound, especially if the breasts are very lumpy in texture.