Deirdre Mary Boyle MBBCh, FFRRCSI, Abstract Co-Author: Nothing to Disclose

John Kavanagh MBBCh, MRCPI, Abstract Co-Author: Nothing to Disclose

Lorraine Quinn, Abstract Co-Author: Nothing to Disclose

Susannah Harte FFRRCSI, Abstract Co-Author: Nothing to Disclose

Ronan A. McDermott, Abstract Co-Author: Nothing to Disclose

Oisin Jude Flanagan MBBCh, MRCPI, Presenter: Nothing to Disclose

Sylvia Alison O'Keeffe MBBCh, Abstract Co-Author: Nothing to Disclose

The incidence of breast cancer among women under 35 years in Ireland is 0.006%. Clinical breast examination (CBE) is an essential part of the assessment of all breast lumps. Young women present a unique challenge as increased breast density reduces the sensitivity of mammography for the detection of cancer and routine mammography is not performed in all women in this age group presenting with breast symptoms. This has lead to greater reliance on CBE to correctly identifiy those with a suspicious lump. The aim of this study was to review the presentation of breast cancer in women 35 years or younger.

All patients 35 years or younger diagnosed with breast cancer between January 2006 and December 2011 were identifed from electronic patient records. E (clinical examination) score, R score (BI-RADs equivalent) along with mammographic density, tumour size and final histology were recorded. The performance of CBE was assessed by calculating sensitivity and specificity.

5848 women aged 35 years or younger presented to the symptomatic breast unit between January 2006 and December 2011. 50 were diagnosed with breast cancer. The incidence of breast cancer was 0.8%. The sensitivity and specificity of CBE was 37% and 99.4% respectively. 46% of patients with breast cancer were classified as E3, probably benign. 71% of patients had dense breasts. The average tumour size was 20mm.

Young women with breast cancer represent a unique group. The majority have dense breast tissue. It is well established that increased breast density reduces the sensitivity of mammography leading to greater reliance on CBE. This study proves that CBE has a low sensitivity for the detection of cancer and highlights the crucial role of ultrasound and biopsy for accurate detection of cancer in young women.

Detection of breast cancer in young women is challenging because of low sensitivity of mammography and CBE resulting in greater reliance on the accuracy of ultrasound and biopsy in this age group.

Boyle, D, Kavanagh, J, Quinn, L, Harte, S, McDermott, R, Flanagan, O, O'Keeffe, S, The Clinical and Radiological Presentation of Breast Cancer in Women Aged 35 Years or Younger.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12025696.html