In the adolescent, the aberrations associated with cyclical variations of mammary gland have little clinical expression. Indeed, in the early pubertal period, cyclical mastalgia is exceptional. But the probability of observing cyclical hormonal mastalgia increases over time from the first menstruation.
Cyclical mastalgia must be defined by strict clinical criteria: appearance before menstruation for more than 4 days, disappearance some days after menstruation, and bilaterality.
Breast cancer constitutes only about 1% of childhood cancers and <0.1% of all breast cancers occurring in this age group. Three clinical presentations have been identified: (1) primary malignancy of the breast: carcinoma (juvenile secretory carcinoma), sarcoma or lymphomas; (2) metastatic disease: rhabdomyosarcoma or leukemia, non-Hodgkin’s lymphoma, and (3) secondary malignancy: post-radiation therapy (mantle irradiation).
Mammography is not helpful in the diagnosis of breast cancer. It is less sensitive in detecting malignancies in younger patients than in older ones. An accurate strategy is essential to discover the rare malignancy. Physical examination is essential before performing surgical biopsy (a) if the eccentric subareolar mass is not centralized beneath the areola in a child before puberty, and (b) since in adolescents with malignancy (current or former), metastatic lesions are more common than primary lesions.
Breast diseases in adolescence show specific characteristics linked to the developmental process and physiology of the mammary gland. The distinction between an aberration (divergence of normal development) and disease, as proposed by the ANDI classification, applies to adolescence particularly well.
Moreover, the absence of malignant pathology at this age makes it possible to reassure women early at the first consultation. Diagnoses are most often only clinical. Complementary investigations are sometimes necessary and ultrasound is best. Mammography is not informative at this age.
Revision date: July 8, 2011
Last revised: by Janet A. Staessen, MD, PhD