The teenager's breast lump: to cut or not to cut? - abstract

ABSTRACT

The presence of a breast lump, in any age group, raises the possibility of malignancy and, as a result, it has been suggested that all solid descrete lesions in the breast be excised. Since breast masses are quite common in teenage West Indian women and breast carcinoma in this group is very rare, we thouht it necessary to examine this policy to early excision in our population. Of 2,642 consecutive breast biopsies (1976-1982), 658 (24.5 percent) were in teenage girls. All lumps were benign in this age group. Fibroadenoma was the commonest lesion (77.6 percent). For fibroadenoma, clinical diagnostic accuracy was 92 percent; in the 8 percent that were misdiagnosed, the histological findings were always benign. Fourteen per cent of patients with fibroadenoma either had previous excision or returned with recurrences during the study period. An initial conservative policy in our teenagers with clinically benign breast masses will result in minimising the number of operations by (a) avoiding surgery in most patients with fibroadenosis; (b) performing a single operation in many patients with "recurrent or multiple fibroadenomas, and (c) avoiding surgery where spontaneous regression of fibroadenomas occurs. Minimising the number of breast operations has clear economic benefits while, in a population prone to hypertrophic scarring and keloids, there are cosmetic advantages. A conservative policy is not likely to increase the risk of missing malignancies because clinical diagnostic accuracy is high in this age group and we have not encountered teenagers with breast carcinoma. Among West Indian teenagers, routine observation of clinically benign breast disease needs to be considered as the management of choice (AU)