Breast imaging in women under 35 with symptomatic breast disease

With the increasing utilization of mammography, young women under the age of 35 are being referred for mammographic examination more frequently. A review of the mammograms of 159 consecutive patients aged under 35 was conducted to evaluate the clinical value of the examination in the age group for whom the probability of malignancy is low. 74% of patients referred had no discrete palpable mass and presented predominantly with lumpy or tender breasts, the remaining 24% had a discrete palpable mass. In neither group did radiographic examination beneficially influence clinical management. We propose protocol where no imaging is performed in women under 35 in the absence of a palpable mass unless there is a localized bloody discharge or a strong family history or previous personal history of breast cancer. In patients with a palpable mass, ultrasound should be performed initially to identify simple cysts and if negative only then progressing to mammography.