Breast Mass

The most common breast lesion in an adolescent female is a fibroadenoma. Usually located at the upper outer quadrant, fibroadenomas are nontender, smooth, freely mobile masses that usually are less than 3 cm in size. The overlying skin is unaffected, and there is no associated discharge from the nipple.

Other etiologies of breast masses include fibrocystic changes, cysts, abscesses, and rarely, malignancies. Without a family history of breast cancer in a first- or second-degree relative, primary breast cancer is extremely rare in adolescents. Fewer than 1/1,000 of adolescent breast masses are malignant. Metastatic lesions from rhabdomyosarcoma, neuroblastoma, and lymphoma can occur, but they are highly unlikely in the healthy adolescent who has no current or past history of cancer.

The choice of evaluation of a breast mass in an adolescent girl depends on its location, size, and consistency and the degree of anxiety it causes the adolescent and her family. For most lesions, such as the one described in the vignette, reassurance and re-evaluation at a later date are sufficient because fibroadenomas are the most common entity and almost always are benign. Fine-needle aspiration (FNA) or biopsy of the lesion may be performed in the adolescent who has an unusually large or otherwise atypical mass or who is highly anxious about its malignant potential. FNA can be preceded by ultrasonography to determine the size and to differentiate between cystic and solid masses.

Excisional biopsy rarely is indicated in adolescents, but if it is performed, the size of the lesion in relation to overall breast size should be considered prior to removal. Referral for surgical consultation is indicated at that time. Mammography never is indicated for evaluation of a breast mass in a teenager because the dense breast tissue in most adolescents makes the study very difficult to interpret.

References:
Neinstein LS. Breast disease in adolescents and young women. Pediatr Clin North Am. 1999;46:607-629
Neinstein LS. Breast disorders. In: Adolescent Health Care: A Practical Guide. 3rd ed. Baltimore, Md: Williams & Wilkins; 1996:840-849