Fibroadenoma

Although most breast cancers occur in women over the age of 40 (with incidence markedly increasing after the age of 50), younger women tend to develop the most aggressive forms of breast cancer, accounting for the lower survival rates. Therefore all unexplained breast lumps in women aged 30 years and over must be investigated on a cancer pathway via the breast clinic . Mammography is the first-line imaging choice in the older woman (over 40 years); however, the increased breast density in younger patients makes ultrasound investigation more sensitive. Most malignant breast lumps are painless, so this is not a reliable indicator of serious pathology; neither is the size of the lump. In this age group however the most likely cause of a breast lump is a benign fibroadenoma.

Nice referral guidelines can be found here.

This patient has a single breast lump that has only been examined. Because she is over 30 years of age and has an unexplained breast lump, she should be referred for a triple assessment (examination, imaging, biopsy if required) on a cancer pathway as per NICE guidelines. The next stage of triple assessment is imaging. In most cases, the primary mode of imaging is mammography, i.e. an X-ray of the breast. Women under the age of 35 years have breast tissue that is more dense, so mammography is not as reliable. It is for this reason that in women under 35 years an ultrasound scan is the first-line imaging technique.