detection and diagnosis of breast cancer

As the sensitivity for mammography is lower at younger ages, ultrasound examination is recommended as the first-line imaging test for symptomatic women younger than 35 years and for women who are pregnant or lactating; however, both imaging modalities may be used as part of the triple test to provide complementary information.42


Most breast cancers in younger women are diagnosed as a result of the investigation of a lump or other breast symptom;35 these symptoms are most often self- or partner-detected.36,37 While some younger women may delay in presenting with breast symptoms, evidence suggests that physician delay in referral for assessment is a key factor in delaying diagnosis.34,38,39 A systematic review of five studies about delayed presentation of symptomatic breast cancer
reported an association between younger age and physician delay in referral in four studies involving a total of 5,146 women.40 This may be attributable to the belief that a woman is ‘too young to have breast cancer’, as incidence in this population is low and breast changes in young women are common. It is recommended that the triple test approach is used in investigating breast symptoms. The components of the triple test are clinical breast examination and
medical history; breast imaging (mammography, ultrasound, or both); and nonexcision biopsy (fine needle aspiration biopsy, core biopsy, or both).41 While the correct sequencing of tests is important to the overall interpretation of the results, not all breast symptoms will require investigation using all three tests.

Most breast symptoms are physiological and are adequately assessed by thorough clinical breast examination with or without imaging.

If there is any suspicion of cancer on clinical examination or ultrasound, a mammogram should be performed and, in many instances, ultrasound and mammography are both used to provide complementary information. Any clinical or imaging abnormality should be further investigated with percutaneous biopsy tests.