Adolescent breast imaging

This article explores the evolving approach to managing breast symptoms in adolescents, emphasising the need for age-appropriate care distinct from adult breast cancer pathways. Historically, young patients were often referred to adult two-week wait clinics, leading to unnecessary anxiety and procedures. Recognising the rarity of malignancy in this age group, Barts Health NHS Trust established a multidisciplinary paediatric breast clinic to provide tailored assessment and management.

Ultrasound is the imaging modality of choice due to its safety and effectiveness, while mammography is avoided. Most adolescent breast lumps are benign, with fibroadenomas being the most common. These are typically managed conservatively unless they are large or deforming, in which case surgical excision may be considered. Core biopsies are generally discouraged to avoid damaging developing breast tissue.

The article also addresses gynaecomastia in adolescent males, usually a benign and self-limiting condition, and highlights the extreme rarity of primary breast cancer in this population. When malignancy does occur, metastases are more common than primary tumours. The article concludes with a management algorithm promoting reassurance, observation and selective surgical intervention, underscoring the importance of safeguarding and psychological support in adolescent care.

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