Patient Education for a 16-Year-Old with Multiple Breast Masses
Reassure this patient that breast masses in adolescents are almost always benign, with fibroadenomas being the most common diagnosis, and that breast cancer is exceedingly rare in her age group. 1
Understanding the Findings
Multiple breast masses in teenagers are typically benign. The most common diagnosis is fibroadenoma, which is a benign solid tumor that frequently occurs in adolescents and young women. 1
Breast cancer is extremely rare at age 16. Malignancy is uncommon even in women under 30 years old, and exceptionally rare in adolescents. 1
The mobile nature of the masses is reassuring. Mobile nodules are characteristic of benign lesions like fibroadenomas rather than malignant tumors. 1
Next Steps in Management
Based on ACR guidelines for women under 30 with breast masses, ultrasound is the appropriate imaging modality, and the next step depends entirely on the ultrasound findings. 2, 3
If Ultrasound Shows Probably Benign Findings (BI-RADS 3):
Short-interval ultrasound follow-up every 6 months is the standard approach to monitor for stability over 1-2 years. 2
No biopsy is needed unless the masses grow or change character during follow-up. 2
Mammography is not appropriate for this age group due to breast density and extremely low cancer risk. 2, 3, 4
If Ultrasound Shows Suspicious Features (BI-RADS 4-5):
Image-guided core biopsy would be performed to obtain a definitive tissue diagnosis. 2
Diagnostic mammography or tomosynthesis may be added to complete the evaluation before biopsy. 2
If Ultrasound is Negative or Benign (BI-RADS 1-2):
Clinical observation for 1-2 months is appropriate for discrete masses that don't feel suspicious on examination. 1
No additional imaging is recommended if the clinical exam correlates with benign ultrasound findings. 2
Important Points to Emphasize
Avoid self-examination that involves repeated compression or manipulation of the breast masses, as this can cause unnecessary anxiety and is not recommended for adolescents. 2
Report any changes immediately: New spontaneous nipple discharge, rapid growth of masses, skin changes, or development of new masses should prompt immediate re-evaluation. 2
Follow-up is essential: Even with benign findings, scheduled follow-up appointments must be kept to ensure masses remain stable. 2
Common Pitfall to Avoid
The presence of a palpable mass with negative imaging does not automatically mean cancer can be excluded. If there is discordance between clinical findings and imaging results, further evaluation with biopsy may still be warranted based on clinical suspicion. 2, 5 However, at age 16 with mobile masses and no high-risk features, this scenario is unlikely.
Prognosis and Reassurance
Most fibroadenomas in adolescents either remain stable or regress over time. Some may be observed indefinitely without intervention. 1
Surgical excision is only necessary if masses grow significantly, cause symptoms, or if there is diagnostic uncertainty. 1
The patient can continue normal activities without restriction while awaiting ultrasound results and during observation periods. 1