The need for triple assessment and predictors for diagnosis of breast cancer in patients <40 years of age

• Published in: Clinical radiology Vol. 73; no. 8; pp. 758.e19 - 758.e25
• Main Authors: Mazari, F.A.K., Sharma, N., Reid, D., Horgan, K.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-08-2018
• ISSN: 0009-9260; 1365-229X
• DOI: 10.1016/j.crad.2018.03.014

To assess the safety of selective use of triple assessment with omission of radiological assessment proposed in patients <40-years old.
Data were collected retrospectively for all patients seen in the one-stop breast clinic between January 2014 and August 2015. Demographics, symptoms, diagnostics, and treatment details were recorded. Subgroup and logistic regression analysis was performed to identify predictors for breast cancer.
Of the 3,305 patients included, 95.6% (n=3,161) were first-time referrals. 57.6% (n=1,903) had a breast lump, and 4% (n=133) had a high-risk family history; 75.6% (n=2,499) underwent imaging and 16.7% (n=552) underwent a biopsy. The median age was 29 years (interquartile range [IQR]=25–34). Breast cancer was diagnosed in 29 cases (0.88%) and 3.2% (n=105) had surgery. Median referral-to-diagnosis time was 13 days (IQR=9–14) and referral-to-surgery time was 44 days (IQR=34–95). Patients with breast cancer were significantly older (33 versus 28 years, p=0.016). All patients were first-time referrals. Most patients had a breast lump with low suspicion on clinical examination and breast cancer identified on imaging. Time-to-diagnosis (12 versus 14 days, p=0.017) and time-to-surgery (37 versus 67 days, p=0.012) was significantly shorter in the breast cancer group. Comparative older age (odds ratio [OR]=1.08, 95% confidence interval [CI]: 1.01–1.15) and breast lump (OR=11.43,95% CI: 2.72–48.07) were the only significant predictors of cancer on uni/multivariate regression.
Triple assessment is also the best practice for all patients in the younger age group. This cohort should not be treated any differently regarding one-stop clinic infrastructure as the cancers detected were not clinically malignant. Missed cancers in this age group would have significant personal, clinical, and legal consequences.
•Incidence of breast cancer is very low in the under 40 age group.•Omission of radiological assessment from one-stop clinics can lead to missed cancers in this age group.•Breast lump at presentation is the most reliable predictor of cancer in this cohort.•Triple assessment is also the best practice for all patients in younger age group.