Breast cancer is overwhelmingly associated with adult women, but children and adolescents can be diagnosed with it. This includes individuals from infancy through their teenage years. However, it is an exceptionally rare occurrence, and these cancers are often biologically distinct from common adult forms. This article provides context, differentiating the statistically rare possibility of malignancy from the far more common benign changes that occur during development.
Understanding the Extreme Rarity
The incidence of breast cancer in the pediatric and adolescent population is remarkably low. It accounts for less than 1% of all cancers diagnosed in this age group, and less than 0.1% of all breast cancer diagnoses across all ages.
For perspective, the incidence rate for girls aged 15 to 19 is estimated to be around one case per one million teens. Therefore, a breast mass found in a minor is statistically far more likely to be a normal developmental change or a benign condition than a cancerous tumor.
Common Benign Breast Conditions in Youth
The vast majority of lumps or masses discovered in young people are entirely benign, related to normal growth and hormonal fluctuations. The onset of puberty, known as thelarche, is the initial stage of breast development. It often begins with a small, tender, firm lump beneath the nipple area, which is frequently mistaken for a problematic mass.
The most common solid mass found in adolescent girls is the fibroadenoma, accounting for over 90% of all solid breast lesions in this age group. These non-cancerous tumors result from an overgrowth of glandular and connective tissue, driven by hormonal changes. They are typically firm, smooth, and easily movable under the skin, often described as feeling like a marble.
Another common finding, particularly in teenagers, is the presence of cysts, which are fluid-filled sacs that can appear suddenly. These cysts often become larger and more tender just before the menstrual period begins due to fluctuating hormone levels. Less common benign conditions include juvenile hypertrophy and pseudoangiomatous stromal hyperplasia (PASH), an overgrowth of stromal tissue.
Malignant Tumors Affecting Pediatric Patients
While rare, the malignancies that occur in the pediatric breast differ substantially from the invasive ductal and lobular carcinomas typical of adults. Secretory carcinoma is the most common type of primary breast cancer found in children and adolescents. This specific subtype typically presents as a slow-growing, painless mass. It often has a more favorable prognosis compared to adult breast cancers, though it can still metastasize to lymph nodes.
Other rare malignancies that can arise are non-epithelial tumors, originating from supporting tissues rather than milk ducts or glands. These include sarcomas, such as rhabdomyosarcoma or angiosarcoma, which are highly aggressive but extremely uncommon.
Specific risk factors are associated with the development of these rare cancers in youth. A strong genetic predisposition, such as certain inherited syndromes, can increase risk. The most significant acquired risk factor is prior therapeutic radiation to the chest area, often received for treating other childhood cancers like Hodgkin lymphoma.
The Diagnostic Process for Minors
Parents and guardians should seek medical evaluation for changes that persist or feel distinctly different from typical hormonal lumps. A mass warrants evaluation if it is hard, fixed to the chest wall, rapidly growing, or accompanied by skin changes or bloody nipple discharge. The initial medical approach for a breast concern in a minor differs significantly from the standard adult screening process.
The primary imaging tool used to evaluate a breast lump is ultrasound, not mammography. Ultrasound uses sound waves, avoiding radiation exposure, and is highly effective because young breast tissue is typically dense. This density makes mammography less informative, making ultrasound better for distinguishing between solid masses and fluid-filled cysts.
If the ultrasound reveals a suspicious solid mass or if a presumed benign mass shows rapid growth, a biopsy is necessary for definitive diagnosis. A core needle biopsy, guided by ultrasound, is the standard procedure to remove a small tissue sample for analysis. This minimally invasive approach helps physicians avoid unnecessary surgical removal of benign lesions, which could affect future breast development.