Mammographic sensitivity in women under 50 years presenting symptomatically with breast cancer

The sensitivity of mammography with respect to age in women with symptomatic palpable invasive breast cancers has been assessed. The mammogram reports of 257 women less than 50 years old were compared with those of 143 women between 50 and 70 years old. The reports were classified as malignant, indeterminate, or normal/benign. Mammography demonstrated a lesion classified as suspicious of malignancy in 83 % of women over-50 compared to 65 % of those under 50 (p = < 0.001). There was a steady increase in the number of suspicious lesions seen on mammography with increasing age of the patient, ranging from 57% in women under 40 years to 87% in women aged 60–70 years. In 348 cases (87%) the mammograms were available for review and the parenchymal patterns were graded according to Wolfeʹs classification. There was a significant increase in the DY/P2 patterns with decreasing age of the woman (p = < 0.001). The sensitivity of mammography for the diagnosis of malignancy was decreased in women with DY/P2 patterns when compared to those with P1/N1 patterns (93% vs 66%; P = < 0.001). This study confirms that mammography is less sensitive in detecting breast cancers in women less than 50 years old. The increased density of the breast parenchyma in younger women appears to be an important factor. It is likely to be a major reason for the reduced efficacy of mammographic breast cancer screening programmes in women under 50 years of age.