The importance of the non-palpable lesion in women under 50, detected by mammography on self-referral for screening, symptoms or follow up

Between 1.1.88 and 31.12.91, 349 consecutive patients had an x-ray localization excision of a non-palpable breast lesion less than 10 mm in diameter detected by 2-view mammography performed as a result of self-referral for screening (133), breast symptoms (164), or follow-up for breast disease (52). All lesions greater than 11 mm were excluded. 250 had benign and 99 (28%) had malignant lesions. 37 of 99 (37%) patients with malignancy were aged 49 or under. 133 patients requested screening, 33 (25%) had carcinoma of whom 11(33%) were aged 49 or less. 164 patients presented with breast symptoms; 47 (29%) had cancer and 15 (32%) of these were aged 49 or less. 52 patients requested follow up for breast diseases including previous cancers, 19 (37%) had carcinoma of which 11 were 49 years or less (58%). 223 had microcalcifications, of which 68 (31%) were positive for cancer, and 126 had no microcalcification, of which 31 (25%) patients had cancer. The specific spiculate radiological lesion yielded 16 carcinomas in 31 cases (52%). Microcalcification was seen in 110 patients under 49 with 27 (25%) carcinomas detected. Microcalcification was a significant diagnostic criterion in the patients aged 49 or less, accounting for 27/37 (73%) patients. Dutal carcinoma in situ accounted for 18/37 (49%) in patients aged 49 or less, and 19/62 (31%) in patients over 50 years. Mammography should not be withheld from patients who are seeking screening, have symptoms, or who wish to be followed up, irrespective of age.