Background. Breast masses in young women are common, but carcinoma is rare. This study was under taken to determine how often a complaint of mass was found to represent a dominant mass and to define the role of breast imaging and fine-needle aspiration cytology (FNA) in the evaluation of clinically nonworrisome masses. Methods. A retrospective review was made of 605 patients younger than 40 years of age with a breast mass between February 1994 and February 1996. Results. Dominant masses were confirmed by surgeon examination in 36% of 484 self-detected masses compared with 29% of physician-detected masses (difference not significant). With pathologic confirmation, 29% of self-detected masses had a dominant mass compared with 19% of physician-detected masses (P = .02). Carcinoma was present in 5% of both groups and not predicted by family history. Imaging studies were not useful in patients with normal examinations but were more likely to identify dominant masses in patients with an examination described as benign (P <. 001). FNA did not identify any cancers in normal or benign examinations. Conclusions. Self-examination is as reliable as a general physician examination in detecting breast masses. When an examination by an experienced surgeon is normal, imaging studies and FNA are low yield. When the examination is equivocal, directed ultrasonography is a useful adjunct.
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