Dr Ra­jen Ram­paul

Breast and On­coplas­tic Sur­geon

Pink Hi­bis­cus Breast Cen­tre

Breast health and aware­ness are not of­ten dis­cussed in re­la­tion to ado­les­cence or the teenage years. Yet, this stage—typ­i­cal­ly be­tween ages 10 or 11 and 17 or 18—is when girls ex­pe­ri­ence some of the most sig­nif­i­cant phys­i­cal and emo­tion­al changes of their lives.

Among this group, the most com­mon con­cerns re­late to breast de­vel­op­ment. Some girls may no­tice asym­me­try, where one breast is larg­er or small­er than the oth­er, or macro­mas­tia, where the breasts are par­tic­u­lar­ly large and cum­ber­some. Both sit­u­a­tions can lead to feel­ings of self-con­scious­ness and af­fect body im­age and self-es­teem.

At the oth­er end of the spec­trum, younger girls in ear­ly pu­ber­ty may be­come anx­ious af­ter feel­ing what they be­lieve to be a lump in the breast. In most cas­es, this is sim­ply the de­vel­op­ing breast bud—a nor­mal part of growth. What’s need­ed then is re­as­sur­ance and guid­ance, help­ing both the par­ents and the child un­der­stand that these changes are hor­mon­al and nat­ur­al and will usu­al­ly bal­ance out over time.

An­oth­er com­mon con­cern among girls in this age group is breast pain. This dis­com­fort can be par­tic­u­lar­ly un­set­tling, es­pe­cial­ly since it is not al­ways recog­nised as be­ing re­lat­ed to men­stru­al cy­cles. For­tu­nate­ly, breast pain in ado­les­cents is usu­al­ly be­nign and sim­ply a nor­mal part of pu­ber­ty, of­ten re­quir­ing no in­ter­ven­tion or treat­ment. Re­as­sur­ance for both the teenag­er and her par­ents is typ­i­cal­ly all that is need­ed. Once again, re­as­sur­ance to both par­ent and teenag­er is all that is re­quired.

Fi­broade­no­mas

or breast cysts

Oth­er con­di­tions that may present as lumps in­clude fi­broade­no­mas or breast cysts. True lumps in this age group are usu­al­ly one of these two types. In cer­tain cas­es, a biop­sy may be need­ed to con­firm the tis­sue type be­yond what an ul­tra­sound can show. Even then, both fi­broade­no­mas and cysts are gen­er­al­ly be­nign and can of­ten be man­aged con­ser­v­a­tive­ly with­out im­me­di­ate in­ter­ven­tion.

Par­ents with a fam­i­ly his­to­ry of breast can­cer of­ten seek as­sess­ment and con­sul­ta­tion for their young chil­dren. This is es­pe­cial­ly com­mon among moth­ers who have been di­ag­nosed with breast can­cer, who may ask, “Is my daugh­ter at risk, or when should I be­gin screen­ing my daugh­ters?” Un­der­stand­ably, this con­cern is deeply sig­nif­i­cant for both the par­ents and the chil­dren.

Each case needs to be in­di­vid­u­alised, with a clear path­way for us to as­sess and de­ter­mine the risk lev­el for each child. Nonethe­less, it is very un­usu­al for the risk in the moth­er to trans­late in­to a lev­el that re­quires in­ter­ven­tion in a young teenag­er. How­ev­er, it is nev­er too ear­ly to be­gin un­der­stand­ing breast de­vel­op­ment and learn­ing how to self-ex­am­ine.

Gy­nae­co­mas­tia in boys and young men

Sur­pris­ing­ly, I have had no rec­ol­lec­tion of any par­ent wor­ry­ing about breast can­cer de­vel­op­ment in their boys. How­ev­er, breast can­cer can de­vel­op in men, though it is very rare. What is far more com­mon in young and teenage boys is a con­di­tion called gy­nae­co­mas­tia. Gy­nae­co­mas­tia is a con­di­tion where young men or boys can de­vel­op breast tis­sue. This can oc­cur on one side or both and may be ei­ther the fat­ty type or the lump type.

This is a be­nign con­di­tion and will not de­vel­op in­to breast can­cer; how­ev­er, it can have a pro­found psy­cho­log­i­cal im­pact on the young male. It can af­fect him in many ways—for ex­am­ple, when he is un­dressed at the beach, dur­ing sport­ing ac­tiv­i­ties, or wear­ing T-shirts, es­pe­cial­ly in our cli­mate.

Such sit­u­a­tions can be dis­tress­ing, and it can be em­bar­rass­ing for him to even seek med­ical at­ten­tion or dis­cuss it with his par­ents. Con­se­quent­ly, he may lim­it or avoid phys­i­cal ac­tiv­i­ty. The cause of this con­di­tion is al­most ex­clu­sive­ly due to hor­mon­al changes dur­ing pu­bes­cence, and ad­vice and re­as­sur­ance are all that is need­ed, as most cas­es re­solve spon­ta­neous­ly. In ex­cep­tion­al cir­cum­stances, surgery may be re­quired to ad­dress the prob­lem.

Di­et and lifestyle

We can­not have a dis­cus­sion about ado­les­cents and young adults with­out ad­dress­ing how di­et and lifestyle can im­pact them. We have been very clear that this is not the age group where there is a risk of de­vel­op­ing breast can­cer. How­ev­er, there are as­pects of their young lives that can present a risk lat­er in life.

Obe­si­ty is a well-doc­u­ment­ed risk fac­tor for breast can­cer in adults, but there is emerg­ing da­ta show­ing that obe­si­ty in ado­les­cents can al­so neg­a­tive­ly im­pact their risk of de­vel­op­ing breast can­cer in lat­er years.

Obe­si­ty car­ries high lev­els of oe­stro­gen and IGF-1, both of which are fac­tors that can be car­cino­genic at high lev­els and there­fore may in­flu­ence the de­vel­op­ment of breast can­cer in the post­menopausal era. Sim­i­lar­ly, a 2017 study shows that a lack of ex­er­cise in ado­les­cence can neg­a­tive­ly af­fect the ma­ture adult, rais­ing the risk of breast can­cer in lat­er years.

In teenagers, the risk of de­vel­op­ing breast can­cer is un­usu­al, but ir­re­spec­tive of their con­cerns or whether they have a prob­lem, they should see a doc­tor or a spe­cial­ist breast unit for as­sess­ment and re­as­sur­ance. Lifestyle fac­tors such as obe­si­ty and phys­i­cal ac­tiv­i­ty can af­fect the de­vel­op­ment of breast can­cer in lat­er years, and there­fore more ac­tion needs to be in­cor­po­rat­ed in­to the in­for­ma­tion they are ex­posed to and en­cour­aged to fol­low in schools and at home.

Gen­der iden­ti­ty is­sues

An emerg­ing con­cern in many coun­tries is gen­der iden­ti­ty is­sues in young fe­males. It is well doc­u­ment­ed that this is an emerg­ing con­di­tion where young fe­males may be­gin to iden­ti­fy as male, and they may per­ceive their breast de­vel­op­ment as a neg­a­tive as­pect of their body im­age.

As clin­i­cians, we are en­cour­aged to em­brace this and guide both par­ents and pa­tients to­ward psy­cho­log­i­cal sup­port and coun­selling to help them un­der­stand their chang­ing and de­vel­op­ing bod­ies and how these changes align with their per­cep­tion of their own gen­der iden­ti­ty. This is a par­tic­u­lar­ly com­plex area and is left to spe­cial­ists to pro­vide ap­pro­pri­ate sup­port to young girls and their par­ents.

Our teenage pop­u­la­tion is our fu­ture. We have an im­por­tant role in shap­ing their over­all per­cep­tion of health and well-be­ing, and these are cru­cial years to cul­ti­vate this aware­ness.