Incidence and Risk Factors
Benign fibroadenomas are the most common breast tumors seen in children aged 18 years or younger.[
Fibroadenomas have been associated with Beckwith-Wiedemann, Maffucci, and Cowden syndromes.[
Other benign breast masses include tubular adenomas, benign phyllodes tumors, and benign fibroepithelial neoplasms.[
Clinical Presentation
Fibroadenoma usually presents as an asymptomatic mass that can vary in size with a woman's menstrual cycle. They can cause localized pain or breast asymmetry. They can also be associated with skin ulceration and venous engorgement.[
Giant juvenile fibroadenomas have been variably defined as any rapidly enlarging encapsulated fibroadenoma with a diameter greater than 5 cm, a weight more than 500 g, or displacement of at least four-fifths of the breast.[
In one retrospective series of 80 girls aged 12 to 18 years with fibroadenomas, 10% of patients had bilateral disease, and 2.5% of patients had unilateral disease but more than one nodule (multicentric fibroadenoma).[
Diagnosis
Fibroadenomas are benign biphasic tumors with epithelial and stromal components that have variable mitotic activity.[
Fine needle aspiration is not considered to be adequate for diagnosis. Indications for core needle biopsy or excision of a suspected fibroadenoma in children and adolescents are not based on evidence. The indications include tumor size at presentation of 2 cm to 5 cm (or larger), tumor enlargement during 2 to 12 months of observation, and multiple breast masses or bilateral breast masses.[
One single-institution retrospective review conducted between 1999 and 2018 aimed to characterize the breast masses of 70 females aged 19 years or younger with fibroadenomas who underwent excision of masses between 2 cm and 16 cm. Histological evaluation found that 87% of the breast masses were benign, 10% of the masses were benign phyllodes tumors that were aggressive in nature (n = 7), one mass was a malignant phyllodes tumor, and one mass was a metastatic sarcoma.[
Pathological examination of the core needle biopsy specimen may underestimate or overestimate the aggressiveness of lesions when compared with what is found on excision in about 13% of patients.[
Another single-institution retrospective analysis performed genomic profiling on 44 fibroadenomas and 36 giant fibroadenomas.[
Treatment of Fibroadenoma and Phyllodes Tumors
Treatment options for fibroadenoma include the following:
Observation
Evidence (observation):
There is no evidence that childhood or adolescent fibroadenomas have carcinomatous potential.
Surgery
Indications for resection include tumor size at presentation of 2 cm to 5 cm (or larger); tumor enlargement during 2 to 12 months of observation; multiple breast masses or bilateral breast masses; and patient, parental, or provider anxiety.[
Evidence (surgery):
Surgical complications have included breast hypoplasia, acute pain, and chronic pain.[
While recurrence is rare, careful follow-up monitoring is important. Recurrent tumors can be resected successfully using conservative techniques.[
Treatment options for phyllodes tumors include the following:
Surgery (wide local excision without mastectomy)
Phyllodes tumors can be very large and challenging to treat surgically in women with smaller breasts. Complete excision of the phyllodes tumor with grossly negative margins and a small amount of normal tissue circumferentially is necessary. Radical mastectomy or modified radical mastectomy should be avoided. Lymph node evaluation is not necessary.[
Phyllodes tumors present a small risk of recurrence, as they fall into the intermediate-grade sarcoma category. These tumors do not metastasize, but they can recur locally.
References:
Cancer in children and adolescents is rare, although the overall incidence has slowly increased since 1975.[
For specific information about supportive care for children and adolescents with cancer, see the summaries on
The American Academy of Pediatrics has outlined guidelines for pediatric cancer centers and their role in the treatment of children and adolescents with cancer.[
Dramatic improvements in survival have been achieved for children and adolescents with cancer. Between 1975 and 2020, childhood cancer mortality decreased by more than 50%.[
Childhood cancer is a rare disease, with about 15,000 cases diagnosed annually in the United States in individuals younger than 20 years.[
The designation of a rare tumor is not uniform among pediatric and adult groups. In adults, rare cancers are defined as those with an annual incidence of fewer than six cases per 100,000 people. They account for up to 24% of all cancers diagnosed in the European Union and about 20% of all cancers diagnosed in the United States.[
Most cancers in subgroup XI are either melanomas or thyroid cancers, with other cancer types accounting for only 2% of the cancers diagnosed in children aged 0 to 14 years and 9.3% of the cancers diagnosed in adolescents aged 15 to 19 years.
These rare cancers are extremely challenging to study because of the relatively few patients with any individual diagnosis, the predominance of rare cancers in the adolescent population, and the small number of clinical trials for adolescents with rare cancers.
Information about these tumors may also be found in sources relevant to adults with cancer, such as
References:
Incidence, Histological Types, and Prognosis
Breast cancer has been reported in both males and females younger than 21 years.[
A review of the Surveillance, Epidemiology, and End Results (SEER) Program database of the National Cancer Institute shows that 75 cases of malignant breast tumors in females aged 19 years or younger were identified from 1973 to 2004.[
A National Cancer Database report described 181 cases of breast malignancies in patients aged 21 years and younger.[
A subsequent report from the SEER database (1973–2009) discovered 91 girls aged 10 to 20 years with breast cancer.[
While rare, breast cancer in males has also been described. In a review of the National Cancer Database, 677 male adolescent and young adult (AYA) patients were diagnosed with breast cancer between 1998 and 2010.[
Breast tumors may also occur as metastatic deposits from leukemia, rhabdomyosarcoma, other sarcomas, or lymphoma (particularly in patients who are infected with HIV).
Risk Factors
Risk factors for breast cancer in AYA people include the following:
Mammography with adjunctive breast magnetic resonance imaging (MRI) starts at age 25 years or 8 years after exposure to radiation therapy (whichever came last). For more information about secondary breast cancers, see
Genetic Factors
Homologous recombination deficiency (HRD) is a prevalent phenotype of breast cancer in AYA patients (aged 15–39 years). HRD influences the efficacy of PARP inhibitor–based therapy and platinum agent–based therapy.[
An analysis of 46 Japanese AYA patients with breast cancer and two existing breast cancer cohorts of U.S. and European patients identified an HRD-high phenotype that was associated with germline BRCA1 and BRCA2 pathogenic variants, somatic TP53 variants, triple-negative subtype, and higher tumor grade.[
Treatment of Breast Cancer in Adolescents and Young Adults (AYA)
Breast cancer is the most frequently diagnosed cancer among AYA women aged 15 to 39 years, accounting for about 14% of all AYA cancer diagnoses.[
In a review of data from the National Cancer Database, AYA patients (aged 15–39 years) had a higher incidence of triple-negative breast cancer (TNBC) or HER2-positive (HER2+) cancer than did adult patients (TNBC: 21.2% vs. 13.8%, respectively; HER2+: 26.0% vs. 18.6%, respectively; both P < .001). In addition, patients aged 15 to 29 years had more advanced disease and TNBC or HER2+ disease than did patients aged 30 to 39 years.[
Treatment of AYA patients is similar to that of older women. However, unique aspects of management include attention to genetic implications (i.e., familial breast cancer syndromes) and fertility.[
For more information, see
Treatment Options Under Clinical Evaluation for Childhood and AYA Breast Cancer
Information about National Cancer Institute (NCI)–supported clinical trials can be found on the
The following is an example of a national and/or institutional clinical trial that is currently being conducted:
References:
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
This summary was comprehensively reviewed.
This summary is written and maintained by the
Purpose of This Summary
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of childhood breast tumors. It is intended as a resource to inform and assist clinicians in the care of their patients. It does not provide formal guidelines or recommendations for making health care decisions.
Reviewers and Updates
This summary is reviewed regularly and updated as necessary by the
Board members review recently published articles each month to determine whether an article should:
Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.
The lead reviewers for Childhood Breast Tumors Treatment are:
Any comments or questions about the summary content should be submitted to Cancer.gov through the NCI website's
Levels of Evidence
Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Pediatric Treatment Editorial Board uses a
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The preferred citation for this PDQ summary is:
PDQ® Pediatric Treatment Editorial Board. PDQ Childhood Breast Tumors Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at:
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Last Revised: 2024-09-11
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