Eleven-year-old Miriam came to my office for a routine physical examination. The exam proved to be normal but I could tell she had some concern that she needed to mention.
Being a shy, ordinarily awkward pre-teen it took a series of carefully prescribed questions to finally arrive at the matter of concern.
It seems that Miriam had been suffering from pain caused by a lump in her right breast for some three weeks. The area was tender to even the slightest pressure. More important the child was acutely aware of her family history--breast cancer. Could this be the beginning of cancer for her?
A more extensive exam of the chest showed a unilateral lump under the nipple. This is a common finding in the pre-adolescent female. It is not indicative of cancer. But it can be so sensitive to pressure that a blouse touching the nipple can be painful. In some cases a lump may be noted under both nipples.
This occurs because the breast tissue is very sensitive to the small amount of hormones produced by the young lady. As the hormone level rises further, at puberty, the other secondary sexual characteristics will appear. The breast lump may appear years before puberty. This condition is called premature thelarche and should provoke no concern.
If the lump were not under the nipple but off to one side, one must consider other diagnoses. And without question a physician must examine the patient. If both breasts have a lump and other signs of sexual development are present in a girl under eight and one-half years of age, the possibility of a hormone-secreting tumor could exist. In this situation an immediate examination by a physician is mandatory.
In Miriam’s particular case it became certain that cancer was ruled out and premature thelarche was the diagnosis. The child was saved from the discomfort of unnecessary lab tests or the potentially disfiguring results of a breast biopsy. The breast bud can be damaged by a surgical biopsy to such a degree that it will never develop. The long-term psychological implications of this catastrophe can be easily imagined. Miriam left the office relieved of her anxiety and assured that adolescence was just down the road.