The young breast cancer patient: A tertiary institution’s experience

Background: Breast cancer (BC) in sub-Saharan Africa affects not only older females but also those aged ≤ 40 years. At Chris Hani Baragwanath Academic Hospital (CHBAH), females with suspicious breast lesions undergo combined mammography and ultrasound with integrated Breast Imaging Reporting and Data System (BI-RADS) assessment to guide biopsy. The diagnostic performance of this approach in younger females remains clinically relevant because of increased breast density. Aim: To assess the concordance between bimodal BI-RADS classification and histopathological diagnosis in females aged ≤ 40 years with biopsy-confirmed BC. Setting: Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa, using data from the South African Breast Cancer and HIV Outcomes (SABCHO) cohort. Methods: A retrospective review of females aged ≤ 40 years diagnosed with invasive BC over seven years was performed. Clinical and demographic characteristics were described, and concordance between bimodal BI-RADS classification and histopathological diagnosis was assessed. Results: Of 354 patients identified, 309 met the inclusion criteria. The mean age was 35.2 ± 3.9 years, and invasive ductal carcinoma was the predominant subtype (93.5%). Concordance between bimodal BI-RADS classification and histopathological diagnosis was 97.7%. BI-RADS 5 was the most common imaging category, while discordant cases were confined to stage I, stage II and stage III disease. Most patients presented with locally advanced disease. Conclusion: Bimodal BI-RADS assessment showed high concordance with histopathological diagnosis in females aged ≤ 40 years with biopsy-confirmed BC, supporting the use of combined mammography and ultrasound for evaluating suspicious breast lesions in this setting. Contribution: This study adds evidence on the concordance of bimodal BI-RADS assessment with histopathological diagnosis in young females with BC in sub-Saharan Africa.