I am 31 and just had my annual checkup. My doctor, who is not an OB-GYN, found some areas in both breasts that seemed to concern him. He didn't recommend a mammogram, but just said I should watch for changes in texture. I am really concerned. The spots are painful and seem to dip inward. Should I have a second opinion, or just do as my doctor says? How old should a woman be before she starts having mammograms? About a year ago he found a spot and sent me for an ultrasound, which didn't even reveal a lump, although one could be felt. This is the same area he seemed concerned about now. Please advise.

Katherine

Because of the density of younger women's breasts, a mammogram much before age 40 is more likely to miss a small, subtle abnormality. That does not mean a mammogram should never be done in a younger woman with a palpable abnormality, it just means the interpretation has to be taken with a grain of salt. For general screening purposes, mammograms are not started until age 40.

Any area that feels different, and not obviously cystic (fluid-filled, which is usually benign) warrants additional investigation. Sometimes, that just means coming back for another exam in a month, after a period, when your breasts are generally less lumpy. Maybe you will be asked to avoid caffeine until after you are reexamined. If an abnormal area persists, it should be examined further, with mammogram, ultrasound or referral to a surgeon for possible biopsy. Areas that "dip" do concern me, and I would suggest you seek a second opinion, ideally from a breast surgeon. A breast surgeon is NOT the same as a plastic surgeon -- it is a general surgeon with special expertise in breast disease; if one is not available in your area, see a general surgeon.