The Development of New, Primary, Noninvasive Carcinoma of the Breast 29 Years after Bilateral Radical Mastectomy

Abstract

: We present the case of a patient with a new, primary noninvasive breast carcinoma arising in residual breast tissue 29 years after radical mastectomy. The patient, a 75-year-old black woman with no family history of breast or ovarian cancer, had undergone left radical mastectomy in 1956 (age 35) and right radical mastectomy in 1965 (age 44). Examination revealed a 3-mm nodule in the right anterior axillary line. On excision, the lesion was a 1.5-mm intracystic papillary ductal carcinoma in situ arising in a background of atypical ductal hyperplasia (representing residual breast tissue). The patient has not agreed to testing for BRCA1 or BRCA2 mutations. The theoretical risk of new primary breast cancers arising in residual breast tissue has been suggested as a reason why prophylactic mastectomy may not be completely effective. This case suggests that even after what appeared to be aggressive radical mastectomy, enough breast tissue remained so that the patient was at risk for recurrent breast cancer.