Family History Of Breast Disease Research Articles

Response to different medical treatment options for mastalgia in fibrocystic breast disease

Background: Fibrocystic breast disease is the most common type of benign breast disease and mastalgia is the most common symptom of fibrocystic breast disease. Various types of medical management are given as a gold standard treatment for that. The aim of this study was to compare the effects of different commonly used medical management options of mastalgia of fibrocystic breast disease on the quality of life of patients and their side effects as well.
 Methods: This quasi-experimental study was carried out in Out-patients Department of General Surgery, BIRDEM General Hospital, Dhaka, from July 2018 to June 2019. Total 45 patients with fibrocystic breast disease were selected according to the eligibility criteria and were allocated to two groups by alternative random selection. In non-pharmacological treatments receiving group, lifestyle modification advices along with evening primrose oil were given. On the other hand, in pharmacological treatment receiving group, bromocriptine and danazole were given according to some selection criteria of the patients. Response of treatments to each group and side effects were determined at one month, three months and six months follow-up respectively. Mastalgia was measured by visual analogue scale (VAS) score and quality of life was calculated by modified WHO-QOL scoring in each follow-up.
 Results: Patients had an average age of 30.24±6.93 years with a majority in the age group 31-35 years (33.3%). Most patients were married (64.4%), housewives (62.20%), from middle-class groups (62.20%), multiparous (57.78%) and the majority had absence of the family history of breast diseases (84.45%). Majority of them presented with cyclical mastalgia (57.78%), bilateral mastalgia (60%) and mastalgia with lumpiness (44.4%). Among the patients who received non-pharmacological treatment, mastalgia improved in 34.78% cases and patients received pharmacological treatment, mastalgia improved in 72.73% cases. Different domains of quality of life were improved significantly in patients who received pharmacological treatment. Though majority of the patients had side effects due to pharmacological treatment, they were well tolerated.
 Conclusion: Despite having various side effects, pharmacological management by danazol or bromocriptine was well tolerated to our patients and a dramatic improvement was observed on quality of life than the nonpharmacologically treated patients.
 BIRDEM Med J 2022; 12(1): 22-29

163P Epidemiological profile of breast cancer in Morocco: First results from the Reference Center for Reproductive Health in Kenitra

Since the implementation of the Breast and Cervical Cancer Early Detection Program in late 2012 in the former region of Gharb-Chrarda-Béni Hssen, a marked improvement has been observed in terms of breast cancer screening and diagnosis. The aim of this study is to describe the epidemiological profile of breast cancer in this region in Morocco. This is a descriptive retrospective study of women screened for breast cancer in public and private health establishments in Kenitra, Sidi Kacem and Sidi Slimane, referred for investigation at the Reference Center for Reproductive Health in Kenitra (RCRHK) between January 1, 2013 and December 31, 2018. During the period 2013-2018, 973 new cases of breast cancer were diagnosed in women at the RCRHK, of which 62% were aged between 40 and 59 years. The average age at diagnosis of breast cancer was 51.15 ± 12 years. According to the results, 67% came from Kenitra and 65% lived in urban areas. Almost two-thirds (66%) of women were married. According to the data recorded, 55% benefited from the Medical Assistance Scheme (RAMED) and 22% had no social security coverage. The average age at first pregnancy was 24 ± 6.9 years, with an average of 4.32 pregnancies and 3.76 live births per woman. More than half (55%) of the women were postmenopausal and 54% used hormonal contraception. Nearly 7% of women had a personal history and 13% had a family history of breast disease. Invasive breast carcinoma was the most common histological type of breast cancer, with 88% of cases. According to the results, unilateral breast cancer was more frequent in the left breast than in the right. It should be noted that 67% of the lesions were classified as BI-RADS 5. The epidemiological surveillance of breast cancer will contribute to the revision, or consolidation of strategic axes of the National Breast Cancer Early Detection Program, in order to reduce morbidity and mortality due to cancer, and provide optimal care for cancer patients.

Early onset, multiple, bilateral fibroadenomas of the breast: a case report

BackgroundWhile fibroadenomas are common in the general population, affecting 10–20% of women, they are rarely early-onset, multiple, and bilateral.Case presentationAn 18-year-old woman presented with a 6 year history of multiple, bilateral breast masses without family history of breast disease. Magnetic resonance imaging (MRI, Fig. 1) of the breasts showed innumerable, bilateral breast masses ranging in size from 0.5 to 4 cm. Two needle biopsies showed fibroadenoma. Although the patient’s family history did not meet National Comprehensive Cancer Network (NCCN) guidelines for genetic testing, it was performed due to the rarity of her presentation. Genetic testing identified a pathogenic mutation in the phosphatase and tensin homolog (PTEN) gene.ConclusionsA germline mutation in PTEN is associated with an increased risk of breast cancer and often occurs as part of Cowden Syndrome. This case highlights the importance of genetic testing in patients with unusual presentations of early-onset, bilateral, and multiple (greater than four) fibroadenomas.

"Sein dans le sein": échographie et mammographie de l'hamartome

We report a 20-year-old patient, mother of 2 children and with no personal or family history of breast disease who consulted for a painless right breast mass evolving for 6 months. The mass was firm, painless and mobile at the right inferior-external quadrant. No inflammatory signs, nipple discharge or associated axillary adenopathy. Breast ultrasonography revealed a tissue formation of 4x2x4cm, parallel to the skin plane, well limited, heterogeneous hypoechoic with hyperechoic trabeculae, and containing tubulated structures with echogenic content, without attenuation or reinforcement of the echoes (A). In color Doppler, its vascularization was identical to that of the normal mammary gland. In view of this aspect, a complementary mammography was performed. It allowed the visualization in the right inferior-external quadrant of a well-limited, encapsulated oval mass of mixed fat and glandular density, thus producing the image of "breast within the breast" (B, C). This allowed the diagnosis of mammary hamartoma. The mammary hamartoma is a pseudotumor (benign) consisting of fibrous tissue, adipose tissue and glandular element. It is a rare mammary disorder occurring at any age from puberty. In its typical form as in our patient, mammography is the key examination and is sufficient to establish the diagnosis even without biopsy. Its treatment does not require an excision except in the case of aesthetic discomfort. It should be noted that its differential diagnosis includes other benign mammary tumors of adolescents and young adults such as adenofibroma, phyllode tumor, lipoma and papilloma.

Dietary Phytochemical Index and Benign Breast Diseases: A Case–Control Study

Background: Dietary phytochemical index (DPI) is an inexpensive method for estimating the amounts of phytochemicals in foods. No study has investigated the association of DPI and benign breast diseases (BBD). Our study aimed to compare DPI in patients with BBD and the control group.Subjects: This is a case–control study of 115 subjects with BBD and 116 healthy women attending the Iranian Center for Breast Cancer affiliated with Academic Center for Education, Culture and Research. Energy-adjusted DPI was calculated based on data collected from 168-item validated food frequency questionnaire. Sociodemographic data, physical activity, and anthropometric measures such as body weight, height, and waist circumference were determined.Results: After adjustment for age, estrogen therapy, family history of breast disease, intake of dietary supplement, menopause status, waist circumference and physical activity, the odds ratio (OR) of BBD across the energy-adjusted DPI quartiles decreased significantly (OR = 0.3, 95%CI = 0.12–0.93) (P‑trend = 0.02).Conclusion: We found that higher DPI score is related to lower BBD OR. This simple method may be used for the improvement of dietary intake to prevent BBD.

Psychosocial stress is associated with benign breast disease in young Chinese women: results from Project ELEFANT.

Psychosocial stress, including bereavement and work-related stress, is associated with the risk of breast cancer. However, it is unknown whether it may also be linked with increased risk of benign breast disease (BBD). Our study leveraged 61,907 women aged 17-55 years old from the Project ELEFANT study. BBD was diagnosed by clinician. Self-reported data on psychosocial stress over a 10-year period was retrospectively collected from questionnaires and categorised by cause (work, social and economic) and severity (none, low and high). Odd ratios (ORs) for the development of BBD were estimated using logistic regression. The model was adjusted for age, BMI, TSH levels, smoking, alcohol consumption, family history, age of menarche, oral contraceptive usage, education and occupation. Within our study, 8% (4,914) of participants were diagnosed with BBD. Work-related stress [OR 1.57, 95% confidence interval (CI) 1.46-1.69] and financial stress (OR 1.34, 95% CI 1.24-1.44) were significantly associated with BBD incidence, with a smaller but still significant association with social stress (OR 1.11, 95% CI 1.01-1.21). The associations remained significant after exclusion of participants with first- and second-degree family history of breast disease. The presence of multiple forms of stress did not synergistically increase risk. The neutrophil-lymphocyte ratio (NLR), a marker of systemic inflammation and prognostic marker for breast cancer, was not associated with BBD. Psychosocial stress, particularly work-related and financial stress, is associated with increased risk of benign breast disease among young Chinese women.

Tuberculosis of the Breast: An Initial Presentation of the Metabolic Syndrome with Type 2 Diabetes Mellitus in a Young Nigerian Woman.

Breast tuberculosis is an uncommon presentation of extra pulmonary tuberculosis. A 40-year-old obese woman presented with a right breast abscess which had failed to heal after surgical drainage. There was no family history of breast disease. Biopsy and histology of the lesion showed chronic granulomatous inflammation with positive stains for acid fast bacilli compatible with tuberculosis. Further evaluation confirmed metabolic syndrome with type 2 diabetes mellitus. She was placed on antituberculosis chemotherapy and appropriate therapy for diabetes mellitus with complete resolution of the lesion. We report this case because of its rarity and to highlight the association between tuberculosis an infectious disease and overnutrition in diabetes mellitus, a noncommunicable disease.

Predictors of knowledge level and awareness towards breast cancer among Turkish females.

Breast cancer (BC) is the most-common malignancy of women worldwide. Though there are differences among developed and developing countries, BC remains the most common cancer type of women in Turkey. This study aimed to identify the level of knowledge, awareness, and their potential predictors towards BC in Ankara, Turkey. The present descriptive study was conducted on 376 females attending a breast health outpatient clinic. A self-administered questionnaire was designed to evaluate knowledge level about BC and predictors effecting its level. Data analysis was performed using the chi-square test. A value of p<0.05 was considered statistically significant. Mean age of the participants was 46.2±9.93 (22-75). The majority (92.6 %) were married; 41.5% were educated less than nine years. Most of the women were housewives (82.7%) and, were living in an urban region (86.4%). Predictors of effecting responses to seven knowledge and awareness questions about BC varied from demographic features including older age groups, higher educational levels, being married, living in an urban area, being employee, smoking, having greater BMI to additional attributes associated breast health such as the increased number of births, applying for the purpose of control, positive family history of breast diseases, any diagnoses of breast diseases and performing BSE practice. It was determined that females in Turkey have better knowledge of BC than other developing countries even though it is not at the desired level. These findings revealed that females should be more informed about BC risk factors, prognosis and treatments by primary health-care providers to counteract the ascending burden of this disease.

Breast self-examination practices in Nigerian women attending a tertiary outpatient clinic.

The morbidity and mortality caused by breast cancer can be decreased by early detection with breast self-examination (BSE). The objective of this study was to determine the prevalence and the factors determining the practice of BSE. The study was conducted on 140 women aged above 18 years who presented consecutively in a General Outpatient's clinic in a tertiary hospital in Nigeria. This was the baseline study from an intervention study which looked at the effect of demonstration of BSE on improving Clinical Breast Examination (CBE) among two groups of respondents. Structured questionnaires were validated and administered by an interviewer and the data were analyzed using Statistical Package for Social Sciences (SPSS) version 12. The overall self-reported prevalence of BSE practice was 62.1% among the respondents. Older women (16, 76.2%), married women (63, 65.6%) and women with tertiary education (51, 68.9%) had the highest prevalence of BSE practice. Prevalence rate was highest for civil servant (25, 78.1%), P = 0.04. The practice of BSE was higher among women with a previous history of breast disease (15, 68.2%) and in respondents with a family history of breast disease (7, 63.6%), Only 11 (12.6%) performed BSE as per guidelines, which was once in a month. The prevalence of BSE was found to be high, especially in those with tertiary education and in those with a past personal or family history of breast disease. In resource-constrained countries, BSE is a screening tool that can be employed to help reduce the breast cancer burden because routine mammography screening is not yet feasible. Women need to be informed about the when and how to perform BSE.

Dietary habits contributing to breast cancer risk among Iranian women.

The aim of this study was to investigate demographic features, dietary habits, and some possible risk factors for being susceptible to breast cancer in Iranian women. A study of dietary habits and breast cancer was conducted among 53 Iranian women with histological confirmed disease and 40 matched controls. A dietary habits questionnaire was used to evaluate the pattern of selected food intakes. The risk of cancer was analyzed after adjustment for confounding factors. Age, weight, body mass index (BMI), waist circumference, educational status, parity, lactation, marital status, menopause, history of estrogen therapy, and family history of breast disease or cancer were assessed among participants. Special attention was given to the relationship between consumption of high fat meat, milk, yogurt and cheese as well use of frying oils for frying foods, use of olive/liquid oils for cooking, removing fat from meat and poultry, removing chicken skin and not use of mayonnaise as salad dressing and the risk of breast cancer. Moreover, salad, vegetable and fruit consumption, and eating outdoors owere investigated. Our results revealed significant lower education and higher BMI and waist circumference levels in patients with breast cancer. There was significantly increased breast cancer risk in overweight women in comparison with normal weight (OR=2.91, 95%CI 1.24 to 6.82). High intake of fat dairy products including milk and cheese was found to be a statistically significant factor for increasing breast cancer risk in models adjusting for age, BMI and education. Use of olive/liquid oils for cooking and avoidance of mayonnaise as salad dressing are related to lower risk of breast cancer. The frequency of vegetable and fruit consumption was significantly lower in patients with breast cancer compared to healthy women. Dietary habits might be risk factors for breast cancer among Iranian women. Adoption of a prudent diet could be an appropriate strategy for preventing breast cancer.

Predictors affecting breast self-examination practice among Turkish women.

Breast cancer (BC) is the most common cancer among females in Turkey. Predictors affecting the breast self-examination (BSE) performance vary in developing countries. To determine the frequency of BSE performance and predictors of self-reported BSEs among women in the capital city of Turkey. This cross-sectional study was conducted on 376 Turkish women using a self- administered questionnaire covering socio-demographic variables and BSE-related features. Of the participants, 78.7% (N=296) reported practicing BSE, whereas 9.5% (N=28) were implementing BSE regularly on a monthly basis, and only 5.7% (N=17) were performing BSE regularly within a week after each menstrual cycle. Multivariate logistic regression modeling revealed that BSE performance was more likely in younger age groups [20-39 years] (p=0.018, OR=3.215) and [40-49 years] (p=0.009, OR=3.162), women having a family history of breast disease (p=0.038, OR=2.028), and housewives (p=0.013, OR=0.353). Although it appears that the rates of BSE performers are high, the number of women conducting appropriate BSE on a regular time interval basis is lower than expected. Younger age groups, family history of breast diseases and not being employed were identified as significant predictors of practicing BSE appropriately. Older age and employment were risk factors for not performing BSE in this sample.

Breast cancer screening in a resource poor setting: A preliminary report

Background: Breast cancer is a leading cause of death among Nigerian women. Patients typically present late with advanced and aggressive diseases from a younger age. Cure for breast cancer is only possible when the disease is discovered early and breast cancer screening greatly increases the chances of early detection. We present the results of a breast cancer screening program at the Taimako Breast and Cervical Cancer Screening Centre, Lafia, Nigeria. Methodology: This is a prospective study of subjects who presented to our breast cancer screening centre between May 2009 and April 2010. A community mobilization and awareness campaign was mounted 3 months before screening began. A structured questionnaire was administered on each subject to elicit demographic data and risk factors. Each had a clinical breast examination. Those 35 years and above had a mammography while those below 35 years had breast ultrasound scan. Where a lump was discovered, it was subjected to tissue biopsy and histology. Results: Two thousand and ninety five subjects were seen over the one year period. Mean age was 34 + 12 years. Mean age at menarche was at 14.3 + 1.7 years, mean parity was 3.6 +2.6. Two thousand and thirty six subjects (97.2%) had some knowledge about breast cancer, 1,269 (60.5%) had no formal education, 881(42.1%) were petty traders while 501(23.9%) were full time housewives. Four hundred and seventy (22.4%) had a positive family history of breast disease, 437 (20.9%) had history of use of oral contraceptives, and 9 (0.4%) had a previous breast biopsy. Four hundred and sixty one (22.0%) complained of breast discomfort, 184 (8.8%) complained of breast lumps, but only 95 (4.6%) of them had lump on clinical breast examination, while a further 8 (0.4%) lumps were found on breast imaging. One thousand nine hundred (90.7%) had normal breast screening results, 166 (7.9%) had benign breast diseases and 29 (1.4%) had breast cancer. Conclusion: Knowledge about breast cancer was high because of prior campaigns and should be encouraged. Proportion of subjects with breast cancer is low even though many complained of breast lumps on presentation. Majority of the lumps were found at clinical breast examination while mammogram had a very low yield. A treatment arm needs to be incorporated into the screening program to demonstrate survival benefit.

Tumorous PASH Presenting as Rapid Unilateral Breast Enlargement

36-year-old woman presented with a 3-month history of progressive, rapid enlargement of the right breast. She had no family history of breast diseases and had not been taking any medications. On examination, the right breast was dramatically enlarged when compared with the left (Figure 1). We obtained a bilateral diagnostic mammogram, ultrasonography, core biopsies (Figure 2 ,A ), and magnetic resonance imaging (Figure 2 ,B ) of the right breast. Pathologic examination revealed pseudoangiomatous stromal hyperplasia (PASH), with no evidence of malignancy. The patient underwent a bilateral mastectomy with immediate breast reconstruction, and the tumor resected from the right breast measured 11.0 8.5 6.0 cm and weighed 666.0 g. The final pathologic findings were consistentwithtumorousPASH. 1 Thisisamong thelargestPASHtumorsreportedinthemedical literature. The patient had an excellent clinical and cosmetic outcome. An incidental finding of microscopic PASH

Breast Screening in North India: A Cost-Effective Cancer Prevention Strategy

Breast cancer is a leading cause of morbidity and mortality in women worldwide. Breast screening in normal and/or asymptomatic women is essential to reduce the burden of breast malignancies. Our study aimed to identify possible risk- and/or co-factors associated with breast screening in North Indian women. A public health research survey was conducted among 100 women of North Indian ethnicity during clinic visits in a 6-month timeline (April-October 2012). Demographic and clinical data, including mammography screening, were recorded in the questionnaire-based proforma after conducting a 10 minute interview. Written informed consent was taken from all the participants. The mean age of the participants was 32.2±9.9 years. Out of 100 women, 6% had family history of breast disease. Breast-related complaints/malignancy, including galactorrhoea, mastitis, axillary lump, fibrocystic disease, fibroadenosis and adenocarcinoma were observed in 41% participants; age stratification revealed that 82.9% of this group (n=41) were <30 years, while 9.7% and 7.3% were >30 years and 30 years of age, respectively. 32% participants underwent mammography screening and 8% had breast ultrasound imaging. Age stratification in the mammography screening group demonstrated that 24 women were <40 years, while 7 women were >40 years. Our pilot study identified possible co-factors affecting breast screening in North Indian women. These findings may be beneficial in early detection of breast abnormalities, including malignancies in women susceptible to breast cancer, and thus aid in future design of cost-effective screening strategies to reduce the increasing burden of breast carcinoma in women worldwide.

Diabetic mastopathy: A clinical and radiological challenge

A 41-year-old woman presented with a lump above the right areola. She also complained of a burning and heavy sensation of the right breast of recent onset. On further history, the patient was an insulin-dependent diabetic of 35 years’ duration. She had no family history of breast disease. On examination, a palpable thickening above the right areola was detected.&#x0D; &#x0D; Bilateral mammography revealed dense fibro-glandular tissue, denser in the right retro-areolar region than the left, with right peri-areolar skin thickening. There was no discreet mass nor suspicious microcalcifications or axillary adenopathy. Ultrasound (US) demonstrated an ill-defined peri-areolar region of decreased echogenicity and posterior shadowing. Core biopsy under US guidance showed abundant thick collagen bands containing epitheloid fibroblasts and a stroma with small capillary-sized and larger muscularised blood vessls, some of which contained peri-vascular lymphocytic inflammatory cells. Small ductal elements and an occasional lobule showed a peri-ductal and a peri- and intra-lobular lymhocytic and plasma cell infiltrate. These features were in keeping with sclerosing lymphocytic mastitis, known also as diabetic mastopathy.

Characterization of Two Constitutively Active Prolactin Receptor Variants in a Cohort of 95 Women with Multiple Breast Fibroadenomas

The role of prolactin (PRL) and its receptor (hPRLR) in promoting breast tumors is debated. We recently identified a gain-of-function hPRLR variant (I146L) in four women with multiple breast fibroadenomas (MFA) and no control subject. The specific aims were to describe this cohort of women presenting with MFA to identify and functionally characterize germline variants of hPRL/hPRLR genes and compare phenotypes of all patients. Ninety-five patients prospectively underwent clinical examination, breast ultrasonography, magnetic resonance imaging, and hormonal evaluation of gonadal and lactotrope functions. We analyzed hPRL/hPRLR coding sequences and made comparisons with a control population of 194 women. Functional characterization of hPRLR variants was performed. Pathology and immunochemistry were systematically carried out after surgical removal of tumors. One third of patients had a family history of breast disease. No hormonal imbalance was observed, except 30.7% of explosive stimulated PRL. Prolactin receptor variants were identified in exon 5 (I76V: 10 patients, eight controls) and exon 10 (one patient, no control). Both I146L and I76V variants exhibited constitutive activity. Pathology showed common fibroadenomas and identified six benign phyllodes tumors. Estrogen and progesterone receptors were detected in 85 and 98% of samples, respectively. Ki-67 median staining was less than 5%. No phenotypic difference was observed between carriers and noncarriers of either hPRLR variant. We present the largest population with MFA ever described, 15% of which had a hPRLR exhibiting basal activity in vitro. This questions the involvement of the hPRLR in MFA etiology and the potential relevance of therapeutic inhibition of PRLR signaling in patients.

The Pattern of Breast Diseases at Kenyatta National Hospital

Objective: To determine the pattern of breast diseases. Design: Retrospective descriptive study. Setting: Kenyatta National Hospital (KNH), a University Teaching and National Referral Hospital. Patients: One thousand one hundred and seventy two patients records were reviewed. Results: An average 469 new patients per year or 11 new patients per clinic visit were reviewed over a two and a half year period. Females predominated (98.9%). The mean age of the patients was 34.71 years (range 1 to 96 years). The average age at menarche was 14.49 years and the mean duration of symptoms was 6.86 months. Only 2.6% of 843 patients had a positive family history of breast disease. Fibroadenoma was the commonest diagnosis made (33.2%) followed by ductal carcinoma (19.7%). Gynaecomastia was the most common lesion seen in males. Two thirds of patients presenting with lumps had masses measuring more than 5cm. Overall, five conditions (fibroadenoma, ductal carcinoma, breast abscesses, fibrocystic disease and mastalgia) accounted for over 85% of all breast ailments. Surgery formed the mainstay of care in over 80% of patients. Conclusions: The pattern of breast diseases at KNH closely mirrors those reported in literature. This study indicates that a large proportion of patients presenting with breast diseases are treated initially by surgery. It may be wise to consider other alternative forms of therapy where appropriate.

The prevalence of benign breast disease in women with polycystic ovary syndrome: a review of a 12-year follow-up

A cross-sectional study of benign breast disease (BBD) was conducted to determine the actual prevalence and follow-up importance of BBD among women with polycystic ovary syndrome (PCOS) in conjunction with an ongoing prospective cohort study. The present study involved a subset of the original group of 244 women with a diagnosis of PCOS and 244 control women matched by age and race. A total of 240 women (116 cases and 124 controls) were included in the present analysis. The majority of women in each group were Caucasians (93 and 96%, respectively). The median age was 46 years in the cases and 47 years in the controls. Screening mammography begins at the age of 40 and has been carried out in 69% of cases and 66% of controls since the study began. Family history of breast disease was observed in 27 cases of both the groups (p > 0.05). Neither fibrocystic breast disease, lump thickening, calcification, fibroadenoma, pain, redness, discharge nor hyperplasia showed a significantly higher prevalence rate in cases than in controls. Eleven (9%) women with PCOS and 21 (17%) controls underwent diagnostic or curative surgery (relative risk: 0.56). These results, in contrast to the previously published literature, do not allow us to conclude that there is a higher risk for BBD among women with PCOS, and the proportion of women with a positive family history of breast cancer was significantly greater in women with PCOS compared with controls. Our observation is that having PCOS does not appear to affect surgeons' decisions to remove BBD.

Painful axillary mass in a middle-aged woman

CLINICAL PRESENTATION: (Dr. J. McNeil) A 57-yearold African-American woman was seen in the surgery clinic because of a painful left axillary mass that had been present for 6 weeks. During that time, the mass had markedly increased in size and had developed a foul-smelling purulent drainage. A mammogram performed 4 years earlier had been interpreted as normal, and no family history of breast disease existed. The patient’s medical history included hypertension and 10-packyears of tobacco abuse. She denied previous surgery. A review of systems was significant for a 30-pound weight loss over 5 months associated with intermittent fevers, chills, and night sweats. In addition, the patient described chronic fatigue and generalized myalgias. On physical examination, the patient was alert, oriented, and afebrile with stable vital signs. Her examination was significant for a 10 3 12-cm fungating mass located in the lateral aspect of her left breast with extension into the axilla (Fig. 1). The right breast and the remainder of her examination were unremarkable. Laboratory evaluation revealed a white blood cell count of 30,300, a hematocrit of 31.3 and a platelet count of 965,000. The serum chemistries included sodium 127, potassium 3.1, chloride 87, bicarbonate 23, and a calcium increased to 14.2. All renal and liver function tests were within the normal range. The patient was hospitalized for further management, including pain control, intravenous antibiotics, and treatment of the hypercalcemia. A computed tomography (CT) scan of the chest was obtained (Fig. 2). The left breast mass measured 12 3 12 cm and showed evidence of marked necrosis. Involvement of the underlying musculature as well as adjacent axillary lymphadenopathy appeared to exist. Two cystic areas suggestive of either necrotic lymph nodes or fluid collections were also visualized. Thoracic and abdominal CT imaging studies showed no evidence of distant metastases. Likewise, a bone scan and spine films were negative for definitive bony metastases. The patient underwent ultrasound-guided drainage of 500 ml of serosanguinous fluid, and a core biopsy specimen was obtained. Pathologic examination confirmed a grade 3 invasive ductal carcinoma. The tumor was estrogen receptor negative, progesterone receptor negative, borderline positive for c-erbB2/HER-2 oncoprotein, and positive for p53 tumor suppressor gene product. The Ki67 proliferation index was 53%. The medical oncology service was consulted, and chemotherapy was initiated with cyclophosphamide and doxorubicin. The patient was subsequently discharged on her eighth hospital day.

Pain experienced by women attending breast cancer screening.

The purpose of this study was to evaluate the pain experience of women during mammography for breast cancer screening. Possible associations with personal and medical history, sociodemographics and/or situational factors were studied. It was also investigated whether this pain influenced the intention to return for future breast cancer screening. In the Netherlands, women between 50-75 years are invited for screening every two years. A total of 1200 participants were asked to fill up a questionnaire. The response rate was 79.5% (n = 954), and 945 questionnaires contained adequate information for analyses. A total of 689 women (72.9%) described mammography as mild to severely painful. In this group, compared to the group that reported no pain, the following factors occurred significantly more often: sensitive breasts (P = 0.001), family history of breast diseases (P = 0.017); expected pain based on former mammography (P = 0.001), high education (P = 0.008), anxiety (P = 0.001), breast sensitivity in last three days (P = 0.001), insufficient attention of technologist (P = 0.001). Other factors like age, hormonal status, breast size and hormone use were not associated with the pain experienced. Thirty-two women (3.3%) indicated that they would not attend further screening, 25 (2.6%) reported that the pain might deter them, six women (0.6%) had other reasons, one woman (0.1%) was sure not to come because of severe pain. In conclusion, a large majority of women attending breast cancer screening describes mammography as painful (72.9%). Factors associated with pain were described. Relatively few women (2.7%) indicated that the pain might deter them from future mammography. Recommendations are given to reduce the pain experienced during screening mammography.