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Breast carcinoma in pregnancy and lactation: A diagnostic and therapeutic dilemma

Objective: To study the clinical presentation, pathological features, receptors type, and reason for the delay of diagnosis of breast carcinoma during pregnancy and lactation.

Patients and methods: This is retrospective study of patients with pregnancy associated breast carcinoma (PABC), treated at our hospital from 2003 to 2009.

Results: Of the 16 patients, 8 (50%) were pregnant and 8 (50%) were lactating with an average age of 30years (range, 21 to 41years). Four (25%) underwent therapeutic abortions, two (12.5%) cesarean section, one (6.25%) patient had spontaneous abortions and one (6.25%) had no follow up. Fifteen (94%) presented with a breast mass, 37.5% with nipple retraction and 31% presented with inflammatory changes in the breast. Symptoms and signs were overlooked by physicians in 8 (50%) of patients, resulting in delay of referral. In 5 (31.25%) the delay was due to patients' fear of cancer and only 3 (18.75%) there was no delay. The majority of cases were ductal 12 (75%). Only one-third presented with early stage, the rest with advanced stage. Half (50%) were Estrogen receptor and Progesterone receptor (ER, PR) negative, while 6 (37.5%) were positive. Human epidermal growth factor receptors type2 (HER2) positivity was found in 3 (18.75%) while 2 (12.5%) were ER negative but PR positive.

Conclusion: Breast masses during pregnancy and lactation is not always benign. It may be overlooked and all appropriate methods should be used to role out breast carcinoma.

Author(s): Ali M. Al-Amri

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