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Breast Cancer in Previously Lactating Women

Amer Hashim Al Ani, Hussein Shammout, Awad Al Domour, Monther Abu Reden

Introduction: Many studies suggest that women who breast-fed, had a decreased risk of developing breast cancer (ranging from 10%-64%) compared to women who never breast-fed. Some studies revealed that breastfeeding had no influence on the risk of developing breast cancer. Breastfeeding may be more protective against the development of premenopausal compared to postmenopausal breast cancer. Although there are a few studies that report a decrease in the risk of breast cancer after only three or more months of breastfeeding, the evidence for risk reduction becomes more consistent with the longer women breastfeed. Breast cancer in previously lactating women is rarely dealt with in the medical literature.

Patients and Methods: From January 2009 to May 2012, fifty previously lactating women with breast cancer were studied in Al Bashir Teaching Hospital, Amman, Jordan. Their age ranged from 27-70 yrs, the number of their children were ranging from 3-8 with a history of breastfeeding for 3 months to 3 yrs. The clinical presentation, and ultrasound characteristics, mammogram findings and histopathological criteria were examined.

Result: Breast cancer in lactating women was present in right breast in 23 patients (46%), in the left breast in 27 patients (54%). It was present in the upper outer quadrant in 27 patients (54%), upper inner quadrant in 8 patients (16%), lower outer quadrant in 10 patients (20%), and in the lower inner quadrant in 2 patients (4%). Presenting symptoms were: mass in 25 patients (50%), nipple retraction in 10 patients (20%), ulcers in 5 patients (10%), nipple discharge, or skin tethering in 4 patients each (8%), and pain in 2 patients (4%). By ultrasound 21 lesions (42%) were hypo-echoic, 19 lesions (38%) were of mixed echogenicity, 5 lesions (10%) were isoechoic and 5 lesions (10%) were hyper-echoic. By mammogram 15 lesions (30%) were radio opaque, 12 lesions (24%) were of low opacity, and 2 lesions (4%) were radiolucent. In 4 lesions (8%) micro calcifications were present, in 3 lesions (6%) macro calcifications were present, the mass was speculated in 9 lesions (18%) and skin thickening was present in 5 patients (10%) of the lesions. Forty seven lesions (94%) were a ductal carcinoma, 2 lesions (4%) were a lobular carcinoma, and only 1 case (2%) was a malignant phylloid tumor. Thirty one lesions (62%) were poorly differentiated, 19 lesions (38%) were moderately differentiated, and no well differentiated lesions were detected.

Conclusion: Breast cancer in lactating women is mostly ductal carcinoma that is present as a mass in upper outer quadrant of the left breast, which is hypo-echoic by ultrasound, radio opaque by mammogram and of poor differentiation. These findings need to be reviewed with a larger number of patients.