RIVIERA MAYA, MEXICO — Aspirate or biopsy any breast mass discovered in a pregnant or lactating woman, because breast cancer in these patients is associated with higher mortality—probably because of delay in diagnosis, Dr. Carol Scott-Conner said at a meeting on medical negligence and risk management.
Studies show that women who are pregnant within 2 years of a breast cancer diagnosis are at a much higher risk of poor outcomes, with 50% having locally advanced or regional disease at diagnosis, compared with 39% of nonpregnant patients, said Dr. Scott-Conner, professor of surgery at the University of Iowa, Iowa City.
Reasons for diagnostic delay may include the fact that masses are more difficult to detect in engorged breasts; patient denial and physician procrastination also probably play a role. “These masses also may be confused with mastitis or other benign entities, like fibroadenoma, lactating adenoma, galactocele, or breast abscess,” she said.
Although it has not been proven, there are concerns that pregnancy-associated breast cancer may be a more aggressive form of the disease. “Many patients I see have experienced no delay in diagnosis but still have a fairly advanced tumor. We just don't know,” she said.
Most patients come in with a self-identified palpable mass. Fine-needle aspiration cytology will give valuable information for these lesions. “I'm a great believer in liberal use of FNAC,” said Dr. Scott-Conner, previous chair of surgery at the university.
“It's a benign test that's easy to do and is very helpful.” Make sure to inform the lab that the patient is pregnant or lactating, though, because normal proliferative changes can mimic neoplastic changes, she noted at the meeting, which was sponsored by Boston University.