By Jessica L. Bienstock MD MPH, Harold E. Fox MD MSc, Edward E. Wallach MD
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Sample text
In contrast to puerperal mastitis, nonpuerperal mastitis is usually a polymicrobial infection and the woman is generally not systemically ill. Antibiotic coverage typically includes clindamycin or metronidazole, in addition to a beta-lactam antibiotic. All breast inflammation must raise concern for inflammatory breast cancer, and the threshold for performing a skin biopsy should be low, particularly in the elderly population. Failure to respond to antibiotic treatment should prompt biopsy in any patient.
It carries a four- to fivefold increased risk of breast cancer, usually in the ipsilateral breast. Complete excision is recommended. Proliferative lesions, such as sclerosing adenosis, ductal epithelium hyperplasia, and intraductal papillomas, also carry an increased risk of cancer. Lobular carcinoma in situ (LCIS), sometimes called lobular neoplasia, is a nonpalpable, noninvasive lesion arising from the lobules. LCIS is more common in premenopausal women and is often an incidental finding on biopsy.
This is increased to 95% if combined with a bilateral salpingo-oophorectomy. Pregnancy and Breast Cancer Pregnancy-associated breast cancer is diagnosed during pregnancy, in the first postpartum year, or any time during lactation. Breast cancer is the most common cancer in pregnancy, with an incidence of 1 in 3,000 gestations. The average patient age is 32 to 38 years. Breast cancer can be especially difficult to diagnose during pregnancy and lactation (secondary to increased glandular breast tissue), which may lead to a delay in diagnosis.