Expert: Claes-Gustaf Nordquist, M.D. - 1/15/2008

Question
QUESTION: Hello Doctor-
I will try and be a precise and detailed with my information and questions....

My mother who is 57 was diagnosed with breast cancer less than a year ago. She was diagnosed with level one cancer of the milk ducts/calcification. The sand like calcifications in her breast had not formed a lump.

She underwent several biopsies, 1 lumpectomy and 8 weeks of radiation treatment. The radiation treatment was very difficult for her and caused blackening and burning of her breast. She finished her radiation treatments about 1.5 months ago. The breast remained tender and warm to the touch.

The past week she had a fever and said she can feel a lump by the incision. She is in the process of seeing her doctor and is scheduled for a mammogram tomorrow. She is also on antibiotics. The doctors think that she has mastitis and thinks that she may have developed an infection(lump) around the incision.

What is the probability that this is something more serious than mastitis? What is the implications of mastitis? What are the chances that this could be inflammatory breast cancer?

I would like to make sure that all questions are asked... is there specific things that we should be asking the oncologist and radiologist?

Thank you in advance,

Lisa

ANSWER: Without an examination I can not exclude anything. She may have a bacterial mastitis (caused by infection). The inflammation in her skin may also be caused by radiation (like a sun burn). In order to find out what it is I suggest an MRI breast scan AND a needle biopsy of the lump she can feel - if possible. An infection is not at all impossible after surgery. But given the time factor a radiation inflammation is also probable. She should ask for the investigations mentioned.


---------- FOLLOW-UP ----------

QUESTION: When you say "inflammation is also probable" are you refering to inflammation of the breast or specifically "inflammation breast cancer"?

Thank you,

Lisa

Answer
While I can not a priori rule out an inflammatory breast cancer without an examination it is probably in this situation less probable. And when I write inflammation I mean JUST inflammation. Had I meant an inflammatory cancer I would have written that (and such a cancer is not really any kind of inflammation in a strict sense). Furthermore since your mother was treated with a lumpectomy just followed by radiation her cancer before treatment can hardly have shown any "inflammatory" characteristics. I therefore regard any such possibilities now as less likely. Her radiation is a more likely candidate as a cause, but an infection is also possible.