[Nonpuerperal mastitis--a disease with increasing clinical relevance?]

Coincidence of nonpuerperal mastitis and noninflammatory breast cancer

BACKGROUND

Nonpuerperal mastitis may mimic breast cancer but the incidence of noninflammatory cancer among such patients is unknown.

AIM

To estimate the risk of breast cancer in patients with nonpuerperal mastitis within 12 months of treatment.

STUDY DESIGN

Two hundred seventy-seven patients with nonpuerperal breast inflammation were prospectively screened for breast cancer within 1 year after mastitis was diagnosed. The age-related standardized breast cancer incidence ratio of the female population was calculated.

RESULTS

Five women (35, 43, 47, 61, and 72 years, respectively) were identified as having noninflammatory breast cancer independently, and at a location distant from the infectious lesion. In 1992, breast cancer incidence in the German federal state of Saarland was 110.0 new cases per 100,000 female inhabitants (0.11%). This gives a standardized incidence ratio in our study population of 37.8 (95% confidence interval: 12.3-88.1) i.e. 37 fold increase in risk.

CONCLUSION

Our data suggest that women with nonpuerperal mastitis (who do not have inflammatory breast cancer) are at significantly increased risk to have breast cancer diagnosed within 12 months following treatment. The reason for this higher incidence in the study population is unknown. Although benign mastitis is not thought to be a risk factor for breast cancer, patients warrant long-term surveillance after diagnosis.

Acute inflammation of the breast--the role of breast ultrasound in diagnosis and management

Twenty female patients aged between 24 and 69 years were referred for breast ultrasound (US) examination between June 1989 and June 1990, with clinical suspicion of a breast abscess. Six were currently lactating. Initial US examination confirmed the presence of an abscess collection in nine out of 20 patients. Seven of these subsequently had surgical incision and drainage. Two settled on medical treatment. No abscess was detected on initial US examination in the remaining 11 patients who were treated conservatively with oral antibiotics. One patient, who had markedly dilated ducts on her initial US examination, remained symptomatic. Follow-up US demonstrated a small fluid collection, which within 7 days developed into a large multiloculated abscess requiring surgical drainage. We feel that US is very useful in accurately demonstrating the presence or absence of an abscess collection in the acutely inflamed breast.

Primary periareolar abscess in the nonlactating breast: risk of recurrence

The estimated probability of relapse of primary periareolar abscess of the nonlactating breast was 38 percent (95 percent confidence interval 18 to 58 percent) 8 years after simple incision and healing by granulation. Relapses were mainly fistulas in the line of incision. An attempt to identify relapses early was unsuccessful. This finding, in combination with the unsatisfactory results of simple incision and healing by granulation and the character of relapses, suggests improper initial operation and multifactorial causes. Initial incision followed by a search for a possible sinus tract and extensive excision in all patients with primary abscesses has been described and is recommended.