Carcinoma Breast in young females in early 30 s

I came across my friends relative Mrs XYZ who is just 32 years old complaining of lump in breast who was in her lactational period and had a baby of 1 year .she thought that it was due to lactation.when she was advised investigation and fnac she was diagnosed with malignancy of breast.I have seen this youngest patient of ca breast who was married just 2 years ago .she didn't have any family history.no other any significant medical history I consulted a surgeon known to me and advised her to Go for breast conservative surgery at the earliest so that cancer cells don't enter and metastasis the circulatory system Felt happy to counsel the patient.

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Carcinoma in young and lactating breast is always of an aggressive and infiltrative type - sometimes it is referred to as mastitis carcinomatosa . As early as possible she needs 1.Breast conservation surgery followed by 2.Radiotherapy and 3.Chemotherapy and hormonal therapy-,depending upon the ER , PR receptors and HER - 2 protein status

Lactational breast cancer is known for its aggressiveness Preoperative staging of breast cancer need to be done, by CT chest abdomen and pelvis and PET CT to look for distant metastasis and lymph node metastasis Based on finding she may be a candidate for trucut biopsy, neoadjuvant chemotherapy followed by breast conservative surgery of there is good response to chemotherapy

Cancer among young adults and adolescents is a growing concern among indian oncologist.we see a lot of young patients in India being diagnosed with cancer.

I disagree with the surgeons assessment. Will need to get a biopsy to evaluate the status of ER/PR and HER2. She should also have a whole body CT/PET to evaluate for metastatic disease. In addition as she is young, should consider workup for genetic causes, as she may benefit from prophylactic mastectomy on the other breast is there is a high risk hereditary syndrome (BRCA 1/2). If she is triple negative, she should get neoadjuvant chemotherapy before surgery. If Her 2+ may still consider neoadjuvant therapy, as now we have treatment for patient who have non CR response to neoadjuvant therapy. Please see a good medical and surgical oncologist before taking any step.

She needs evaluation for metastasis. She will need whole body PET CT scan Biopsy of the breast lump with Er,PR,Her2Neu and ki67%. Before any surgical procedure Usually it will be triple negative, she will need neoadjuvant chemotherapy if axillary disease is high. Followed by surgery whether BCS or mastectomy. If BCS then radiotherapy is a must. Ask the patient to meet the surgical oncologist and go in a orderly manner rather than doing surgery in urgency. Will young age she will need BRCA evaluation also

NEED'S.. ONCOLOGISTS OPINION FOR FURTHER MANAGEMENT..

ADVISABLE BIOPSY AND CT. SCAN

Needs work up with a core tissue biopsy with immunohistochemistry. Staging as per clinical presentation. NACT for diwnsizing subject to immunohistochemistry. Fertility preservation, genetic counselling, psycho-social support. There is lot to be done. She needs review by a surgical oncologist.

BIRADS VI indicate FNAC confirm carcinoma Then clinical stage by examination After that advise for chemotherapy - surgery-radiotherapy

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