Abstract PO4-20-07: Dense Breast Tissue in a High-Risk African-American Woman with DCIS and Nodal Metastasis of Intra-ductal Carcinoma: A Case Report and Discussion on the Current USPSTF Draft Recommendation
Authors: Akula Vinita , Jones Jessica 
Published: May 2024

Introduction and objectives:

The incidence of breast cancer (BC) in younger women has increased in recent years, raising the discussion on adjustments to screening recommendations. This past May, a new draft recommendation to the USPSTF guidelines for BC screening adjusted the age of screening from 50 to 40. However, there is still insufficient evidence to recommend adjusted screening guidelines for patients at increased risk including ethnic minorities with higher mortality and women with dense breasts. The paucity of trials and reviews for many of these at-risk groups may be leading to later diagnosis and poorer outcomes. This case highlights the importance of clinical judgment when screening patients whose presentation lies outside the guidelines.

Clinical Case:

A 29-year-old AAW with past medical history of bipolar disorder presents to her primary care physician in April 2023 with concern for left breast mass. Patient was previously on risperidone and Depakote for her bipolar disorder one year prior which resulted in drug-induced amenorrhea and breast tenderness with evidence of elevated prolactin. She was taken off her medication with return of her menses, but breast tenderness persisted for three months. During this time, she noticed a palpable breast mass. Family history is not significant for breast cancer. Breast ultrasound and mammography revealed “extremely dense” breast tissue bilaterally. Imaging significant for 7.6 × 6.2 × 6.3 cm irregular mass in the lower inner quadrant of the left breast with pleomorphic calcifications. Biopsy subsequently performed with breast pathology significant for ER+/PR- ductal carcinoma in situ. However, lymph node pathology showed evidence of invasive ductal carcinoma raising question of diagnosis of possible occult breast cancer versus breast cancer with axillary metastasis. PET CT did not show evidence of metastatic disease. She was started on neoadjuvant chemotherapy.

Discussion and Conclusion:

It is well known that African American women (AAW) are at increased risk for mortality due to BC, aggressive secondary BC, and for high-risk tumor biology. Additionally, AAW generally have more dense breast tissue, another risk factor for BC. Dense breast tissue can make it more difficult to characterize high-risk lesions on screening modalities. In regard to this patient, her dense breast tissue may obfuscate characterization of areas of possible primary cancer being the cause of her nodal metastasis. Current guidelines do not take these well-known associations and risk factors into account. A separate treatment algorithm may be required to work up a patient from high-risk groups such as this patient case. It is crucial that future guidelines on screening should incorporate specific risk factors which would help detect BC earlier in vulnerable populations.

Citation Format: Vinita Akula, Jessica Jones. Dense Breast Tissue in a High-Risk African-American Woman with DCIS and Nodal Metastasis of Intra-ductal Carcinoma: A Case Report and Discussion on the Current USPSTF Draft Recommendation [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-20-07.