Abstract PO4-21-01: Recurrent Desmoid Tumor and Ductal Carcinoma In Situ in an African-American Woman: A Case Report and Discussion on Disparities for These Two Cancer Subtypes
Authors: Akula Vinita , Jones Jessica 
Published: May 2024

Introduction: Disparities in cancer care in patients from different races and ethnicities unfortunately do exist and are well described in literature. Hormonal-driven cancers, such as some soft-tissue tumors and DCIS, have been demonstrated to impact African-American women (AAW) disproportionately. These patients are at increased risk for not only development of these cancers, but also experience disparities in survival, treatment outcomes, and modalities of treatment.

Clinical Case: A 47-year-old premenopausal AAW with past medical history of recurrent desmoid sarcoma of the abdomen and ductal carcinoma in-situ (DCIS) of the left breast presented to oncology clinic with recurrent abdominal mass. The patient was originally diagnosed with DCIS in the left breast in 2018 and subsequently underwent left breast mastectomy with TRAM reconstruction and fat graft later that year. In 2020, the patient noticed a left lower abdominal growth that quickly enlarged and became painful. She underwent imaging without biopsy and was taken to surgery in April 2021 with tumor removal and mesh placement. Pathology showed desmoid fibromatosis infiltrating skeletal muscle and involving the inked resection margin of the specimen. Conservative re-excision and additional therapy was recommended but not done at the time. In 2022, the patient had resection of the area again with pathology of the incisional scar showing skin and deep soft tissue foci suspicious for recurrent desmoid fibromatosis extending to the inked deep margin. No mesh was placed, and the wound closed almost completely. The patient was not aware of positive margins at the time. In January 2023, patient again notice a new bump that was bothersome. Initial CT and MRI without finding of defined mass, but with right rectus thickening and enlarged right external iliac lymph node. Core biopsy in June 2023 confirmed recurrent desmoid fibromatosis. In April 2023, annual screening with mammogram was performed with a finding of 2.9 cm cluster of heterogenous calcification in the right breast. Diagnostic mammogram and ultrasound performed. Core needle biopsy was subsequently performed in May with pathology consistent with high grade DCIS with low ER and PR positivity. Lymph node biopsy was negative, but clinically positive. She is currently undergoing further genetic testing with surgical workup for mastectomy.

Discussion and Conclusion: AAW diagnosed with DCIS have higher all-cause and disease specific mortality in comparison to white women (WW) diagnosed with DCIS. AAW are also at increased risk of aggressive secondary breast cancers in both the ipsilateral and contralateral breast in comparison to other races. In regards to tumor biology, WW have been shown to have higher ER and PR positivity in both primary and primary breast cancers than AAW. In many of these large-scale studies higher mortality, recurrence, and metastasis in AAW have been identified regardless of treatment modality. Research into differences in treatment between AAW and WW has shown that AAW, in contrast to our patient case, are more likely to undergo endocrine and radiation therapy rather than mastectomy. Although there does not seem to be an increased risk of desmoid fibromatosis in AAW when compared to WW, other soft-tissue tumors and malignancies do show a predilection for AAW. Incidence of sarcoma in black patients is higher than white patients, and black patients also have poorer survival outcomes. This case provides an example of the intersectionality of two cancer subtypes that impact black patients disproportionately. More evidence is required to unearth the reasons why these two cancer subtypes which are driven by similar processes impact AAW to a greater degree.

Citation Format: Vinita Akula, Jessica Jones. Recurrent Desmoid Tumor and Ductal Carcinoma In Situ in an African-American Woman: A Case Report and Discussion on Disparities for These Two Cancer Subtypes [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 PO4-21-01.