Case Presentation
A woman in her 70s with a previous history of hypertension visited
another hospital in 1999 for nipple discharge, but the cytological
examination did not demonstrate any malignant cells. Since then, she has
undergone checkups every six months without any malignancy being
detected.
She noticed that her discharge color was turning reddish about two
months before and visited our hospital in Iwaki City, Fukushima
Prefecture, in January 2019. The mammography and ultrasonography
demonstrated a well-defined smooth margined oval mass with
calcification, which appeared to be a series of masses from the left E
to the AB area. Since malignancy could not be excluded, we performed a
needle biopsy, and she was diagnosed with mastopathy. Considering the
possibility of an enlarged mass, we instructed her to revisit our
hospital in six months. When she visited our hospital in July 2019, no
enlargement of the mass was identified on mammography and
ultrasonography. At this time, since the discharge was bloody, we
performed a cytological diagnosis and found it to be Class 2 and
instructed the patient to follow up for one year. Subsequently, Japan’s
COVID-19 pandemic became severe, leading to the declaration of a state
of emergency around April 2020. Thus, she failed to visit our hospital
at the expected time and came to consult in March 2022 with the primary
symptom of increased bloody discharges. However, there was no lump or
any other noticeable abnormality. On examination, a 50mm-sized mass was
found just under the left nipple, and she was diagnosed with cT2N0M0
Stage IIA invasive breast ductal carcinoma (ER >90%, PR
>90%, HER2 0, Ki67 31.2%). On April 27, she underwent
mastectomy and sentinel lymph node biopsy. A rapid examination revealed
no metastasis to the sentinel node, so an axillary dissection was
omitted. Based on final pathology, she was diagnosed with pT3 (55mm)
N0M0 Stage IIB, invasive breast ductal carcinoma, NG3, and HG3. Given
that the patient had an RS13 score on the 21-gene assay (Oncotype DX
Recurrence Score, Genomic Health), the patient was treated only with
hormone therapy.
The patient was then interviewed about the background of the delay in
visiting our hospital. According to her, she decided to wait to see us
until after the outbreak of the COVID-19 infection because she had
thought that medical facilities would be in a difficult situation, and
she believed her disease was already benign. Later, around January 2021,
there was an increase in secretion and its redness. Since it was not
clear when the outbreak of COVID-19 would settle down, she called the
hospital in November 2021. As the increase in secretions was not
mentioned then, an appointment was made for the patient in March 2022.
Overall, the reason for not rushing to see the doctor was that she had
not been diagnosed with cancer previously, so she assumed everything
would be okay. Indeed, she mentioned herself as an easy-going and
laid-back person.
Regarding her family, her daughter had already matured and was living
away from Iwaki City, but she was living with her husband. However, she
also has the tendency to keep everything to herself and did not consult
with her husband, daughter, or friends during this period.