Pediatric Breast Cancer

Breast masses in female children are mainly benign with fibroadenoma being the most common diagnosis.  Breast cancer in the pediatric age is very rare occurring in 0.1% of all breast cancers with an estimated incidence of one case for every 125000 females under the age of 21 years. When breast cancer occurs in the pediatric age, the child presents with late stage disease, more nodal metastasis and lymphovascular invasion and few to none hormone receptor positive tumor. Breast cancer is the most common cancer in females between 15 and 40 years of age. The median age in the pediatric group with breast cancer is 17 years with 80% of cases in nonblack patients. Common symptoms include a lump, changing size of the breast, dimple of the skin, inverted nipple, and red or swollen skin changes in the breast. US and MRI suggest the presence of a malignancy and biopsy confirms the diagnosis. Suspicious lesions of any size with atypical findings on ultrasound or MRI (cystic areas, hyperlobulation, angularity, calcifications or irregular margins) or masses above 4 cm should undergo core or excisional biopsy. The most common histology in order of frequency is breast adenocarcinoma (50%), fibroepithelial/phylloides tumors (35%) and sarcomas (15%). Most cases undergo surgery as management of the tumor including modified mastectomy. Adenocarcinomas and sarcoma carry a worse survival when compared with fibroepithelial tumor. By stage fibroepithelial tumors is almost all early stage disease, whereas adenocarcinomas and sarcomas have both early and advanced stage tumors. High grade and advanced stage disease has a worse outcome than low grade and early stage disease. Fibroepithelial tumors are nearly as twice as common in black patients when compared to nonblack patients. This is probably caused by an early menarche age in black females with longer exposure to estrogen. Fibroepithelial tumors arise from the specialized connective tissue around mammary lobules and are often large (> 6 cm) estrogen-sensitive tumors with a high risk of local recurrence. Almost 20% of pediatric breast cancer dies of their disease.

References:
1- Westfal ML, Chang DC, Kelleher CM: A population-based analysis of pediatric breast cancer.  J Pediatr Surg. 2018 Oct 5. pii: S0022-3468(18)30627-4. doi:10.1016/j.jpedsurg.2018.10.009.
2- Chen HL, Zhou MQ, Tian W, Meng KX, He HF: Effect of Age on Breast Cancer Patient Prognoses: A Population-Based Study Using the SEER 18 Database. PLoS One. 2016 Oct 31;11(10):e0165409. doi: 10.1371/journal.pone.0165409. eCollection 2016.
3- Ademuyiwa FO, Gao F, Hao L, Morgensztern D, Aft RL, Ma CX, Ellis MJ: US breast cancer mortality trends in young women according to race. Cancer. 121(9):1469-76, 2015
4- Gutierrez JC, Housri N, Koniaris LG, Fischer AC, Sola JE: Malignant breast cancer in children: a review of 75 patients. J Surg Res. 147(2):182-8, 2008
5- Wang XX, Jiang YZ, Liu XY, Li JJ, Song CG, Shao ZM: Difference in characteristics and outcomes between medullary breast carcinoma and invasive ductal carcinoma: a population based study from SEER 18 database. Oncotarget. 2016 Apr 19;7(16):22665-73. doi: 10.18632/oncotarget.8142.



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