Faculty Bibliography

INTRODUCTION: Cancer screening is a key component of primary care, and access to regular screening mammography (SMG) is highly dependent on recommendation and referral by a primary care provider (PCP). Women with no health insurance or who are underinsured often lack access to a regular PCP and thus access to routine screening. METHODS: We retrospectively reviewed the charts of 173 surgical patients diagnosed between January 2012 and December 2013. The main outcome variables were PCP status, method of cancer detection, and breast cancer stage at diagnosis. Additional variables included race, age at diagnosis, family history of breast and ovarian cancer, and medical comorbidities. RESULTS: Patients with a PCP received more mammograms (SMG) compared with patients without a PCP (61 vs. 37 %; p = 0.003). The majority (73 %) of patients without a PCP presented symptomatically with a palpable mass versus 42 % of patients with a PCP. A significant difference was noted with regard to final pathologic stage of breast cancer between the two groups (p = 0.019), and Caucasian and African American patients were more likely to have locally advanced breast cancer. CONCLUSIONS: Underserved patients with a PCP are more likely to present asymptomatically and at an earlier stage of breast cancer compared with patients without a PCP. Community engagement programs that build relationships with patients may help bring vulnerable patients into the healthcare system for routine screening. Moreover, PCP education regarding the subtleties of breast cancer screening guidelines and referral to a breast specialist is also critical in improving outcomes of underserved patients.

Breast cancer is the most common cancer in women in the USA, with the lifetime incidence of 1 in 8 women. Dermatomyositis (DM) is an uncommon idiopathic inflammatory myopathy that can manifest as a paraneoplastic syndrome of an underlying malignancy. Here, we report a case of a patient who presented with breast cancer and DM symptoms. The patient's rash and muscle weakness progressed during the workup of her breast cancer, while she was already started on medical treatment of these symptoms with oral prednisone. Her cutaneous and musculoskeletal improved dramatically following the treatment of her breast cancer. Our case report describes the rapid progression and regression of her symptoms emphasizing the benefit of early diagnosis and treatment of DM as well as the underlying breast cancer.

BACKGROUND: Granulomatous mastitis is an uncommon chronic inflammatory breast condition that is characterized by granulomatous inflammation. Granulomatous mastitis presents a challenging clinical scenario, because it can mimic carcinoma. The etiology and optimal treatment remain unclear. We report our experience with granulomatous mastitis patients who presented to our clinic within the past 2 years and describe their response to our treatment modalities. METHODS: Our clinic records were reviewed for the diagnosis of granulomatous mastitis. Charts were used to collect clinical data, patients were reinter viewed, and physicians completed detailed reports on their management of these cases. All cases were diagnosed with granulomatous mastitis based on histological findings and by ruling out other etiologies. RESULTS: Twenty-four patients were identified. The mean age was 34 years. Fifty-three percent of our patients emigrated from Mexico. Most patients were treated with prednisone and/or methotrexate with overall response rate greater than 80 %. Cases that failed to improve were treated with other modalities, including antituberculosis drugs. CONCLUSIONS: Granulomatous mastitis remains a difficult entity to diagnose and to treat. The clinical course of patients often is prolonged. Exclusion of other causes of granulomatous conditions is essential before initiating anti-inflammatory treatment.