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.