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  • Fosfomycin calcium br Breast masses among pediatric patien

    2019-11-11


    Breast masses among pediatric patients are not uncommon, but breast malignancies, as shown in this and several other studies, remain rare. When considering the approach to a breast mass in this population, guidelines have not been firmly established, and when suggested, are not stratified by race. In general, most recommendations for pediatric patients with breast masses suggest performing a physical exam only and imaging with ultrasound if there are clinical concerns such as pain or rapid growth [14,16,22–25]. Suspicious lesions of any size with atyp-ical findings on ultrasound (cystic areas, hyperlobulation, angularity, or irregular margins and tumors N4–5 cm) should undergo core biopsy [7], while benign lesions should be observed clinically with repeat exam in approximately 6 months to document stability or regression. Surgery is typically only indicated for pediatric patients with a breast mass when the tumor is greater than 5 cm at initial presentation, shows rapid en-largement on follow up (N20% within 6 months), is associated with sys-temic symptoms, or in patients with a personal history of malignancy or chest radiation [4,7,15]. However, given our findings, providers caring for this patient Fosfomycin calcium must remain aware not only of the overall poor outcomes [8–12] but also the racial differences in tumor biology and survival [26–28]. We recommend that providers stratify their sur-veillance programs keeping in mind the higher risk of poor outcomes in black patients.
    Limitations of this study pertain largely to the limitations of the SEER database. First, the inability to collect family history data does not allow for a comprehensive assessment of a patient's overall risk of breast cancer. SEER also does not provide data regarding a patient's presenting symptoms, type of surgery performed, or follow-up treatment. As seen in our results, there are areas of incomplete data that decrease the strength of generalizable conclusions that can be made. Other database limitations include variability in coding, self-report data, and selection bias. Importantly for our subset analysis, all but one Hispanic patients included in this database were coded by race as white. Therefore, conclusions regarding differences between Hispanic and black groups were not made. This could have clinical significance as shown by Stapleton et al. in the adult population where Hispanic females had an earlier age of diagnosis than all other racial/ethnic groups [21].  4. Conclusions
    Breast masses in the pediatric population remain largely benign, with fibroadenomas being the most common diagnosis in this pa-tient population [29]. Despite this, nearly one fifth of pediatric breast cancer patients die secondary to their disease, thus highlighting the need for strategies aimed at early diagnosis such as the development of data directed management guidelines. Additionally, in this study, black patients were found to have most of the noncarcinomatous fibroepithelial tumors with less advanced disease, but this did not confer the expected survival advantage. Therefore, black patients with breast masses may require a more aggressive surveillance and treatment paradigm.
    Funding
    ML Westfal is financially supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health (Award Number: T32 DK007754) and by the Massachusetts General Hospital Department of Surgery Marshall K. Bartlett Fellowship. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
    References
    [4] Knell J, Koning JL, Grabowski JE. Analysis of surgically excised breast masses in 119 pediatric patients. Pediatr Surg Int 2016;32:93–6.