In the last week, I have seen two patients who have presented with features of a breast abscess but they ultimately turned out to be breast cancers. Although, inflammatory breast cancers are a known entity and they can present as breast abscesses but this fact is not well known among patients and many general practitioners, which leads to late detection of these cancers.

With this case, I want to highlight some pointers to diagnose these lesions early. A 39 year old, non lactating mother presented to with complaints to swelling in the right breast for the last 3 weeks. She had already taken a course of antibiotics from a general practitioner but did not get relieved of her symptoms. On examination, she had a swelling involving the skin fold below the breast (infra-mammary crease) with swelling and hardness spreading till the lower part of the breast. In addition to this, she had lymph nodes (glands) in the underarm area (axilla) as well.

An USG revealed a lump in the breast associated with fluid collection, which on biopsy turned out to be an invasive cancer. Fortunately for the patient, on further examination, the cancer was found to be restricted to the breast and the underarm area only.

When should we suspect that a breast abscess can actually be associated with a malignancy (cancer)?

1. A non healing breast abscess – which is persisting despite antibiotics and surgical management
2. Breast abscess in a patient who is not lactating. 
3. Breast abscesses in elderly patients
4. Breast abscesses associated with hard lumps in the breast

Patients with these symptoms should get an ultrasound and biopsy done to confirm the diagnosis. In India, another entity which should be ruled out is Breast Tuberculosis.