Revisiting the Milk Rejection Sign: Infant`s Refusal to Feed from One Breast as the Presenting Symptom of Pregnancy-Associated Breast Cancer
2Meirav Breast Cancer Center, Sheba Medical Center, Israel
Background
Pregnancy-associated breast cancer (PABC) is a rare and diagnostically challenging condition that may present with atypical clinical features during lactation. Refusal of the infant to feed from the affected breast, referred to as the “milk-rejection” sign, has been anecdotally described as a possible presenting symptom, but its clinical relevance has not been systematically evaluated.
Research aim/question(s)
To evaluate the frequency of the “milk-rejection” sign among lactating patients with PABC and its association with disease severity at diagnosis.
Method
A retrospective observational study was conducted using an institutional radiology database to identify lactating patients diagnosed with PABC between 2011 and 2023. Data regarding presenting symptoms, including the milk rejection sign, histopathological characteristics, tumor size, nodal status, disease stage and grade at diagnosis were collected. Comparative analyses were performed between patients who reported the milk rejection sign and those who did not.
Results
Among 56 lactating patients with PABC, 9 (16.0%) reported the “milk-rejection” sign as part of their clinical presentation. Patients reporting the milk rejection sign had significantly larger primary tumors at diagnosis compared with those without this symptom (mean diameter 7.77 cm versus 3.70 cm, p < 0.001) and were more likely to have metastatic axillary lymph nodes (88.9% versus 56.0%, p < 0.05). No significant differences were observed in other demographic or prognostic variables.
Conclusion(s)
The “milk-rejection” sign is an uncommon but clinically relevant presenting feature of PABC and is associated with indicators of more advanced disease at diagnosis.