An extreme itch causes concern

DEAR DR. ROACH

>> I am a 68-yearold female who has had four benign breast biopsies/ lumpectomies in the last 25 years. I’ve also been dealing with extreme itching on one side of my breast. I recently had my annual 3D mammogram as well as an ultrasound, which didn’t show anything amiss. Could scar tissue from lumpectomies be a cause behind this? Or should I encourage my gynecologist to order an MRI? I have small, dense breasts, and I’m concerned about an inflammatory type of breast cancer.

DEAR READER >> There are many reports of itching after a biopsy. The itching normally goes away, and I don’t know how long it has been since the biopsies or when the itching started. There are many types of skin conditions that can cause itching, and fortunately, these are much more common to cause itching than cancer does.

Inflammatory breast cancer is one of the most aggressive and, thankfully, uncommon types of breast cancer. This disease may look like infection of the skin, but it does not respond to antibiotics. The skin has a very characteristic look (“peau d’orange” — an uneven thickening of the skin resembling the texture of an orange peel), along with symptoms of redness and warmth. The mammogram and ultrasound can come out negative in very early stages of inflammatory breast cancer, but the exam is always abnormal.

I do want to emphasize that it is possible to have breast cancer and have normal breast imaging. Women with dense breasts, like yourself, are particularly prone to false-negative mammograms. If the suspicion for breast cancer is high, like with a palpable mass, a biopsy is indicated even if the imaging is reassuring. However, only about 3% of breast cancers have a normal ultrasound and mammogram, and inflammatory breast cancer wouldn’t show up when there’s an absence of visual skin changes, warmth or redness, in addition to normal imaging.

In the absence of a mass, itching alone wouldn’t normally make me insist on additional imaging. However, my personal practice is to frequently refer patients to a breast surgeon for an expert opinion.