Case Reports in Medicine
Volume 2013, Article ID 354682, 5 pages
Multifocal Breast Cancer in Young Women with Prolonged Contact between Their Breasts and Their Cellular Phones
John G. West,1 Nimmi S. Kapoor,1 Shu-Yuan Liao,2 June W. Chen,3 Lisa Bailey,4 and Robert A. Nagourney5
1Breastlink, Department of Surgery, 230 S. Main Street, Suite 100, Orange, CA 92868, USA
2Department of Pathology, St. Joseph Hospital, University of California Irvine, 1100 West Stewart Drive, Orange, CA 92868-5600, USA
3Breastlink, Department of Radiology, 230 S. Main Street, Suite 100, Orange, CA 92868, USA
4Bay Area Breast Surgeons, Inc., Department of Surgery, 3300 Webster Street, Suite 212, Oakland, CA 94609, USA
5Department of Obstetrics and Gynecology, Rational Therapeutics, University of California Irvine, Long Beach, CA, USA
Received 30 July 2013; Accepted 19 August 2013
Academic Editor: Hans-Joachim Mentzel
Copyright © 2013 John G. West et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Breast cancer occurring in women under the age of 40 is uncommon in the absence of family history or genetic predisposition, and prompts the exploration of other possible exposures or environmental risks. We report a case series of four young women—ages from 21 to 39—with multifocal invasive breast cancer that raises the concern of a possible association with nonionizing radiation of electromagnetic field exposures from cellular phones. All patients regularly carried their smartphones directly against their breasts in their brassieres for up to 10 hours a day, for several years, and developed tumors in areas of their breasts immediately underlying the phones. All patients had no family history of breast cancer, tested negative for BRCA1 and BRCA2, and had no other known breast cancer risks. Their breast imaging is reviewed, showing clustering of multiple tumor foci in the breast directly under the area of phone contact. Pathology of all four cases shows striking similarity; all tumors are hormone-positive, low-intermediate grade, having an extensive intraductal component, and all tumors have near identical morphology. These cases raise awareness to the lack of safety data of prolonged direct contact with cellular phones.
1. Case Reports
1.1. Case 1
一名21岁的女性患有左侧自发性血性乳头溢液。 她的历史值得注意的是她每天都要将手机放在左侧的胸罩里几个小时。 她的乳房X线照片显示广泛的多形性钙化和从后腹部区域到胸壁的密度跨越12厘米的长度。 磁共振图像（MRI）显示对应于在她的乳房X线照片上看到的变化的节段分布中的广泛异常非质量增强（图1（a）-1（c））。 她接受了乳房切除术和病理学检查，发现广泛导管原位癌（DCIS）伴有多灶性微小浸润。 前哨淋巴结对转移性疾病呈阴性。
A 21-year-old female presented with left spontaneous bloody nipple discharge. Her history was notable for keeping her cellular phone tucked into her bra on the left side for several hours each day. Her mammogram showed extensive pleomorphic calcifications and densities from the retroareolar region to the chest wall spanning a length of 12 cm. A magnetic resonance image (MRI) showed extensive abnormal nonmass enhancement in a segmental distribution corresponding to changes seen on her mammogram (Figures 1(a)–1(c)). She was treated with mastectomy and pathology revealed extensive ductal carcinoma in situ (DCIS) with multifocal microinvasion. Sentinel lymph nodes were negative for metastatic disease.
Figure 1: Representative imaging of patient in Case 1. Left mammogram showing clustered calcification corresponding to multiple sites of disease in craniocaudal (a) and mediolateral-oblique (b) projections. MRI showing extensive nonmass enhancement in the lateral hemisphere of the left breast in segmental distribution (c).
1.2. Case 2
一名21岁的女性在她的手机与她的左乳房直接接触的区域内出现可触及的乳房肿块。 在过去的六年里，她一直将她的手机设备放在她的胸罩里，每天八小时或更长时间。 乳房MRI显示四个不同的独立病变，直径15至18毫米，涉及左乳房上半球的广泛区域。 她的乳房切除术的病理学显示具有广泛DCIS的多灶性侵袭性癌症。 9个腋窝淋巴结中有2个为转移性疾病阳性。 后来的研究发现骨转移。
A 21-year-old female presented with a palpable breast mass in the area where her cellular phone was kept in direct contact with her left breast. She had been placing her cellular device in her bra for eight hours a day or longer for the past six years. Breast MRI demonstrated four distinct separate lesions ranging from 15 to 18 mm in diameter involving an extensive area of the upper hemisphere of the left breast. Pathology of her mastectomy showed multifocal invasive cancer with extensive DCIS. Two of nine axillary lymph nodes were positive for metastatic disease. Later studies found metastasis to the bone.
1.3. Case 3
一名33岁的女性在右乳房的上外象限中出现两个可触及的肿块，她的手机被放置在胸罩下方。 她间歇地将手机放在胸罩里八年了。 在诊断前的两年内，她会经常将手机放入胸罩，每周慢跑3-4次。 在此期间，她将在她的手机上使用全球定位系统（GPS）应用程序来确定她在慢跑时的位置。 MRI显示右乳房上部外象限至少有6个可疑病灶，长度为8厘米。 乳房切除术标本显示广泛的DCIS伴有多灶性侵袭。 在一个前哨淋巴结中发现5mm转移。
A 33-year-old female presented with two palpable masses in the upper outer quadrant of her right breast directly underneath where her cellular phone was placed against her breast in her bra. She had been placing her cellular phone in her bra intermittently for eight years. In the two years prior to diagnosis she would routinely place her phone in her bra while jogging 3-4 times per week. During this time period she would use a global positioning system (GPS) application on her cellular phone to determine her location while jogging. MRI demonstrated at least six suspicious lesions spanning a length of 8 cm in the upper outer quadrant of the right breast. Mastectomy specimen showed extensive DCIS with multifocal invasion. A 5 mm metastasis was found in one sentinel lymph node.
1.4. Case 4
一名39岁的女性在手机接触右乳房时出现三个可触及的乳房肿块。 在过去的十年中，她每天上下班并使用蓝牙设备通话几个小时，她一直把手机放在胸罩里。 MRI显示多个质量状和管状区域的增强，主要涉及从11点到1点位置的整个右上乳房。 乳房切除术显示四个独立的浸润性导管癌，大小为1至3厘米，具有10厘米的DCIS。 9个淋巴结中有2个为转移性疾病阳性。 在所有四个病例中观察到的原位和浸润性导管癌的病理学显示出惊人的相似性，并且代表性的组织学图示于图2中。
A 39-year-old female presented with three palpable breast masses in the area of cellular phone contact with her right breast. She had been placing her cellular phone in her bra while commuting and using a Bluetooth device to talk for hours each day for the past ten years. MRI demonstrated multiple mass-like and tubular areas of enhancement essentially involving the entire upper right breast from the 11 to 1 o’clock position. Mastectomy showed four separate invasive ductal carcinomas ranging from 1 to 3 cm in size with 10 cm of DCIS. Two of nine lymph nodes were positive for metastatic disease. Pathology of the insitu and invasive ductal carcinomas observed in all four cases shows striking similarity, and the representative histological figures are illustrated in Figure 2.
Figure 2: Representative histology of all four cases. There is extensive DCIS with cribriform configuration (arrow). The multiple foci of invasion (arrowhead) occur in between the DCIS (magnification ×100).