Mastitis that won’t go away: could it be something else?
Most red, swollen breasts are infections, and most clear up with antibiotics. When redness does not clear, a rare cancer called inflammatory breast cancer is one cause a doctor needs to rule out.
Mastitis is common in women who are breastfeeding. It can also happen in women who are not breastfeeding, though less often. It usually causes redness, warmth, pain, and sometimes fever. Antibiotics usually help within days.
Inflammatory breast cancer is different. Cancer cells block the tiny vessels in the skin that carry lymph, a clear fluid the body drains from tissue. The breast becomes red, swollen, warm, and heavy. Often there is no lump to feel.
The skin may also start to look like the peel of an orange. It thickens and shows small pits where hair follicles pull inward. Doctors call this peau d’orange, French for orange peel. The nipple may flatten or turn inward. Lymph nodes, the small glands under the arm that filter fluid, may swell.
This type of breast cancer is rare. The American Cancer Society says it makes up about 1 to 5 percent of breast cancers. That is why it is easy to miss. A doctor sees many infections and very few of these cancers. The first round of antibiotics is a fair first step. The problem starts when the redness stays and the plan stays the same.
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Article written by Gregory Unatin, Esq. Greg is a managing partner in the law firm of Lupetin & Unatin, a medical malpractice law firm located in Pittsburgh and serving Western Pennsylvania.
Our practice is limited to high-value catastrophic cases because that is where we can do the most for our clients and for patient safety.
The following is a hypothetical situation designed to demonstrate a common form of medical error. It is not a real case, and no physician has reviewed it or offered an opinion about it.
Tasha is 44 and lives in Reading, PA. She is not breastfeeding. One morning her right breast becomes red, warm, and swollen. Urgent care calls it mastitis, a breast infection, and gives her antibiotics.
Two weeks later, the redness is still there. The skin has small pits, like the peel of an orange. Her family doctor prescribes a different antibiotic. Three weeks after that, her breast is larger and the nipple has started to turn inward. A third antibiotic is ordered.
About two months after it started, Tasha has a mammogram and an ultrasound, which uses sound waves to make a picture. A biopsy, which removes a small piece of tissue for testing, shows inflammatory breast cancer.
Tasha wonders whether the two-month delay in diagnosis mattered. This article can help you sort out when a breast infection should have been checked for cancer, and when a delay may support a claim.
When should a breast infection that won’t heal be checked for cancer?
A breast that stays red and swollen after a full course of antibiotics should be checked for cancer. That usually means imaging and often a biopsy, not another antibiotic alone.
The National Comprehensive Cancer Network, a group of major cancer centers, describes this step. The American College of Radiology, a national group of imaging doctors, also addresses it in their guidelines. Careful care usually unfolds in this order.
First, the doctor treats a likely infection. Antibiotics are a reasonable start, especially in a breastfeeding woman with fever and pain. A careful doctor also sets a time to recheck the breast.
Second, the doctor rechecks it. If the redness and swelling are clearly better, the infection is probably healing. If they are not, the doctor looks harder. Skin like an orange peel, a nipple turning inward, or swollen glands under the arm raise the concern.
Third, the doctor orders imaging. That usually means a diagnostic mammogram, which is aimed at the problem area, and an ultrasound. An ultrasound can also find an abscess, a pocket of pus that may need draining.
Fourth, the doctor arranges a biopsy when the picture is unclear. A skin biopsy removes a small round piece of skin. A tissue biopsy uses a needle to sample the breast. A normal mammogram does not rule out this cancer, because this cancer does not present with a breast lump.
Fifth, and if the redness has not cleared, the doctor refers you to a breast surgeon or breast center.
Where does the chance to find it earlier get missed?
- The second and third rounds of antibiotics were given without a workup. Each visit treated it as a new infection. No one stepped back to ask why the first course did not work.
- You were not breastfeeding, and no one asked why you would have mastitis. Mastitis is much more common in nursing mothers. A red breast in a woman who is not nursing deserves a closer look.
- The orange peel skin was not noted, or was noted and not acted on. The chart may describe dimpled or thickened skin, and your doctor did not order imaging.
- A normal mammogram was treated as the answer. This cancer often has no lump. A normal result does not end the workup when the breast is still red and swollen.
- No one set a recheck date. You were told to finish the pills and come back if the redness got worse. Weeks passed before anyone looked again.
What should I check in my own records?
You can answer most of these from memory, your patient portal, or your records.
- When did the redness or swelling start?
- How many rounds of antibiotics were you given, and on what dates?
- Were you breastfeeding at the time?
- Did any note mention orange peel skin, dimpling, or a nipple turning inward?
- Was a mammogram or ultrasound ordered? When was it done?
- Did anyone suggest a biopsy or a breast specialist?
- How many weeks passed between the first visit and the biopsy?
Did the delay in diagnosing breast cancer change the outcome?
A missed step alone is not enough for a claim. The question is whether earlier testing would likely have found the cancer at an earlier, more treatable stage.
With this cancer, weeks matter. Inflammatory breast cancer moves fast. The American Cancer Society says it is at least stage III by the time the cancer is diagnosed. That means it has reached the skin and often nearby glands. The key question is often whether it spread to distant organs during the delay.
Breast cancers grow at different speeds, and this type is one of the fastest. That cuts both ways. A delay of a few weeks can matter. But even when found quickly, it is a serious cancer. Causation is often strongest when the delay was long, such as months of repeated antibiotics.
Medical malpractice lawyers and the experts they consult to review a case focus on a few things. They look at the size of the area involved and whether the cancer had reached the lymph nodes or other organs. They look at the type of cancer. And they measure the time between the missed chance and the diagnosis.
A delay can also change treatment. It may mean more chemotherapy, strong cancer drugs, or treatment that no longer aims for a cure.
In Pennsylvania, a family does not always have to prove that an earlier diagnosis would have saved their loved one. It can be enough to show that the delay meaningfully raised the risk of harm. That added risk must also have played a real part in what happened.
When is a missed inflammatory breast cancer not malpractice?
Not every delay is malpractice. A bad outcome does not prove someone made a mistake.
- One round of antibiotics was given first. Treating a likely infection first is a reasonable step. A claim usually turns on what happened after the first course failed.
- The workup was done and read correctly. Some cancers do not show on a mammogram or ultrasound, even when the test is done and read well. A doctor who did the right workup is not at fault just because the cancer was found later.
- The breast truly got better, then changed later. If the redness cleared and a new change came months later, the first doctor may not have missed anything.
- The delay likely made no difference in prognosis or treatment. The cancer may have already spread to distant organs at the first visit.
What harms matter in these cases?
Our firm focuses on delays that led to death or catastrophic injury. In breast cancer cases, these are the harms that usually matter:
- Cancer that spread to distant organs, such as the bones, liver, lungs, or brain, before it was found. It can still be treated, but it can no longer be cured.
- Death from a breast cancer that, if found earlier, would likely have been curable.
What to expect when you contact our office
Before we take a case, we review the records and imaging with medical experts. Pennsylvania requires a medical professional’s written statement that a claim has merit before a case can go forward. That review also helps answer whether the delay changed the outcome. A doctor, a nurse practitioner, a practice group, an urgent care center, or a hospital system may each have played a role.
Pennsylvania has filing deadlines. For a living patient, the deadline is generally two years from a key date. That is when she knew, or should have known, that she was harmed and that medical care may have caused it. In delayed diagnosis cases, that date is often near the cancer diagnosis. After a death, claims generally must be filed within two years of the date of death. Learn more about how long you have to file a medical malpractice in Pennsylvania. For additional information on breast cancer misdiagnosis, see our main article on delayed diagnosis of breast cancer.
Frequently Asked Questions
Rarely. Most breast infections are just infections. But redness that does not clear with antibiotics can be inflammatory breast cancer.
It means the skin is thick and pitted. It can be a sign of inflammatory breast cancer and calls for a prompt workup.
Usually one full course. If the redness does not clear, imaging and often a biopsy should follow.
No. A claim needs a medical error and proof that the delay likely changed the outcome or raised the risk of harm.
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Lupetin & Unatin, LLC represents Pennsylvania patients harmed by physicians who failed to meet the standard of care.