Aleisha Hunter, a 4-year old girl from Cambridge, Ontario (Canada), is thought to be the youngest breast cancer survivor in the world.

Today, the broad smile on her face and her abundant energy, so typical for a girl of her age, does not show the 15-month-long medical nightmare she endured that ultimately led medical staff in the North York General Hospital (Ontario, Canada) to a diagnosis of a rare form of breast cancer and a surgery for a radical mastectomy.

Wrong diagnosis
In early December 2008, Aleisha?s mother, Melanie, first noticed a pea-sized lump on her daughter?s chest. The doctors initially diagnosed the lump lymphadenitis, an infection of the lymph nodes, a common complication of certain bacterial infections. But the diagnosis and treatment with antibiotics to treat the suspected underlying infection, analgesics, to control the pain and anti-inflammatory medications to reduce inflammation and swelling, did not yield any improvement.

In a recent interview in CTV News program CanadaAM, Melanie said that Aleisha?s condition did not improve and that doctors did not understand what was going on: ?They basically didn’t know what it was and I wasn’t satisfied with their answer and she was getting sicker. She had quite a bit of pain. Most of her pain was at night, she stopped sleeping.?

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Melanie started to worry when, in January 2010, she noticed that the lump on Aleisha?s chest started to grow. By April it grew to 2.5 centimeters (0.4 inch) and by the time surgeons went in to remove the lump, it had grown to 5 centimeters (0.8 inch) was turning purple and had spread out like a web.

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Secretory carcinoma of the breast
Aleisha?s lump was now rediagnosed as secretory carcinoma of the breats, also known as juvenile breast carcinoma or secretory carcinoma of the breast, is a rare, indolent and slow-growing, type of invasive breast cancer in which the tumor secretes fluids.

Because cases of this type of cancer are so rare, little research has been done on this type of breast cancer. “Cases like Aleisha’s are so rare you can almost count them on one hand,” noted Dr. Nancy Down, a surgical oncologist at North York General Hospital who was part of the surgical intervention team treating Aleisha.

Secretory carcinoma of the breast is a relatively non-aggressive form of cancer that doesn’t spread quickly, and most patients recover well with treatment. Distant metastases are extremely rare.

A rare disease
Secretory carcinoma of the breast was described in 1966 by Robert McDivitt, and Fred Stewart, [1, 2] from the Department of Pathology, Memorial Hospital for Cancer and Allied Diseases, New York. In their article, McDivitt and Stewart describe infrequently reported cases in young girls dating back to 1917.

Neoplasias with similar features were subsequently observed in young boys and later in men and in women of all ages. [3] Today, it is the disease is considered to occur equally in children as well as the adults. As a result, the tumor is no longer defined as juvenile breast carcinoma but is instead called secretory carcinoma of the breast. [3-5]

Treatment options
Conservative surgery with sentinel lymph node biopsy, followed by accurate follow-up is generally recommended as the standard treatment approach for secretory carcinoma of the breats. Post-operative radiotherapy is indicated in adult patients who have undergone quadrantectomy, but this not recommended in children. Although several cases of secretory carcinoma have been treated with adjuvant chemotherapy, there are still no reliable data regarding the real value of such a choice. [1]

The principal management problems following surgery include local recurrence and axillary lymph node metastases.

Aleisha’s surgery was successful and she is getting used to the life of a ?normal? 4-year-old. Her doctors believe that her prognosis is good. ?When she’s older, she may choose to do reconstructive surgery, says Down.
After taking her daughter home, the difference was even more remarkable. “She’s much happier. She’s feeling much better. She’s bouncy. She’s growing. She’s putting on weight,” Aleisha’s mother Melanie notes.

References:
[1] Vieni S, Cabibi D, Cipolla C, Fricano S, Graceffa G, Latteri MA. Secretory breast carcinoma with metastatic sentinel lymph node. World J Surg Onco. 2006 Dec 6;4:88. [ Full Article]
[2] McDivitt W, Stewart FW. Breast Carcinoma in Children. JAMA. 1966;195(5):388-390.
[3].Tavassoli FA, Norris HJ Secretory carcinoma of the breast. Cancer. 1980 May 1;45(9):2404-13
[4].Kameyama K, Mukai M, Iri H, Kuramochi S, Yamazaki K, Ikeda Y, Hata J. Secretory carcinoma of the breast in a 51-year-old male. Pathol Int. 1998 Dec;48(12):994-7
[5] Kuwabara H, Yamane M, Okada S. Secretory breast carcinoma in a 66 year old man. J Clin Pathol. 1998 Jul;51(7):545-7.

More information:
Four-year-old Ontario girl surviving breast cancer
Special Series: You’ve Got Cancer. Now What?
Meet the toddler who survived breast cancer

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