Severe Anemia Presenting With Dyspnea In Neglected Locally Advanced Breast Carcinoma: A Case Report

Breast cancer is the most common type of cancer among women. Advances in medical technology have made early diagnosis possible. However, as with many other diseases, the diagnosis of breast cancer may be delayed due to hospital-related phobia. This case report presents the clinical course of a patient with a longstanding breast mass who avoided medical consultation due to hospital phobia, ultimately requiring hospital admission due to the development of profound anemia and dyspnea. The subsequent diagnostic and therapeutic process is also discussed. The tumor identified in this patient likely exhibited indolent biological behavior and did not metastasize despite being present for over a decade. However, chronic blood loss from the ulcerated tumor surface, consistent with iron deficiency anemia, gradually led to a decline in hemoglobin levels, and the slowly developing anemia was initially well tolerated by the patient. Eventually, the patient presented to the emergency department with dyspnea as a result of profound anemia. Following clinical evaluation, a malignant breast mass was detected, and treatment was initiated. The patient underwent neoadjuvant chemotherapy followed by surgical resection. This case underscores several important considerations: treatment response in breast cancer is primarily determined by tumor biology, including molecular subtype and proliferation index; patients may tolerate gradually developing anemia for extended periods; non-healing wounds should raise suspicion for malignancy; all breast masses should be considered malignant until proven otherwise; and while dyspnea is often associated with metastatic breast cancer in the literature, it may also be a presenting symptom in non-metastatic cases.

Keywords: breast cancer, anemia, dyspnea