A total of 2,400 questionnaires were mailed to members of two mid-Atlantic breast cancer awareness/support groups to investigate the association between attitudes, knowledge, and use of BRCA1/2 testing among women with early-onset breast cancer. Of the 493 (21%) questionnaires returned, 406 respondents had a diagnosis of breast cancer, of whom 248 were diagnosed prior to age 50 and included in the analyses. Eighty-three percent (206/248) of these women had heard of BRCA1/2 testing and 12.5% (31/248) had undergone BRCA1/2 testing. Among women who had heard of BRCA1/2 testing, women who had been tested were younger (p = 0.03), more likely to have a college education (p = 0.03), more likely to have a family member who had undergone BRCA1/2 testing (p = 0.005), and had greater knowledge, more positive attitudes, and fewer negative attitudes about BRCA1/2 testing (p = 0.02, p = 0.004, and p = 0.004, respectively). In this sample, knowledge regarding BRCA1/2 testing is high, but uptake of genetic testing is low. Lack of information regarding how genetic testing might alter health-care decisions and fear about the genetic testing procedure, its costs, and possible false-positive results are associated with low uptake of genetic testing. Further education regarding these specific points may enhance the use of genetic testing.

Opinion statementAbnormal uterine bleeding (AUB) is one of the most common reasons adolescent patients present for gynecologic care. A new classification system has been created to provide a universally accepted system of nomenclature to describe uterine bleeding causes in reproductive-aged women. The acronym PALM-COEIN (polyp, adenomyosis, leiomyoma, malignancy and hyperplasia, coagulopathy, ovulatory dysfunction, endometrial, iatrogenic and not yet classified) was introduced in 2011. This classification will help to target not only treatment but also future research into treatment options in the AUB population. In order for treatments to be effective, an accurate diagnosis is paramount. Adolescents tend to have anovulatory, infectious, or pregnancy-related causes of AUB. Traditional treatment modalities have been hormonal in nature, the most common being the use of oral contraceptive pills. The latest development has been the recognition of the effective use of the levonorgestrel intrauterine systems (LNG-IUS) in successful treatment of AUB in the adolescent population.

Granulomatous mastitis is a rare benign inflammatory condition of the breast and is known to be associated with pregnancy. A 25-year-old Hispanic G2P1 at 17 weeks gestation presented to the emergency department with findings consistent of a breast abscess. The abscess failed to resolve with incision and drainage followed by multiple courses of antibiotic therapy. A biopsy was then obtained and yielded a diagnosis of granulomatous lobulitis. The patient was treated with steroids and her symptoms resolved. Granulomatous lobulitis may present with characteristics of various clinical entities including neoplasm or, as in this case, abscess. Clinicians should consider a diagnosis of granulomatous mastitis in cases of recalcitrant breast abscess. KeywordsComplications, high-risk pregnancy, immunology, maternal-fetal medicine, neoplasm Case reportA 25-year-old Hispanic G2P1 at 17 weeks gestation with an uncomplicated prenatal course, presented to the emergency department with fever, erythema nodosum, left breast erythema, tenderness, and swelling. Findings were consistent with a breast infection with a WBC of X10 9 /L and sedimentation rate of 89 mm/h. Urine and blood cultures were negative. She was treated with Nafcillin without improvement. A methicillin-resistant Staphylococcus aureus infection was suspected and antibiotics were changed to vancomycin and ceftazidime. Rheumatology consultation diagnosed the patient with erythema nodosum secondary to primary infection. There was no serologic evidence of lupus, vasculitis, or sarcoidosis. Breast ultrasound was consistent with an abscess. Surgery consulted and she underwent an incision and drainage of the left breast lesion. Postoperatively, the erythema nodosum and breast lesion resolved with prednisone 5 mg twice daily for one week followed by a two week taper.Despite patient compliance with the medication regiment, her left breast abscess continued to drain. She returned at 20 and 27 weeks gestation and had a second and third incision and drainage. During both repeat occurrences, breast cultures remained negative. She received multiple course of antibiotics. Biopsy showed acute and chronic inflammation with necrosis consistent with abscess.At 34 weeks, the patient presented with worsening breast symptoms. Her clinical course, labs, and pathology were reviewed (Figure 1). Upon review of the histologic specimens, a noncaseating granulomatous inflammation in the breast lobules composed of epithelioid cells and multinucleated giant cells was identified. The final diagnosis was determined to be granulomatous lobulitis.Treatment with Prednisone was initiated with a dose of 40 mg daily with a taper to 10 mg daily. The patient had an immediate response, the lesions resolved, and no new areas appeared. Her symptoms flared when Prednisone was decreased to 5 mg daily and she remained on Prednisone 10 mg daily for the remainder of her prenatal course. She had an uncomplicated delivery.Post-partum, she was stable on 5 mg of Prednisone daily. She was offered surgical resec...

III.