Breast Manifestations and breast cancer risk in a Cohort of Female Egyptian Systemic Lupus Erythematosus

Breast Manifestations and breast cancer risk in a Cohort of Female Egyptian Systemic Lupus Erythematosus | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Breast Manifestations and breast cancer risk in a Cohort of Female Egyptian Systemic Lupus Erythematosus Naglaa Afifi, Nada Essam, Dahlia Abdel Mohsen, Asmaa Magdy, Rasha Hassan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7529706/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background: Breast involvement in Systemic Lupus Erythematosus (SLE) has been previously described in the literature. Diagnosing lupus-related mastitis is challenging for both patients and clinicians, as it is essential to rule out more serious conditions such as breast cancer. Unfortunately, there are no established guidelines or distinctive features that clearly define breast involvement in SLE that complicates both diagnosis and management. This study aims to evaluate breast manifestations, sono-mammographic findings, and breast cancer risk in SLE patients Methodology: A case-control study was conducted including 100 female SLE patients (aged > 30 years, diagnosed by 2012 SLICC criteria) and 100 age-matched healthy controls. All participants underwent clinical breast evaluation, laboratory investigations, breast cancer risk assessment using the Gail Model, and breast imaging (mammography and ultrasound), with findings classified according to the BIRADS system. Disease activity was assessed by Systemic Lupus Erythematosus Disease Activity Index-2K(SLEDAI2k). Results Breast manifestations were reported by 12% of patients, most frequently as breast lumps (8%) and pain (6%). Sono-mammographic abnormalities were detected in 28% of patients, with fibroadenoma (10%) and fibrocystic changes (8%) being the most common findings. Lupus mastitis was identified in 5% of patients, all with severe SLE activity; most had subcutaneous edema, and some showed calcifications or fibroadenoma. Pathological confirmation was obtained in two cases. According to the Gail model, 98% of SLE patients had an average 5-year breast cancer risk, all lupus mastitis cases had average risk. Compared to healthy controls, there was no significant difference in sono-mammographic findings, but controls had a higher proportion with above-average breast cancer risk. No significant demographic or laboratory differences were found between SLE patients with and without breast manifestations, except for a higher rate of severe disease activity among those with breast manifestations. Conclusions Breast involvement is not uncommon among SLE patients, with a variety of clinical and sono-mammographic manifestations, including lupus mastitis. Most breast findings were benign, and the risk of breast cancer, as assessed by the Gail model, was generally average, including those with lupus mastitis. These findings highlight the importance of regular breast assessment in SLE patients, particularly those with high disease activity. Lupus mastitis Gail's model SLE Figures Figure 1 Background Systemic lupus erythematosus (SLE) is the commonest systemic connective tissue disease, characterized by immune mediated damage which is affecting more than one system with various clinical manifestations, from muco-cutaneous, articular, haematological, to renal ( 1 ). The breast is rarely affected by systemic diseases like lupus (SLE). However, breast diseases in lupus patients can be directly caused by lupus, such as primary lupus mastitis or indirectly related to lupus, like lymphadenopathy or vascular calcifications. Lupus patients are also subject to breast diseases unrelated to SLE ( 2 ). Lupus Mastitis is defined as lupus panniculitis, one of the manifestations of discoid lupus, which involves the mammary glands ( 3 ). It usually affects patients between the ages of 20 and 50 years, and its occurrence is two times greater in women than in men ( 4 ). Patients who had lupus mastitis may suffer from acute pain, redness, and oedema of the breast. Moreover, it could be manifested with swelling or mass of chronic course which may ulcerate. Suspicious calcification may be showed in the mammography ( 5 ). Lupus mastitis is defined by a distinctive set of histological features. The key finding is hyaline fat necrosis. This is often accompanied by several other characteristics as dense lymphoid infiltrates, which are typically found in a lobular pattern, also fibrosis and calcifications, and lymphocytic vasculitis affecting medium and small vessels ( 2 ). Lupus mastitis is a rare breast cancer differential diagnosis. As autoimmune mastitis and breast malignancy can both affect females of different age and given the distress a patient experiences when malignancy is suspected. In addition, surgical intervention and tissue-damaging biopsies risk could worsen the disease, so physicians ought to carefully establish a precise clinical and radiographic classifications focusing for diagnosis to avoid unindicated breast biopsies ( 7 ). Based on our research, the available literature doesn't describe the full range of breast manifestations in people with lupus. Aside from a few case reports primarily focused on lupus mastitis, there is little updated information or clinical guidance concerning with this specific breast disorder, the purpose of the current study is to evaluate breast manifestation and sono-mamographic findings in SLE patients Methods This case-control study included 100 female patients with systemic lupus erythematosus (SLE), aged over 30 years, diagnosed according to the 2012 Systemic Lupus International Collaborating Clinics (SLICC) criteria (11), and recruited from the Rheumatology Department. An additional 100 age-matched healthy women were selected as controls. Patients with other autoimmune rheumatological diseases, Male SLE patients, Pregnant and lactating females were all excluded. All patients were subjected to comprehensive history taking, with emphasis on age, disease duration, and medications used. included general and musculoskeletal assessment, and disease activity was evaluated using the SLE Disease Activity Index 2-K (SLEDAI 2-K) (12). Complete blood count (CBC), Erythrocyte sedimentation rate, serum creatinine, urinary Protein/Creatinine ratio and/or 24hrs urinary protein were measured. Immunological markers as Anti-Nuclear Antibody (ANA), Anti-DNA Antibody, complement 3 (C3) and complement 4 (C4) were estimated. All participants were subjected to: - Detailed history regarding breast symptoms, menstrual and marital status, contraceptive use, smoking, personal and family history of cancer. - Breast examination looking for mass, discharge, tenderness, and nipple or skin abnormalities. - Breast cancer risk assessment using the Gail Model, which estimates absolute and comparative risk based on personal, medical, reproductive, and family history. https://bcrisktool.cancer.gov/calculator.html Breast Radiological Assessment: Breast imaging (mammogram and ultrasound) was performed by specialized radiologists in women imaging. Ultrasonography used a high-resolution linear transducer L6_15 (Logic P7 GE machine) with images obtained in multiple planes. Mammography study (Amulet Innovality Fijifilm Machine) was performed in two standard projections (CC and MLO) for women aged 40 years or older or those with suspicious clinical findings. - Imaging findings were classified according to the Breast Imaging-Reporting and Data System (BIRADS) developed by the American College of Radiology (14), which is assigned one of seven assessment categories: BIRADS 0: incomplete (need further evaluation), BIRADS 1: negative, BIRADS 2: benign, BIRADS 3: probably benign, BIRADS 4: suspicious of malignancy, BIRADS 5: highly suggestive of malignancy, and BIRADS 6: biopsy-proven malignancy. Ultrasound-guided Tru-cut biopsy was performed for suspicious lesions (BIRADS 4 or 5) for histopathological confirmation. Axillary lymph nodes were evaluated by ultrasound and categorized as: Reactionary (cortex even, <3 mm), Indeterminate (cortex even but ≥3 mm, or <3 mm but focally thickened), and Suspicious for malignancy (cortex focally thickened and ≥3 mm, or absent fatty hilum) (15). Statistical analysis was performed using IBM SPSS Statistics (Version 27.0, IBM Corp., USA, 2019). The normality of continuous variables was assessed using the one-sample Kolmogorov-Smirnov test. Normally distributed data were expressed as mean ± standard deviation (SD) and compared between two independent groups using the student’s t-test. For non-normally distributed data, medians with interquartile range (IQR) were reported, and the Mann-Whitney test was used for group comparisons. Categorical data were presented as numbers and percentages and analyzed with the Chi-square test. Fisher's exact test was used when the expected cell count was 5 or less. The level of statistical significance was set at a p-value of < 0.05. A p-value of < 0.01 and < 0.001 were considered highly significant. Results The studied SLE patients (N = 100) ranged in age from 30 to 57 years, with a mean age of 40 years. The mean disease duration was 12.2 ± 8.44 year, that ranged from 6 months to 33 years. Most of patients (59%) had severe disease activity. Articular involvement was most reported (76%) followed by mucocutaneous manifestation (56%). The other demographic and clinical data of the patients’ group are illustrated in table (1). Breast manifestations were reported by 12 SLE patients (12%) during history taking. The most commonly reported symptom was a breast lump (8 patients, 8%), followed by breast pain (6 patients, 6%). Edema and erythema were noted in 2 patients (2%), and 3 patients (3%) reported nipple discharge. No other nipple/skin abnormalities were observed (Table 1). Sono-mammographic findings revealed finding in Twenty-eight (28%) of the patients, fibroadenoma was the most reported (10.0%) followed by fibrocystic changes (8.0%). Calcifications were reported in 7 (7.0%) of the patients. The sono-mammographic findings of the studied lupus patients are illustrated in table (2) and Fig. 1 . Lupus mastitis was identified in five patients (5%). Their ages ranged from 36 to 55 years, and the duration of SLE varied from 5 to 23 years. All patients exhibited severe SLE activity according to the SLEDAI-2K score. Among these five patients, only three were symptomatic: one reported a painless breast lump, while the other two presented with erythematous and tender breasts. Additional demographic and clinical characteristics of the lupus mastitis patients are detailed in Table 3 Sono-mammographic findings among the five lupus mastitis cases showed that four patients had subcutaneous tissue edema, with increased skin thickness observed in two of them. Calcifications and fibroadenoma were each detected in two patients; one of these was classified as BIRADS III and the other as BIRADS IV. Fibrocystic changes were identified in one patient, who was also classified as BIRADS IV. None of the patients exhibited duct ectasia. The diagnosis of lupus mastitis was pathologically confirmed in two cases. Table 3 Regarding breast cancer risk assessment in SLE patients using the Gail model, the majority (98%) had an average 5-year risk of developing breast cancer. Similarly, the lifetime risk was average in 88 patients (88%). Only two patients were found to have an above-average 5-year risk. All lupus mastitis cases demonstrated average 5-year and lifetime breast cancer risk according to the Gail model. A comparison between the patient group and the healthy control group is presented in Table 2. There was no statistically significant difference between patients and controls regarding sono-mammographic findings. However, there was a highly significant difference in both the 5-year and lifetime risk of breast cancer, with the control group showing a higher number of participants with above-average risk compared to the patient group. No significant differences were reported between lupus patients with and without breast manifestations either regarding demographic data or laboratory investigations. However, statistically significant difference was reported between both group regarding SLEDAI 2-K (Twenty-two (78.6%) of patients with breast manifestations were in severe activity versus 37 (51.4%) of patients without breast manifestations). Discussion Breast involvement is a complex and underexplored area in autoimmune rheumatic diseases, mainly due to the vague pathophysiological background of autoimmune diseases ( 16 ). Currently, there are no standardized radiological or clinical algorithms specifically designed for evaluating rheumatic manifestations in breast tissue. As a result, each case is approached on an individual basis, guided by clinical judgment and multidisciplinary collaboration ( 17 ). Lupus is a multi-systemic autoimmune disease, which rarely may involve the breast. About forty case reports of breast involvement in SLE have been described in the literature ( 18 ), which can present as primary lupus of the breast, such as lupus mastitis, or as secondary manifestations, including axillary lymphadenopathy or vascular involvement ( 2 ). Lupus mastitis is considered a manifestation of lupus panniculitis or discoid lupus. It should be included in the differential diagnosis of suspicious breast masses observed on mammography or ultrasound ( 19 ). Additionally, SLE patients have a lower tendency to develop hormone-sensitive malignancies, including breast cancer, compared to the general population ( 20 ). Thus, in this study, we investigated breast manifestations in a cohort of Egyptian female patients diagnosed with SLE. The primary objective was to evaluate the prevalence and nature of breast symptoms, sono-mammographic findings, and risk of breast cancer in patients with SLE, with a particular focus on lupus mastitis. The study compared these findings with a control group of age-matched healthy women. Breast symptoms were reported in a small subset of SLE patients (12, 12%). Among these, 8 presented with breast lumps, 6 experienced breast pain, 3 reported nipple discharge, and 2 had skin changes such as erythema and oedema. These findings are consistent with those of Chow et al. (2021) , who observed that the most common clinical breast manifestation among 16 SLE patients was the development of palpable lesions in 9 patients, followed by breast pain in 3 patients, and axillary lymphadenopathy in 2 patients ( 2 ). Sono-mammographic findings were positive in 28 (28%) of the lupus patients. The detected abnormalities included fibroadenoma in 10 patients, fibrocystic disease in 8 patients, duct ectasia in 8 patients, tissue edema in 4 patients, and calcifications in 7 patients. Additionally, 14 patients exhibited axillary lymphadenopathy. Consistent with our findings, Chow et al. (2021) reported various breast imaging abnormalities among SLE patients, including breast masses in 10 cases, calcifications in 8 cases, and axillary lymphadenopathy in 7 cases. Less commonly, fat necrosis, architectural distortion, and breast edema were each observed in one patient ( 2 ). Notably, lupus mastitis was identified in 5 cases of the cohort, all had severe disease activity according to SLEDAI 2-K scores. This is consistent with Chan et al., 2005 and Castro et al., 2004 , who concluded that the incidence of lupus mastitis is derived from the incidence of lupus panniculitis, which is also rare and occurs in 2–3% of SLE patients (20 &21). Among the five patients with lupus mastitis in our cohort, two showed fibroadenoma and one exhibited fibrocystic changes. Increased skin thickness and tissue edema were observed in two cases, while macrocalcifications were reported in two patients. According to the BI-RADS classification, three cases were categorized as BI-RADS III and two cases (40%) as BI-RADS IV, necessitating tissue biopsy for the latter. Histopathological evaluation confirmed non-malignant inflammatory changes, specifically lymphocytic infiltration, consistent with lupus mastitis. In the cohort studied by Chow et al. (2021) , two cases of lupus mastitis were documented, both presenting with breast mass and pain. Imaging findings included extensive bilateral breast macrocalcifications in one case and an infiltrative irregular breast lump in the other ( 2 ). In a systematic review of 22 cases of lupus mastitis, the most common radiological findings included isoechoic or hyperechoic breast masses, with or without calcifications. The calcifications were predominantly coarse, suggestive of fat necrosis secondary to post-inflammatory changes ( 22 ). Clinically, lupus mastitis is often observed in patients with long-standing disease ( 7 ) and typically affects middle-aged women with established SLE ( 23 ). In our cohort, the five patients diagnosed with lupus mastitis were in their fifth and sixth decades of life and had experienced a prolonged duration of SLE, up to 23 years. Lupus mastitis may mimic malignancy on imaging studies, necessitating careful evaluation through tissue biopsy to rule out malignancy in suspicious lesions ( 3 ) ( 7 ). However, the avoidance of tissue biopsy was advised by Oktay et al., 2021 who emphasized on the importance of the professional knowledge about the imaging findings in lupus patients and correlating them with the precise history and examination that would decrease the number of interventional procedures that may worsen the breast condition and flare the disease aggressively ( 8 ). Breast cancer risk, calculated using the Gail model, revealed that 2 of SLE patients had a 5-year risk of breast cancer above average while 12 had a lifetime risk more than average. These figures were significantly lower compared to the control group. The reduced risk of breast cancer in patients with SLE, may be influenced by factors such as lower use of hormonal contraception. Previous research indicates that while SLE may increase the risk for certain cancers, such as lymphoma, it doesn't seem to be significantly associated with an increased risk for breast cancer. This is consistent with a Song et al.,2018 who did not find any significant link between SLE and breast cancer incidence ( 24 ). Bernatsky et al., 2003 observed 12 cases of breast cancer among 564 SLE patients, which was higher than the 5.6 cases predicted by the Gail model. However, they suggested that other factors besides SLE itself might have contributed to these cases. These factors could include the use of alkylating agents or other immunosuppressive drugs, environmental exposures, or a genetic predisposition to cancer. Recently, Shah et al., 2021 confirmed that patients with SLE showed a lower risk of breast cancer than non SLE population who are influenced by multiple SLE autoantibodies positivity ( 26 ), giving the interest that anti-DNA can provide direct anti-neoplastic effects in cancer cells with DNA repair defects ( 27 ). Breast manifestations in SLE are relatively uncommon but can present unique diagnostic and therapeutic challenges. Due to the autoimmune nature of SLE and the use of various immunosuppressive therapies, breast health requires careful evaluation and monitoring. Lupus mastitis, although rare, should be considered in SLE patients presenting with breast lumps or inflammatory changes. Early diagnosis can prevent unnecessary surgical procedures and facilitate appropriate management with immunosuppressive therapy. This research has several shortcomings to be pointed out. The study's cross-sectional design prevented us from assessing temporal relationships or long-term outcomes, future prospective follow up studies are hence recommended. Awareness between physicians regarding autoimmune background of breast related disorders is necessitating especially in autoimmune diseases so further research is needed to investigate the pathophysiological mechanisms underlying lupus mastitis and other breast manifestations in SLE to develop targeted therapeutic strategies. Studies should also explore the long-term effects of SLE treatments on breast health, including the impact of immunosuppressive therapy on and risk of breast cancer. Conclusion Breast involvement is not uncommon among SLE patients, with a variety of clinical and sono-mammographic manifestations, including lupus mastitis. Most breast findings were benign, and the risk of breast cancer, as assessed by the Gail model, was generally average, including those with lupus mastitis. These findings highlight the importance of regular breast assessment in SLE patients, particularly those with high disease activity. Abbreviations BIRADS: Breast imaging-reporting and data system SD: standard deviation SLE: Systemic lupus erythematosus SLEDAI 2-K: SLE disease activity index SLICC: Systemic lupus international collaborating clinics criteria Declarations Clinical Trial Number: Not Applicable Declaration: Funding : Not applicable Consent to participate: All participants in this study were fully informed about the purpose, procedures, and potential risks and benefits of their involvement. Written informed consent was obtained from each participant prior to their inclusion in the study. Participants were assured of the confidentiality of their responses and their right to withdraw at any time without consequence. Consent to Publication: Not applicable Ethics approval and consent to participate: The study conforms to the 1995 Helsinki declaration and approved by the research ethical committee, FWA000017585 (No: FMASU M S 606/2023). 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Sci Transl Med. 2012. 4:157ra42 Tables Table (1): Clinical characteristics of the studied lupus patients Patients group Age / years (Mean ± SD) Range 40.03 ± 5.21 30 – 57 Disease duration / years (Mean ± SD) Range 12.22 ± 8.44 0.6 – 33 Constitutional 41(41%) Mucocutaneous 56 (56%) Hematological 41 (41%) Musculoskeletal 76 (76%) Neurological 26 (26%) Serositis 30(30%) Renal 47 (47%) SLEDI-k2 Range Median (IQR) Remission Mild to moderate Severe 1 – 39 15 (8 – 20) 10 (10%) 31 (31%) 59 (59%) Drug history Steroids 100 (100%) Hydroxychloroquine 68 (68%) Azathioprine 86 (86%) Cyclophosphamide 36 (36%) Mycophenolate Mofetil 38 (38%) Rituximab 1 (1%) No. of patients with breast symptoms 12(12%) Lump Discharge Skin abnormalities (oedema or redness) Pain Nipple changes 8 (8.0%) 3 (3.0%) 2 (2.0%) 6 (6.0%) 0 (0%) SD: standard deviation, IQR: Interquartile Range , SLEDAI K2: The Systemic Lupus Erythematosus Disease Activity Index, Table ( 2): Comparison between control and patients groups Control group (N=100) Patients group (N=100) P-value Age / years Mean ± SD 41.64 ± 8.19 40.03 ± 5.20 0.099 Menstrual history Regular Irregular Menopause 76 (76.0%) 57 (57.0%) 0.004 6 (6.0%) 38 (38.0%) <0.001 18 (18.0%) 5 (5.0%) 0.004 Marital status Single Married Divorced Widow 7 (7.0%) 17 (17.0%) 0.030 84 (84.0%) 72 (72.0%) 0.093 4 (4.0%) 10 (10.0%) 0.096 5 (5.0%) 1 (1.0%) 0.097 Contraception 84 (84.0%) 72 (72.0%) 0.093 Hormonal IUCD Others 48 (57.1%) 14 (19.4%) <0.001 20 (23.8%) 25 (34.7%) 0.134 16 (19.0%) 33 (45.8%) <0.001 Non-Smoker 96 (96.0%) 92 (92.0%) 0.234 Sono-mammographic finding(n, %) 12 (12%) 28 (28%) Skin thickness 0 (0.0%) 2 (2.0%) 0.081 Tissue edema 0 (0.0%) 4 (4.0%) 0.316 Ducts ectasia 2 (2.0%) 8 (8.0%) 0.145 Fibroadenoma 8 (8.0%) 10 (10.0%) 0.123 Fibrocystic 2 (2.0%) 8 (8.0%) 0.145 Calcification 2 (2.0%) 7 (7.0%) 0.134 BIRADs category I II III IV V 89 (89.0%) 72 (72.0%) 0.002 6 (6.0%) 7 (7.0%) 0.775 4 (4.0%) 19 (19.0%) 0.001 0 (0.0%) 2 (2.0%) 0.155 1 (1.0%) 0 (0.0%) 0.316 Axillary LN (n, %) 7 (7%) 14 (14%) 0.107 Reactionary Indeterminate Suspicious 5 (5.0%) 1 (1.0%) 1 (1.0%) 12 (12.0%) 2 (2.0%) 0 (0.0%) 0.233 Breast Cancer Risk Assessment 5yrs risk Average More than average 85 (85.0%) 98 (98.0%) 0.001 15 (15.0%) 2 (2.0%) Life-time Risk Average More than average 71 (71.0%) 88 (88.0%) 0.003 29 (29.0%) 12 (12.0%) SD: standard deviation, BIRADs: Breast Imaging Reporting and Data System., LN: lymph node. Table (3): Characteristics of the 5 patients diagnosed as lupus mastitis case 1 case 2 case 3 case 4 case 5 Age/ years 55 43 43 36 41 Age of SLE diagnosis/ years 32 33 38 23 25 Disease duration /years 23 10 5 13 16 Menstrual history Menopause Regular Regular Irregular Irregular Marital status Married Married Married Married Married Contraception No IUCD IUCD No No Smoking No No No No No History of cancer No No No No No SLEDAI 2-K 24 (Severe) 17 (Severe) 38 (Severe) 19 (Severe) 24(Severe) Breast Symptoms Soft mass Pain and erythema pain and erythema No No 5-year risk of breast cancer Average Life-time risk of breast cancer Average Fibroadenoma No Yes No No Yes Fibrocystic Yes No No No No Edema No yes yes yes yes Increased Skin thickness No No Yes Yes No Ducts No abnormality No abnormality No abnormality No abnormality No abnormality Calcifications No Irregular multiple right sided Macro bilateral No No BIRADs IV IV III III III Axillary LN Indeterminate Reactionary Reactionary No Reactionary SLE: Systemic Lupus Erythematosus , SLEDAI K2: The Systemic Lupus Erythematosus Disease Activity Index Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 21 Oct, 2025 Reviews received at journal 12 Oct, 2025 Reviews received at journal 02 Oct, 2025 Reviewers agreed at journal 02 Oct, 2025 Reviewers agreed at journal 30 Sep, 2025 Reviewers agreed at journal 30 Sep, 2025 Reviews received at journal 30 Sep, 2025 Reviewers agreed at journal 30 Sep, 2025 Reviewers invited by journal 30 Sep, 2025 Editor assigned by journal 29 Sep, 2025 Submission checks completed at journal 28 Sep, 2025 First submitted to journal 25 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7529706","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":528408471,"identity":"a216f569-e572-4ed5-80ee-eba26f537ecd","order_by":0,"name":"Naglaa Afifi","email":"","orcid":"","institution":"Ain Shams University","correspondingAuthor":false,"prefix":"","firstName":"Naglaa","middleName":"","lastName":"Afifi","suffix":""},{"id":528408473,"identity":"7ea6c5cd-8d18-4163-a3d4-3098166ba6f5","order_by":1,"name":"Nada Essam","email":"","orcid":"","institution":"Ain Shams 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Hassan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5klEQVRIiWNgGAWjYDCCA1CSn5mx8QGQxcNHtBbJdubDBiAtbERrMehnS5MAMQlq4bt9gO3Dhz935A2Yecwqv+bYybAxMD98dAOPFslzCcwzZ7Y9M9wO1HJbdlsy0GFsxsY5eLQYnGFgZuZtOMy4sxmoRXIbM1ALD5s0QS08fw7bbzjMY1Ysua2eWC1shxM3HGZLY/y47TBhLZJnGJsZZ7YdTp7ZzHxYmnHbcR42ZgJ+4TvDfJjhw5/Dtv38Bxs//txWbc/P3vzwMT4tDAyMDXAmMw+YxKscXfcPUlSPglEwCkbBiAEACjtGmKQhfEAAAAAASUVORK5CYII=","orcid":"","institution":"Ain Shams University","correspondingAuthor":true,"prefix":"","firstName":"Rasha","middleName":"","lastName":"Hassan","suffix":""}],"badges":[],"createdAt":"2025-09-03 18:38:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7529706/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7529706/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":93395799,"identity":"8ddd1cf6-c7e6-4ac9-a042-c45710334592","added_by":"auto","created_at":"2025-10-13 11:35:45","extension":"png","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":391355,"visible":true,"origin":"","legend":"","description":"","filename":"Picture1.png","url":"https://assets-eu.researchsquare.com/files/rs-7529706/v1/19e07a0ccd49a647af87106f.png"},{"id":93395800,"identity":"4790a3c9-3ce4-4019-858a-8ced7f555808","added_by":"auto","created_at":"2025-10-13 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1","display":"","copyAsset":false,"role":"figure","size":258240,"visible":true,"origin":"","legend":"\u003cp\u003eSome of the Sono-mammographic findings of the studied lupus patient A: macro calcifications noted by the yellow arrow and increase skin thickening, B: increased skin thickness, C: right sided fibroadenoma BIRADs III measuring0.51 by 0.45 D: multiple irregular fibroadenomas BIRADS IV with calcifications, E: left sided duct ectasia with content measuring 0.36.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7529706/v1/8cdadf050707b733f25ee36f.png"},{"id":93396683,"identity":"d5b967cf-7149-45bb-9af8-c2ee905d514d","added_by":"auto","created_at":"2025-10-13 11:43:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1225305,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7529706/v1/5dc4ac97-9b54-4d3c-87a6-c890af3c9cf0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Breast Manifestations and breast cancer risk in a Cohort of Female Egyptian Systemic Lupus Erythematosus","fulltext":[{"header":"Background","content":"\u003cp\u003eSystemic lupus erythematosus (SLE) is the commonest systemic connective tissue disease, characterized by immune mediated damage which is affecting more than one system with various clinical manifestations, from muco-cutaneous, articular, haematological, to renal (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe breast is rarely affected by systemic diseases like lupus (SLE). However, breast diseases in lupus patients can be directly caused by lupus, such as primary lupus mastitis or indirectly related to lupus, like lymphadenopathy or vascular calcifications. Lupus patients are also subject to breast diseases unrelated to SLE (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eLupus Mastitis is defined as lupus panniculitis, one of the manifestations of discoid lupus, which involves the mammary glands (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). It usually affects patients between the ages of 20 and 50 years, and its occurrence is two times greater in women than in men (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003ePatients who had lupus mastitis may suffer from acute pain, redness, and oedema of the breast. Moreover, it could be manifested with swelling or mass of chronic course which may ulcerate. Suspicious calcification may be showed in the mammography (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eLupus mastitis is defined by a distinctive set of histological features. The key finding is hyaline fat necrosis. This is often accompanied by several other characteristics as dense lymphoid infiltrates, which are typically found in a lobular pattern, also fibrosis and calcifications, and lymphocytic vasculitis affecting medium and small vessels (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eLupus mastitis is a rare breast cancer differential diagnosis. As autoimmune mastitis and breast malignancy can both affect females of different age and given the distress a patient experiences when malignancy is suspected. In addition, surgical intervention and tissue-damaging biopsies risk could worsen the disease, so physicians ought to carefully establish a precise clinical and radiographic classifications focusing for diagnosis to avoid unindicated breast biopsies (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eBased on our research, the available literature doesn't describe the full range of breast manifestations in people with lupus. Aside from a few case reports primarily focused on lupus mastitis, there is little updated information or clinical guidance concerning with this specific breast disorder, the purpose of the current study is to evaluate breast manifestation and sono-mamographic findings in SLE patients\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis case-control study included 100 female patients with systemic lupus erythematosus (SLE), aged over 30 years, diagnosed according to the 2012 Systemic Lupus International Collaborating Clinics (SLICC) criteria (11), and recruited from the Rheumatology Department. An additional 100 age-matched healthy women were selected as controls. Patients with other autoimmune rheumatological diseases, Male SLE patients, Pregnant and lactating females were all excluded.\u003c/p\u003e\n\u003cp\u003eAll patients were subjected to comprehensive history taking, with emphasis on age, disease duration, and medications used. included general and musculoskeletal assessment, and disease activity was evaluated using the SLE Disease Activity Index 2-K (SLEDAI 2-K) (12). Complete blood count (CBC), Erythrocyte sedimentation rate, serum creatinine, urinary Protein/Creatinine ratio and/or 24hrs urinary protein were measured. Immunological markers as Anti-Nuclear Antibody (ANA), Anti-DNA Antibody, complement 3 (C3) and complement 4 (C4) were estimated.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAll participants were subjected to: \u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e-\u003c/em\u003eDetailed history regarding breast symptoms, menstrual and marital status, contraceptive use, smoking, personal and family history of cancer. \u003c/p\u003e\n\u003cp\u003e- Breast examination looking for mass, discharge, tenderness, and nipple or skin abnormalities. \u003c/p\u003e\n\u003cp\u003e- Breast cancer risk assessment using the Gail Model, which estimates absolute and comparative risk based on personal, medical, reproductive, and family history.\u003c/p\u003e\n\u003cp\u003ehttps://bcrisktool.cancer.gov/calculator.html\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eBreast Radiological Assessment: \u003c/em\u003e\u003c/strong\u003eBreast imaging (mammogram and ultrasound) was performed by specialized radiologists in women imaging. Ultrasonography used a high-resolution linear transducer L6_15 (Logic P7 GE machine) with images obtained in multiple planes. Mammography study (Amulet Innovality Fijifilm Machine) was performed in two standard projections (CC and MLO) for women aged 40 years or older or those with suspicious clinical findings.\u003c/p\u003e\n\u003cp\u003e- Imaging findings were classified according to the Breast Imaging-Reporting and Data System (BIRADS) developed by the American College of Radiology (14), which is assigned one of seven assessment categories: BIRADS 0: incomplete (need further evaluation), BIRADS 1: negative, BIRADS 2: benign, BIRADS 3: probably benign, BIRADS 4: suspicious of malignancy, BIRADS 5: highly suggestive of malignancy, and BIRADS 6: biopsy-proven malignancy. Ultrasound-guided Tru-cut biopsy was performed for suspicious lesions (BIRADS 4 or 5) for histopathological confirmation.\u003c/p\u003e\n\u003cp\u003eAxillary lymph nodes were evaluated by ultrasound and categorized as: Reactionary (cortex even, \u0026lt;3 mm), Indeterminate (cortex even but ≥3 mm, or \u0026lt;3 mm but focally thickened), and Suspicious for malignancy (cortex focally thickened and ≥3 mm, or absent fatty hilum) (15).\u003c/p\u003e\n\u003cp\u003eStatistical analysis was performed using IBM SPSS Statistics (Version 27.0, IBM Corp., USA, 2019). The normality of continuous variables was assessed using the one-sample Kolmogorov-Smirnov test. Normally distributed data were expressed as mean ± standard deviation (SD) and compared between two independent groups using the student’s t-test. For non-normally distributed data, medians with interquartile range (IQR) were reported, and the Mann-Whitney test was used for group comparisons. Categorical data were presented as numbers and percentages and analyzed with the Chi-square test. Fisher's exact test was used when the expected cell count was 5 or less. The level of statistical significance was set at a p-value of \u0026lt; 0.05. A p-value of \u0026lt; 0.01 and \u0026lt; 0.001 were considered highly significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe studied SLE patients (N\u0026thinsp;=\u0026thinsp;100) ranged in age from 30 to 57 years, with a mean age of 40 years. The mean disease duration was 12.2\u0026thinsp;\u0026plusmn;\u0026thinsp;8.44 year, that ranged from 6 months to 33 years. Most of patients (59%) had severe disease activity. Articular involvement was most reported (76%) followed by mucocutaneous manifestation (56%). The other demographic and clinical data of the patients\u0026rsquo; group are \u003cb\u003eillustrated in table (1).\u003c/b\u003e\u003c/p\u003e\u003cp\u003eBreast manifestations were reported by 12 SLE patients (12%) during history taking. The most commonly reported symptom was a breast lump (8 patients, 8%), followed by breast pain (6 patients, 6%). Edema and erythema were noted in 2 patients (2%), and 3 patients (3%) reported nipple discharge. No other nipple/skin abnormalities were observed (Table\u0026nbsp;1).\u003c/p\u003e\u003cp\u003eSono-mammographic findings revealed finding in Twenty-eight (28%) of the patients, fibroadenoma was the most reported (10.0%) followed by fibrocystic changes (8.0%). Calcifications were reported in 7 (7.0%) of the patients. The sono-mammographic findings of the studied lupus patients are illustrated in \u003cb\u003etable (2) and\u003c/b\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eLupus mastitis was identified in five patients (5%). Their ages ranged from 36 to 55 years, and the duration of SLE varied from 5 to 23 years. All patients exhibited severe SLE activity according to the SLEDAI-2K score. Among these five patients, only three were symptomatic: one reported a painless breast lump, while the other two presented with erythematous and tender breasts. Additional demographic and clinical characteristics of the lupus mastitis patients are \u003cb\u003edetailed in Table\u0026nbsp;3\u003c/b\u003e\u003c/p\u003e\u003cp\u003eSono-mammographic findings among the five lupus mastitis cases showed that four patients had subcutaneous tissue edema, with increased skin thickness observed in two of them. Calcifications and fibroadenoma were each detected in two patients; one of these was classified as BIRADS III and the other as BIRADS IV. Fibrocystic changes were identified in one patient, who was also classified as BIRADS IV. None of the patients exhibited duct ectasia. The diagnosis of lupus mastitis was pathologically confirmed in two cases. \u003cb\u003eTable\u0026nbsp;3\u003c/b\u003e\u003c/p\u003e\u003cp\u003eRegarding breast cancer risk assessment in SLE patients using the Gail model, the majority (98%) had an average 5-year risk of developing breast cancer. Similarly, the lifetime risk was average in 88 patients (88%). Only two patients were found to have an above-average 5-year risk. All lupus mastitis cases demonstrated average 5-year and lifetime breast cancer risk according to the Gail model.\u003c/p\u003e\u003cp\u003eA comparison between the patient group and the healthy control group is presented in \u003cb\u003eTable\u0026nbsp;2.\u003c/b\u003e There was no statistically significant difference between patients and controls regarding sono-mammographic findings. However, there was a highly significant difference in both the 5-year and lifetime risk of breast cancer, with the control group showing a higher number of participants with above-average risk compared to the patient group.\u003c/p\u003e\u003cp\u003eNo significant differences were reported between lupus patients with and without breast manifestations either regarding demographic data or laboratory investigations. However, statistically significant difference was reported between both group regarding SLEDAI 2-K (Twenty-two (78.6%) of patients with breast manifestations were in severe activity versus 37 (51.4%) of patients without breast manifestations).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eBreast involvement is a complex and underexplored area in autoimmune rheumatic diseases, mainly due to the vague pathophysiological background of autoimmune diseases (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Currently, there are no standardized radiological or clinical algorithms specifically designed for evaluating rheumatic manifestations in breast tissue. As a result, each case is approached on an individual basis, guided by clinical judgment and multidisciplinary collaboration (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eLupus is a multi-systemic autoimmune disease, which rarely may involve the breast. About forty case reports of breast involvement in SLE have been described in the literature (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), which can present as primary lupus of the breast, such as lupus mastitis, or as secondary manifestations, including axillary lymphadenopathy or vascular involvement (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Lupus mastitis is considered a manifestation of lupus panniculitis or discoid lupus. It should be included in the differential diagnosis of suspicious breast masses observed on mammography or ultrasound (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Additionally, SLE patients have a lower tendency to develop hormone-sensitive malignancies, including breast cancer, compared to the general population (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThus, in this study, we investigated breast manifestations in a cohort of Egyptian female patients diagnosed with SLE. The primary objective was to evaluate the prevalence and nature of breast symptoms, sono-mammographic findings, and risk of breast cancer in patients with SLE, with a particular focus on lupus mastitis. The study compared these findings with a control group of age-matched healthy women.\u003c/p\u003e\u003cp\u003eBreast symptoms were reported in a small subset of SLE patients (12, 12%). Among these, 8 presented with breast lumps, 6 experienced breast pain, 3 reported nipple discharge, and 2 had skin changes such as erythema and oedema. These findings are consistent with those of \u003cb\u003eChow et al. (2021)\u003c/b\u003e, who observed that the most common clinical breast manifestation among 16 SLE patients was the development of palpable lesions in 9 patients, followed by breast pain in 3 patients, and axillary lymphadenopathy in 2 patients (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSono-mammographic findings were positive in 28 (28%) of the lupus patients. The detected abnormalities included fibroadenoma in 10 patients, fibrocystic disease in 8 patients, duct ectasia in 8 patients, tissue edema in 4 patients, and calcifications in 7 patients. Additionally, 14 patients exhibited axillary lymphadenopathy. Consistent with our findings, \u003cb\u003eChow et al. (2021)\u003c/b\u003e reported various breast imaging abnormalities among SLE patients, including breast masses in 10 cases, calcifications in 8 cases, and axillary lymphadenopathy in 7 cases. Less commonly, fat necrosis, architectural distortion, and breast edema were each observed in one patient (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eNotably, lupus mastitis was identified in 5 cases of the cohort, all had severe disease activity according to SLEDAI 2-K scores. This is consistent with \u003cb\u003eChan et al., 2005 and Castro et al., 2004\u003c/b\u003e, who concluded that the incidence of lupus mastitis is derived from the incidence of lupus panniculitis, which is also rare and occurs in 2\u0026ndash;3% of SLE patients (20 \u0026amp;21).\u003c/p\u003e\u003cp\u003eAmong the five patients with lupus mastitis in our cohort, two showed fibroadenoma and one exhibited fibrocystic changes. Increased skin thickness and tissue edema were observed in two cases, while macrocalcifications were reported in two patients. According to the BI-RADS classification, three cases were categorized as BI-RADS III and two cases (40%) as BI-RADS IV, necessitating tissue biopsy for the latter. Histopathological evaluation confirmed non-malignant inflammatory changes, specifically lymphocytic infiltration, consistent with lupus mastitis. In the cohort studied by \u003cb\u003eChow et al. (2021)\u003c/b\u003e, two cases of lupus mastitis were documented, both presenting with breast mass and pain. Imaging findings included extensive bilateral breast macrocalcifications in one case and an infiltrative irregular breast lump in the other (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn a systematic review of 22 cases of lupus mastitis, the most common radiological findings included isoechoic or hyperechoic breast masses, with or without calcifications. The calcifications were predominantly coarse, suggestive of fat necrosis secondary to post-inflammatory changes (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eClinically, lupus mastitis is often observed in patients with long-standing disease (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) and typically affects middle-aged women with established SLE (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). In our cohort, the five patients diagnosed with lupus mastitis were in their fifth and sixth decades of life and had experienced a prolonged duration of SLE, up to 23 years.\u003c/p\u003e\u003cp\u003eLupus mastitis may mimic malignancy on imaging studies, necessitating careful evaluation through tissue biopsy to rule out malignancy in suspicious lesions (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). However, the avoidance of tissue biopsy was advised by \u003cb\u003eOktay et al., 2021\u003c/b\u003e who emphasized on the importance of the professional knowledge about the imaging findings in lupus patients and correlating them with the precise history and examination that would decrease the number of interventional procedures that may worsen the breast condition and flare the disease aggressively (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eBreast cancer risk, calculated using the Gail model, revealed that 2 of SLE patients had a 5-year risk of breast cancer above average while 12 had a lifetime risk more than average. These figures were significantly lower compared to the control group. The reduced risk of breast cancer in patients with SLE, may be influenced by factors such as lower use of hormonal contraception.\u003c/p\u003e\u003cp\u003ePrevious research indicates that while SLE may increase the risk for certain cancers, such as lymphoma, it doesn't seem to be significantly associated with an increased risk for breast cancer. This is consistent with a \u003cb\u003eSong et al.,2018\u003c/b\u003e who did not find any significant link between SLE and breast cancer incidence (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003eBernatsky et al., 2003\u003c/b\u003e observed 12 cases of breast cancer among 564 SLE patients, which was higher than the 5.6 cases predicted by the Gail model. However, they suggested that other factors besides SLE itself might have contributed to these cases. These factors could include the use of alkylating agents or other immunosuppressive drugs, environmental exposures, or a genetic predisposition to cancer.\u003c/p\u003e\u003cp\u003eRecently, \u003cb\u003eShah et al., 2021\u003c/b\u003e confirmed that patients with SLE showed a lower risk of breast cancer than non SLE population who are influenced by multiple SLE autoantibodies positivity (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), giving the interest that anti-DNA can provide direct anti-neoplastic effects in cancer cells with DNA repair defects (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eBreast manifestations in SLE are relatively uncommon but can present unique diagnostic and therapeutic challenges. Due to the autoimmune nature of SLE and the use of various immunosuppressive therapies, breast health requires careful evaluation and monitoring. Lupus mastitis, although rare, should be considered in SLE patients presenting with breast lumps or inflammatory changes. Early diagnosis can prevent unnecessary surgical procedures and facilitate appropriate management with immunosuppressive therapy.\u003c/p\u003e\u003cp\u003eThis research has several shortcomings to be pointed out. The study's cross-sectional design prevented us from assessing temporal relationships or long-term outcomes, future prospective follow up studies are hence recommended. Awareness between physicians regarding autoimmune background of breast related disorders is necessitating especially in autoimmune diseases so further research is needed to investigate the pathophysiological mechanisms underlying lupus mastitis and other breast manifestations in SLE to develop targeted therapeutic strategies. Studies should also explore the long-term effects of SLE treatments on breast health, including the impact of immunosuppressive therapy on and risk of breast cancer.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eBreast involvement is not uncommon among SLE patients, with a variety of clinical and sono-mammographic manifestations, including lupus mastitis. Most breast findings were benign, and the risk of breast cancer, as assessed by the Gail model, was generally average, including those with lupus mastitis. These findings highlight the importance of regular breast assessment in SLE patients, particularly those with high disease activity.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBIRADS:\u0026nbsp;\u003cstrong\u003e\u003cem\u003eBreast imaging-reporting and data\u0026nbsp;\u003c/em\u003e\u003c/strong\u003esystem\u003c/p\u003e\n\u003cp\u003eSD: standard deviation\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSLE: Systemic lupus erythematosus\u003c/p\u003e\n\u003cp\u003eSLEDAI 2-K: SLE disease activity index\u003c/p\u003e\n\u003cp\u003eSLICC: Systemic lupus international collaborating clinics criteria\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eClinical Trial Number: Not Applicable\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e:\u003cstrong\u003e\u0026nbsp;Not applicable\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;All participants in this study were fully informed about the purpose, procedures, and potential risks and benefits of their involvement. Written informed consent was obtained from each participant prior to their inclusion in the study. Participants were assured of the confidentiality of their responses and their right to withdraw at any time without consequence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publication:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eNot applicable\u003c/strong\u003e \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study conforms to the 1995 Helsinki declaration and approved by the research ethical committee, FWA000017585 (No: FMASU M S 606/2023).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data are available on\u0026nbsp;reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eSiegel CH, Sammaritano LR. Systemic Lupus Erythematosus: A Review. \u003cem\u003eJAMA.\u003c/em\u003e 2024. 331(17):1480\u0026ndash;91.\u003c/li\u003e\n \u003cli\u003eChow DLY, Wong T, Chau CM, et al. Breast manifestations in patients with systemic lupus erythematosus. Hong Kong Journal of Radiology. 2021. 24:257-69.\u003c/li\u003e\n \u003cli\u003eHe, L.J., Quimson, L.C., Onajin, O. \u003cem\u003eet al.\u003c/em\u003e Lupus mastitis and antiphospholipid syndrome treated with anticoagulation and immunosuppression: a case report. \u003cem\u003eJ Med Case Reports.\u003c/em\u003e 2023. 17, 356.\u003c/li\u003e\n \u003cli\u003eDeBandt M, Meyer O, Grossin M, Kahn MF. Lupus mastitis heralding systemic lupus erythematosus with antiphospholipid syndrome. \u003cem\u003eJ Rheumatol\u0026nbsp;\u003c/em\u003e1993. 20:1217\u0026ndash;20\u003c/li\u003e\n \u003cli\u003eRosa M, Mohammadi A. Lupus mastitis: a review. Ann Diagn Pathol. 2013;17(2):230\u0026ndash;3.\u003c/li\u003e\n \u003cli\u003eVoizard B, Lalonde L, Sanchez LM, et al., Lupus mastitis as a first manifestation of systemic disease: about two cases with a review of the literature. European journal of radiology. 2017. 1; 92:124-31.\u003c/li\u003e\n \u003cli\u003eGoulabchand R, Hafidi A, Van de Perre P, et al. Mastitis in autoimmune diseases: review of the literature, diagnostic pathway, and pathophysiological key players. Journal of Clinical Medicine. 2020. 9(4):958.\u003c/li\u003e\n \u003cli\u003eOktay A, Esmat HA, Aslan \u0026Ouml;, Mirzafarli I. Lupus mastitis in a young female mimicking a breast carcinoma: A rare entity through a case report and review of the literature. European Journal of Breast Health. 2022.18(1):13-5.\u003c/li\u003e\n \u003cli\u003ePimentel A, Moreira A, Silva S, et al., Lupus mastitis: A rare breast cancer differential diagnosis. Clinical Case Reports. 2021 9(7): e04416.\u003c/li\u003e\n \u003cli\u003eRoongta R, Joshi S, Chattopadhyay A, Ghosh A. Lupus Mastitis. Reumatologia clinica. 2022. 1;18(5):312-3.\u003c/li\u003e\n \u003cli\u003ePetri M, Orbai AM, Alarc\u0026oacute;n GS, et al. Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis and Rheumatology. 2012. 64(8):2677-86.\u003c/li\u003e\n \u003cli\u003eGladman DD, Ibanez D, Urowitz MB. Systemic lupus erythematosus disease activity index 2000. Journal of Rheumatology. 2002. 29(2):288-291.\u003c/li\u003e\n \u003cli\u003eGail MH, Brinton LA, Byar DP, et al. Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. JNCI Journal of the National Cancer Institute. 1989. 81(24):1879-86.\u003c/li\u003e\n \u003cli\u003eD\u0026rsquo;Orsi CJ, Sickles EA, Mendelson EB, et al. ACR BI-RADS\u0026reg; Atlas, Breast Imaging Reporting and Data System. Reston, VA, American College of Radiology; 2013. ISBN:155903016X\u003c/li\u003e\n \u003cli\u003eMaineiero MB, Cinelli CM, Koelliker SL, et al., Axillary Ultrasound and Fine Needle Aspiration In The Preoperative Evaluation Of The Breast Cancer Patient: An Algorithm Based On Tumor Size And Lymph Node Appearance. Women\u0026rsquo;s Imaging Original Research. 2010. 195:1261-67.\u003c/li\u003e\n \u003cli\u003eCiarini L, Fr\u0026ouml;de TS, Simezo \u0026Eacute;E. Mammary manifestation of Systemic Lupus Erythematosus in patient with associated scleroderma: a case report. Brazilian Society o Mastology 2024. 34:e20240030\u003c/li\u003e\n \u003cli\u003eStull C, Sprow G, Werth VP. Cutaneous involvement in systemic lupus erythematosus: a review for the rheumatologist. J Rheumatol. 2023. 50(1):27-35. https://doi.org/10.3899/ jrheum.220089\u003c/li\u003e\n \u003cli\u003eSharma A, Blank A, Komforti MK. Rare initial manifestation of lupus as lobular panniculitis of the breast\u0026ndash;a case report and review of the literature. Am J Dermatopathol. 2021.43(5):381- 85. https://doi.org/10.1097/DAD.0000000000001846\u003c/li\u003e\n \u003cli\u003eWarne RR, Taylor D, Segal A, Irish A. Lupus mastitis: A mimicker of breast carcinoma. BMJ Case Reports. 2011. bcr1120115066.\u003c/li\u003e\n \u003cli\u003eChen X, Hoda SA, Delellis RA, Seshan SV: Lupus mastitis. Breast J. 2005, 11:283-4. 10.1111/j.1075- 122x.2005.21481.x\u003c/li\u003e\n \u003cli\u003eCastro GR, Appenzeller S, Soledade C, et al., Mastitis refractory to cyclophosphamide in systemic lupus erythematosus. Clin Exp Rheumatol. 2004. 22:786.\u003c/li\u003e\n \u003cli\u003eKinonen C, Gattuso P, Reddy VB. Lupus mastitis: An uncommon complication of systemic or discoid lupus. American Journal of Surgical Pathology. 2010. 34:901-6.\u003c/li\u003e\n \u003cli\u003eVilas-Sueiro A, Gonzaales-Vilas D, Aguilera C, Monteagudo B. Hardness and painful lesion of the breast. Acta Dermatovenerologica Croatica. 2017.25(4):305.\u003c/li\u003e\n \u003cli\u003eSong L, Wang Y, Zhang J, et al., The risks of cancer development in systemic lupus erythematosus (SLE) patients: A systematic review and meta-analysis. Arthritis Research \u0026amp; Therapy. 2018. 20:270.\u003c/li\u003e\n \u003cli\u003eBernatsky S, Ramsey-Goldman R, Boivin JF, et al. Do traditional Gail model risk factors account for increased breast cancer in women with lupus? Journal of Rheumatology. 2003. 30(7):1505-7.\u003c/li\u003e\n \u003cli\u003eShah, A.A., Igusa, T., Goldman, D. et al. Association of systemic lupus erythematosus autoantibody diversity with breast cancer protection. Arthritis Res Ther 23, 64.2021. https://doi.org/10.1186/s13075-021-02449-3\u003c/li\u003e\n \u003cli\u003eHansen JE, Chan G, Liu Y, et al. Targeting cancer with a lupus autoantibody. Sci Transl Med. 2012. 4:157ra42\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable (1): Clinical characteristics of the studied lupus patients\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"108%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePatients group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\"\u003e\n \u003cp\u003eAge / years (Mean \u0026plusmn; SD)\u003c/p\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e40.03 \u0026plusmn; 5.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e30 \u0026ndash; 57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003eDisease duration / years (Mean \u0026plusmn; SD)\u003c/p\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12.22 \u0026plusmn; 8.44\u003c/p\u003e\n \u003cp\u003e0.6 \u0026ndash; 33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003eConstitutional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e41(41%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003eMucocutaneous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e56 (56%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003eHematological\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e41 (41%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003eMusculoskeletal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e76 (76%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e\u0026nbsp;Neurological\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e26 (26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003eSerositis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e30(30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003eRenal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e47 (47%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eSLEDI-k2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003cp\u003eRemission\u003c/p\u003e\n \u003cp\u003eMild to moderate\u003c/p\u003e\n \u003cp\u003eSevere\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\"\u003e\n \u003cp\u003e1 \u0026ndash; 39\u003c/p\u003e\n \u003cp\u003e15 (8 \u0026ndash; 20)\u003c/p\u003e\n \u003cp\u003e10 (10%)\u003c/p\u003e\n \u003cp\u003e31 (31%)\u003c/p\u003e\n \u003cp\u003e59 (59%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;Drug history\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003eSteroids\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003eHydroxychloroquine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e68 (68%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003eAzathioprine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e86 (86%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003eCyclophosphamide\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e36 (36%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003eMycophenolate Mofetil\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e38 (38%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003eRituximab\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo. of patients with breast symptoms\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e12(12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" style=\"width: 41px;\"\u003e\n \u003cp\u003eLump\u003c/p\u003e\n \u003cp\u003eDischarge\u003c/p\u003e\n \u003cp\u003eSkin abnormalities (oedema or redness)\u003c/p\u003e\n \u003cp\u003ePain\u003c/p\u003e\n \u003cp\u003eNipple changes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e8 (8.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e3 (3.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e2 (2.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e6 (6.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eSD: standard deviation, IQR: \u0026nbsp;Interquartile Range\u003cstrong\u003e,\u0026nbsp;\u003c/strong\u003eSLEDAI K2: The Systemic Lupus Erythematosus Disease Activity Index,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (\u003c/strong\u003e\u003cstrong\u003e2):\u003c/strong\u003e Comparison between control and patients groups\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl group\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=100)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatients group\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=100)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 49px;\"\u003e\n \u003cp\u003eAge / years \u0026nbsp;Mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e41.64 \u0026plusmn; 8.19\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e40.03 \u0026plusmn; 5.20\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.099\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eMenstrual history\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"3\" style=\"width: 35px;\"\u003e\n \u003cp\u003eRegular\u003c/p\u003e\n \u003cp\u003eIrregular\u003c/p\u003e\n \u003cp\u003eMenopause\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e76 (76.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e57 (57.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e6 (6.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e38 (38.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e18 (18.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e5 (5.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 35px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"4\" style=\"width: 35px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003cp\u003eWidow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e7 (7.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e17 (17.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.030\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e84 (84.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e72 (72.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.093\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e4 (4.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e10 (10.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.096\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e5 (5.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e1 (1.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.097\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 35px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eContraception\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e84 (84.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e72 (72.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.093\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"3\" style=\"width: 35px;\"\u003e\n \u003cp\u003eHormonal\u003c/p\u003e\n \u003cp\u003eIUCD\u003c/p\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e48 (57.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e14 (19.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e20 (23.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e25 (34.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.134\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e16 (19.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e33 (45.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 49px;\"\u003e\n \u003cp\u003eNon-Smoker \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e96 (96.0%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e92 (92.0%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.234\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSono-mammographic finding(n, %)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e12 (12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e28 (28%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 49px;\"\u003e\n \u003cp\u003eSkin thickness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e2 (2.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.081\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 49px;\"\u003e\n \u003cp\u003eTissue edema\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;4 (4.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.316\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 49px;\"\u003e\n \u003cp\u003eDucts ectasia\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;2 (2.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;8 (8.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.145\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 49px;\"\u003e\n \u003cp\u003eFibroadenoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e8 (8.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e10 (10.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.123\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 49px;\"\u003e\n \u003cp\u003eFibrocystic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e2 (2.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e8 (8.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.145\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 49px;\"\u003e\n \u003cp\u003eCalcification\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e2 (2.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e7 (7.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.134\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBIRADs category\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" style=\"width: 32px;\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003cp\u003eII\u003c/p\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003cp\u003eIV\u003c/p\u003e\n \u003cp\u003eV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e89 (89.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e72 (72.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e6 (6.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e7 (7.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.775\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e4 (4.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e19 (19.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e2 (2.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.155\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e1 (1.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.316\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAxillary LN (n, %)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e7 (7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e14 (14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.107\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eReactionary\u003c/p\u003e\n \u003cp\u003eIndeterminate\u003c/p\u003e\n \u003cp\u003eSuspicious\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e5 (5.0%)\u003c/p\u003e\n \u003cp\u003e1 (1.0%)\u003c/p\u003e\n \u003cp\u003e1 (1.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e12 (12.0%)\u003c/p\u003e\n \u003cp\u003e2 (2.0%)\u003c/p\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.233\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003cstrong\u003eBreast Cancer Risk Assessment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5yrs risk\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 32px;\"\u003e\n \u003cp\u003eAverage\u003c/p\u003e\n \u003cp\u003eMore than average\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e85 (85.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e98 (98.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e15 (15.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e2 (2.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLife-time Risk \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 32px;\"\u003e\n \u003cp\u003eAverage\u003c/p\u003e\n \u003cp\u003eMore than average\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e71 (71.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e88 (88.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e29 (29.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e12 (12.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;SD: standard deviation, BIRADs: Breast Imaging Reporting and Data System., LN: lymph node.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u003c/strong\u003e (3): Characteristics of the 5 patients diagnosed as lupus mastitis\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"650\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ecase 1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ecase 2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; case 3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ecase 4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;case 5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eAge/ years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eAge of SLE diagnosis/ years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eDisease duration /years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eMenstrual history\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eMenopause\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eRegular\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eRegular\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003eIrregular\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eIrregular\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eContraception\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eIUCD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eIUCD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eSmoking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eHistory of cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eSLEDAI 2-K\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e24 (Severe)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e17 (Severe)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e38 (Severe)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e19 (Severe)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e24(Severe)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eBreast Symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eSoft mass\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003ePain and erythema\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003epain and\u003c/p\u003e\n \u003cp\u003eerythema\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e5-year risk of breast cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" style=\"width: 530px;\"\u003e\n \u003cp\u003eAverage\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eLife-time risk of breast cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" style=\"width: 530px;\"\u003e\n \u003cp\u003eAverage\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eFibroadenoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eFibrocystic\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eEdema\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eIncreased Skin thickness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eDucts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eNo abnormality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eNo abnormality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eNo abnormality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003eNo abnormality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eNo abnormality\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eCalcifications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eIrregular multiple right sided\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eMacro bilateral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eBIRADs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eAxillary LN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eIndeterminate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eReactionary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eReactionary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eReactionary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSLE: Systemic Lupus Erythematosus , SLEDAI K2: The Systemic Lupus Erythematosus Disease Activity Index\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"egyptian-rheumatology-and-rehabilitation","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"","snPcode":"43166","submissionUrl":"https://submission.springernature.com/new-submission/43166/3","title":"Egyptian Rheumatology and Rehabilitation","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Lupus mastitis, Gail's model, SLE","lastPublishedDoi":"10.21203/rs.3.rs-7529706/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7529706/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eBreast involvement in Systemic Lupus Erythematosus (SLE) has been previously described in the literature. Diagnosing lupus-related mastitis is challenging for both patients and clinicians, as it is essential to rule out more serious conditions such as breast cancer. Unfortunately, there are no established guidelines or distinctive features that clearly define breast involvement in SLE that complicates both diagnosis and management. This study aims to evaluate breast manifestations, sono-mammographic findings, and breast cancer risk in SLE patients\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethodology:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA case-control study was conducted including 100 female SLE patients (aged\u0026thinsp;\u0026gt;\u0026thinsp;30 years, diagnosed by 2012 SLICC criteria) and 100 age-matched healthy controls. All participants underwent clinical breast evaluation, laboratory investigations, breast cancer risk assessment using the Gail Model, and breast imaging (mammography and ultrasound), with findings classified according to the BIRADS system. Disease activity was assessed by Systemic Lupus Erythematosus Disease Activity Index-2K(SLEDAI2k).\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e\u003cp\u003eBreast manifestations were reported by 12% of patients, most frequently as breast lumps (8%) and pain (6%). Sono-mammographic abnormalities were detected in 28% of patients, with fibroadenoma (10%) and fibrocystic changes (8%) being the most common findings. Lupus mastitis was identified in 5% of patients, all with severe SLE activity; most had subcutaneous edema, and some showed calcifications or fibroadenoma. Pathological confirmation was obtained in two cases. According to the Gail model, 98% of SLE patients had an average 5-year breast cancer risk, all lupus mastitis cases had average risk. Compared to healthy controls, there was no significant difference in sono-mammographic findings, but controls had a higher proportion with above-average breast cancer risk. No significant demographic or laboratory differences were found between SLE patients with and without breast manifestations, except for a higher rate of severe disease activity among those with breast manifestations.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusions\u003c/b\u003e\u003c/p\u003e\u003cp\u003eBreast involvement is not uncommon among SLE patients, with a variety of clinical and sono-mammographic manifestations, including lupus mastitis. Most breast findings were benign, and the risk of breast cancer, as assessed by the Gail model, was generally average, including those with lupus mastitis. These findings highlight the importance of regular breast assessment in SLE patients, particularly those with high disease activity.\u003c/p\u003e","manuscriptTitle":"Breast Manifestations and breast cancer risk in a Cohort of Female Egyptian Systemic Lupus Erythematosus","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-13 11:27:40","doi":"10.21203/rs.3.rs-7529706/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-21T04:55:14+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-12T19:23:25+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-02T07:05:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"162587436209278919339761821166874093487","date":"2025-10-02T05:39:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"37635432142406206325937484900832953496","date":"2025-09-30T17:54:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"230574057373011658873945030337754100041","date":"2025-09-30T11:55:47+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-30T11:30:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"6347146807560910434656105124251350808","date":"2025-09-30T11:27:30+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-30T05:00:09+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-29T09:45:40+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-28T23:42:39+00:00","index":"","fulltext":""},{"type":"submitted","content":"Egyptian Rheumatology and Rehabilitation","date":"2025-09-25T09:06:21+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"egyptian-rheumatology-and-rehabilitation","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"","snPcode":"43166","submissionUrl":"https://submission.springernature.com/new-submission/43166/3","title":"Egyptian Rheumatology and Rehabilitation","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"54d15c9e-d2cd-43f8-8c1c-21277a622258","owner":[],"postedDate":"October 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-25T07:38:37+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-13 11:27:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7529706","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7529706","identity":"rs-7529706","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}