I was going through files today and came across my original notes on a woman who had inflammatory breast cancer, this is the second mom to contact me with this horrendous illness while breastfeeding. The first had continuous "deep breast pain" and was not diagnosed until she weaned and she died several months later. I thought you might like to be familiar with this case history. This mom initially called several times with plugged ducts when her baby was about six weeks old. This coincided with her return to work and pumping, separation etc., so we thought it was related to irregular emptying of the breast. She was an experienced nursing mom who was very knowledgable and had access to good resources. She tried massaging and changing nursing positions, heat, ice and every thing else we could think of. The inflammation got worse and she was treated for mastitis although she did not have a fever or flu-like symptoms. After 6 or 7 days and a change in antibiotics, it seemed possibly worse and definitery not better. The inflammation was visible as a large area on the upper outer quadrant of the breast from 8-12 o'clock She had a fine needle aspiration (18 gauge needle) for a culture which collected sterile, sero-sanguinous fluid, ("coffee grounds" was written in my notes), The doctor thought she had an "abcess broken through blood vessels." I suggested she follow up with an ultrasound, this showed an area with "irregular edges"- not consistent with an abcess, so they tried a mammogram. This showed an area dense with inflammation and/or milk, the radiologist said it looked like a lactating breast. Then they did an ultrasound of the whole breast and found several other pockets (?) and recommended a biopsy. Her care providers initial reaction was to give it some more time and not rush things since she was so newly postpartum, but we encouraged him to talk to another knowledgable physician who recommended immediate biopsy. She had a biopsy the following day, was diagnosed with inflammatory breast cancer and started chemo two days later. After her chemo to stop growth, she underwent radiation and then a mastectomy. She has also had a bone marrow transplant and more chemo. She is doing well and still praying that it will not return. It will be three years this January. In working with breastfeeding moms , I think we need to ba aware that there are situations like this that need quick action and that we should trust a mother's feelings that something just doesn't seem right. Cathy Liles