Patients with PABC are often found to have advanced disease at diagnosis, with the median size of tumor ranging from 3.4 to 4 cm and the reported incidence of axillary lymph node metastasis between 56% and 73%.
Delay in diagnosis is often due to the physiologic changes that occur in breasts during pregnancy that can pose challenges for differentiating a new mass from engorged and nodular breast tissue on a physical examination.
In the first and second trimesters, there is active proliferation and differentiation of the lobules, alveoli, and lactiferous ducts, leading to enlargement and increased overall density of breast tissue.
The prolactin level rises during the third trimester, which stimulates milk-producing cells to differentiate, and alveoli and milk ducts are filled with colostrum.
Around parturition, the breasts undergo lactogenesis, which leads to the secretion of colostrum and then milk.
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