Nearly 10% of 444 women who had surgery to reduce the size of their breasts had abnormal-looking cells in the breast tissue that was removed, according to the study reviewed here. Doctors call these abnormal-looking breast cells atypical hyperplasia. Atypical hyperplasia is not cancer and not life-threatening, but is associated with a higher-than-average risk of developing breast cancer later in life. The results were presented at the 2009 ASCO Breast Cancer Symposium.
Atypical hyperplasia usually is found during breast biopsy. A biopsy typically is done if a suspicious area is found by mammogram, doctor's physical breast exam, or breast self-exam. If a large number of healthy women had breast biopsies, doctors would expect about 1% of the women to have atypical hyperplasia.
The researchers in this study aren't sure why atypical hyperplasia was found in a higher percentage (nearly 10%) of the women in the study. An earlier study done by the same researchers also found either early cancer that wasn't recognized (occult breast cancer) or atypical hyperplasia in the removed breast tissue of 12% of women who had breast reduction surgery.
In this study, women most likely to have atypical hyperplasia:
Because women with atypical hyperplasia have a higher-than-average risk of breast cancer, their doctors will likely talk to them about options to reduce that risk. Pre-menopausal women may consider taking tamoxifen, a hormonal therapy medicine, to reduce risk. Doctors consider a number of factors, such as age and family history, when deciding whether a treatment to lower breast cancer risk makes sense. In this study, all the women with atypical hyperplasia were referred to a medical oncologist or surgeon to have their risk status evaluated. Based on personal and medical history, hormonal therapy medicine to reduce risk was recommended to about 33% of the women. Only one woman chose to take hormonal therapy.
If you're considering breast reduction surgery, know that your doctor will likely send the removed breast tissue for analysis by a pathologist, even if you have no breast cancer concerns. As this study shows, it's possible that abnormal results, such as atypical hyperplasia, could be found. If you have breast reduction surgery, it's a good idea to ask your doctor to go over the results of the pathology report on the removed breast tissue so you can address any areas concerns together.
SAN FRANCISCO (MedPage Today) -- Breast reduction surgery turns up abnormal breast pathology in roughly one woman in 10, researchers affirmed.
The 9.7% of women found to have atypia in excised breast tissue was much higher than the less than 1% incidence expected in the general population, Lily Wu, a medical student at Brown University in Providence, R.I., reported here at the ASCO Breast Cancer Symposium.
Her group's retrospective findings affirm those from an earlier study, which found a 12% rate of occult cancer and atypical hyperplasia in women having reduction mammoplasty.
The high rate didn't surprise W. Fraser Symmans, MD, of the M.D. Anderson Cancer Center in Houston, who served as co-chair of the conference program committee. "If you look, you will find," he said, and the more invasive the look (i.e., biopsy or more sensitive imaging) the greater the likelihood of finding something suspicious.
Finding atypia would normally be expected to more than quadruple a woman's risk of a future breast cancer diagnosis, but the implications for women who have already had the breast tissue excised are unclear, Wu noted, particularly since breast reduction surgery is typically considered protective against breast cancer.
Symmans noted that association of atypia with risk is a loose link, as future tumors don't necessarily arise in the same location as the atypia. Rather it may indicate something about hormonal factors in the breast.
Wu's group searched through patient records at Brown-affiliated Roger Williams Medical Center for all women who had had breast reduction surgery over an eight-year period.
The 444 women with pathology results but no history of breast cancer were 37 years old on average, and 14.4% had a family history of breast cancer.
Atypia appeared in the excised breast tissue of 43 of the women (9.7%); one had an incidentally discovered invasive ductal cancer (0.23%) and went on to node biopsy, chemotherapy, and radiation.
Older women were much more likely to have abnormal pathology found at breast reduction surgery. Compared with those younger than 30, the odds were:
Other factors predicting atypia and occult cancer in this healthy population were more prior imaging studies (odds ratio 3.2, P<0.001) and family history of breast cancer (OR 3.6, P<0.001).
The women in the study who were identified with abnormal pathology were all referred to a medical oncologist or surgeon for high-risk evaluation. About one-third were recommended to take prophylactic hormonal therapy, although only one of the women accepted treatment.
Wu's group cautioned that the study did not have data on some potentially important factors, such as reproductive history, and that longer-term follow-up is needed to see the effect of intensive surveillance and outcomes in these patients.
Until such evidence is available, these women with incidentally discovered atypia should not be considered automatically high risk, commented Lori Pierce, MD, of the University of Michigan in Ann Arbor and co-chair of the conference program committee.
"Depending upon other factors such as family history, it would be important to assess what her risk is," she said. "And then put her in the appropriate follow-up scheme."
The researchers reported no conflicts of interest.
Pierce reported having received research funding from the National Institutes of Health and the Breast Cancer Research Foundation.
Symmans reported conflicts of interest with Agendia, Genentech, Invitrogen, Nuvera Biosciences, Amgen, Cell Therapeutics, and Isis Pharmaceuticals.
Primary source: ASCO Breast Cancer Symposium Source reference: Wu L, et al "The incidence of abnormal pathologic findings in women undergoing elective breast reduction" ASCO Breast 2009; Abstract 12.
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