SABCS: Unsuspected Malignancies and Atypical Hyperplasia Found in Breast Reduction Tissue

Charles Bankhead
SAN ANTONIO, Dec. 17 -- Women undergoing breast reduction surgery have much higher rates of occult cancer and atypical hyperplasia than previously recognized, according to data reported here. Almost 12% of 160 women had significant pathologic findings, Abiy B. Ambaye, M.D., of the University of Vermont in Burlington, said at the San Antonio Breast Cancer Symposium. This is more than double the highest occurrence rate of occult breast cancer in breast reduction tissue found by previous studies and apparently reflects more thorough pathology of specimens.
"The risk of significant pathology is higher in women over the age of 40, and especially women who are 50 or older," said Dr. Ambaye. "You have an opportunity to identify occult cancer, so it is important to perform adequate tissue sampling, particularly in older women."
More than 100,000 women undergo reduction mammoplasty each year in the U.S. Estimates of occult carcinoma in those patients range from 0.06% to 4.6%, said Dr. Ambaye. However, no standard approach exists for pathologic assessment of reduction mammoplasty specimens.
Investigators prospectively analyzed records on 160 patients who had reduction mammoplasty procedures for macromastia or breast asymmetry. For the study, a more extensive pathologic examination was performed.
Routine analysis involves three breast tissue sections and one skin section. Dr. Ambaye and colleagues analyzed two additional tissue section sets of four breast tissue sections each (a total of 11 breast tissue sections compared with the usual three).
Overall, 19 patients (11.9%) had significant pathologic findings:
Nine cases of atypical lobular hyperplasia
Three cases of lobular carcinoma in situ
Three cases of atypical ductal hyperplasia
Two cases of ductal carcinoma in situ
Two invasive breast cancers
Four patients had skin nevi that were evident clinically and on visual examination.
Patients found to have significant pathologic findings (carcinoma and atypical hyperplasia) had preoperative negative mammograms within one year (17), 18 months (1), or three years (1) prior to reduction mammoplasty procedures.
All but one of the abnormalities involved women ages 40 and older. Atypical lobular hyperplasia was found in a specimen from a 39-year-old woman. The cancer occurrence rate was 6.5% in women 40 or older and 7.8% (five of the seven cancers) in patients 50 or older. The study demonstrated no association between breast size and the likelihood of breast pathology.
All of the breast pathology was identified in the second tier of tissue sampling, suggesting that the third level of sampling is unnecessary.
On the basis of the findings, Dr. Ambaye and colleagues recommend that patients ages 40 or older should be sampled more extensively for pathologic analysis. Sampling of skin is unnecessary in the absence of clinically or visually apparent lesions. They emphasize that a negative preoperative mammogram does not exclude the possibility of occult breast pathology.
Dr. Ambaye reported no potential conflicts of interest.
Primary source: Breast Cancer Research and TreatmentSource reference:Ambaye AB, et al "Carcinoma and atypical hyperplasia are frequent findings in women with macromastia undergoing reduction mammoplasty: a prospective study" Breast Cancer Res Treat 2007; 106(Suppl): Abstract 6051.