Lobular involution: localized phenomenon or field effect?

As women age, the lobules in their breasts undergo involution. We have shown that, in women with benign breast disease, progressive involution assessed near the benign lesion is associated with lower breast cancer risk. However, it is unknown whether the extent of involution is variable or uniform across the entire breast. We compared involution across the four quadrants of both breasts for fifteen women undergoing bilateral prophylactic mastectomy. One pathologist classified involution extent as none (0% involuted lobules), mild (1–24%), moderate (25–74%), or complete (≥75%). We assessed intra-woman concordance using intraclass correlation coefficients (ICCs), kappa coefficients, and pairwise comparisons of agreement. We found strong intra-woman concordance of involution across the eight quadrants of breast tissue (ICC = 0.75, 95% CI 0.59, 0.89). Our study suggests that lobular involution is a homogeneous process, supporting the use of involution measures from a single benign biopsy as a component in breast cancer risk assessment paradigms.