Top

Published in:

01-01-2019 | Epidemiology

Pathologic findings in reduction mammoplasty specimens: a surrogate for the population prevalence of breast cancer and high-risk lesions

Authors: Francisco Acevedo, V. Diego Armengol, Zhengyi Deng, Rong Tang, Suzanne B. Coopey, Danielle Braun, Adam Yala, Regina Barzilay, Clara Li, Amy Colwell, Anthony Guidi, Curtis L. Cetrulo Jr., Judy Garber, Barbara L. Smith, Tari King, Kevin S. Hughes

Published in: Breast Cancer Research and Treatment | Issue 1/2019

Abstract

Purpose

Mammoplasty removes random samples of breast tissue from asymptomatic women providing a unique method for evaluating background prevalence of breast pathology in normal population. Our goal was to identify the rate of atypical breast lesions and cancers in women of various ages in the largest mammoplasty cohort reported to date.

Methods

We analyzed pathologic reports from patients undergoing bilateral mammoplasty, using natural language processing algorithm, verified by human review. Patients with a prior history of breast cancer or atypia were excluded.

Results

A total of 4775 patients were deemed eligible. Median age was 40 (range 13–86) and was higher in patients with any incidental finding compared to patients with normal reports (52 vs. 39 years, p = 0.0001). Pathological findings were detected in 7.06% (337) of procedures. Benign high-risk lesions were found in 299 patients (6.26%). Invasive carcinoma and ductal carcinoma in situ were detected in 15 (0.31%) and 23 (0.48%) patients, respectively. The rate of atypias and cancers increased with age.

Conclusion

The overall rate of abnormal findings in asymptomatic patients undergoing mammoplasty was 7.06%, increasing with age. As these results are based on random sample of breast tissue, they likely underestimate the prevalence of abnormal findings in asymptomatic women.

Siegel RL, Miller KD, Jemal A (2018) Cancer statistics, 2018. CA Cancer J Clin 68:7–30. https://doi.org/10.3322/caac.21387 CrossRefPubMed

Tozbikian G, Brogi E, Vallejo CE et al (2017) Atypical ductal hyperplasia bordering on ductal carcinoma in situ. Int J Surg Pathol 25:100–107. https://doi.org/10.1177/1066896916662154 CrossRefPubMed

Allison KH, Abraham LA, Weaver DL et al (2015) Trends in breast biopsy pathology diagnoses among women undergoing mammography in the United States: a report from the Breast Cancer Surveillance Consortium. Cancer 121:1369–1378. https://doi.org/10.1002/cncr.29199 CrossRefPubMed

Fagerberg G, Baldetorp L, Gröntoft O et al (1985) Effects of repeated mammographic screening on breast cancer stage distribution: results from a randomised study of 92 934 women in a swedish county. Acta Oncol (Madr) 24:465–473. https://doi.org/10.3109/02841868509134418 CrossRef

Moss S, Thomas I, Evans A et al (2005) Randomised controlled trial of mammographic screening in women from age 40: results of screening in the first 10 years. Br J Cancer 92:949–954. https://doi.org/10.1038/sj.bjc.6602396 CrossRefPubMedPubMedCentral

Bjurstam N, Björneld L, Warwick J et al (2003) The Gothenburg breast screening trial. Cancer 97:2387–2396. https://doi.org/10.1002/cncr.11361 CrossRefPubMed

Miller AB, Baines CJ, To T, Wall C (1992) Canadian National Breast Screening Study: 1. Breast cancer detection and death rates among women aged 40 to 49 years. CMAJ 147:1459–1476PubMedPubMedCentral

Miller AB, Baines CJ, To T, Wall C (1992) Canadian National Breast Screening Study: 2. Breast cancer detection and death rates among women aged 50 to 59 years. CMAJ 147:1477–1488PubMedPubMedCentral

Roberts MM, Alexander FE, Anderson TJ et al (1990) Edinburgh trial of screening for breast cancer: mortality at seven years. Lancet 335:241–246. https://doi.org/10.1016/0140-6736(90)90066-E CrossRefPubMed

10.

Shapiro S (1977) Evidence on screening for breast cancer from a randomized trial. Cancer 39:2772–2782. https://doi.org/10.1002/1097-0142(197706)39:6 CrossRefPubMed

11.

Frisell J, Eklund G, Hellström L et al (1989) The Stockholm breast cancer screening trial–5-year results and stage at discovery. Breast Cancer Res Treat 13:79–87CrossRefPubMed

12.

Thomas ET, Del Mar C, Glasziou P et al (2017) Prevalence of incidental breast cancer and precursor lesions in autopsy studies: a systematic review and meta-analysis. BMC Cancer 17:1–10. https://doi.org/10.1186/s12885-017-3808-1 CrossRef

13.

Statistics ANC of PSP (2016) 2016 plastic surgery statistics. 23

14.

Data M (2016) 2016 Cosmetic Surgery National Data Bank statistics. Am Soc Aesthetic Plast Surg

15.

Degnim AC, Visscher DW, Hoskin TL et al (2012) Histologic findings in normal breast tissues: comparison to reduction mammaplasty and benign breast disease tissues. Breast Cancer Res Treat 133:169–177. https://doi.org/10.1007/s10549-011-1746-1 CrossRefPubMed

16.

Desouki MM, Li Z, Hameed O et al (2013) Incidental atypical proliferative lesions in reduction mammoplasty specimens: analysis of 2498 cases from 2 tertiary women’s health centers. Hum Pathol 44:1877–1881. https://doi.org/10.1016/j.humpath.2013.02.015 CrossRefPubMed

17.

Pitanguy I, Torres E, Salgado F, Viana GAP (2005) Breast pathology and reduction mammaplasty. Plast Reconstr Surg 115:729–734. https://doi.org/10.1097/01.PRS.0000152683.62899.50 discussion 735.CrossRefPubMed

18.

Usón Junior PLS, Callegaro Filho D, Bugano DDG et al (2018) Incidental findings in reduction mammoplasty specimens in patients with no prior history of breast cancer. An analysis of 783 specimens. Pathol Oncol Res 24:95–99. https://doi.org/10.1007/s12253-017-0230-6 CrossRefPubMed

19.

Dotto J, Kluk M, Geramizadeh B, Tavassoli FA (2008) Frequency of clinically occult intraepithelial and invasive neoplasia in reduction mammoplasty specimens: a study of 516 cases. Int J Surg Pathol 16:25–30. https://doi.org/10.1177/1066896907307176 CrossRefPubMed

20.

Kakagia D, Fragia K, Grekou A, Tsoutsos D (2005) Reduction mammaplasty specimens and occult breast carcinomas. Eur J Surg Oncol 31:19–21. https://doi.org/10.1016/j.ejso.2004.07.026 CrossRefPubMed

21.

Viana Pires GA, Pitanguy I, Torres E (2005) Histopathological findings in surgical specimens obtained from reduction mammaplasties. Breast 14:242–248. https://doi.org/10.1016/j.breast.2004.12.006 CrossRef

22.

Sofianos C, Zinn RJ, Geoffreys DA, Kruger D (2015) Pathological findings in reduction mammoplasty specimens: a South African perspective. S Afr Med J 105:308–311. https://doi.org/10.7196/SAMJ.9108 CrossRefPubMed

23.

Slezak S, Bluebond-Langner R (2011) Occult carcinoma in 866 reduction mammaplasties: preserving the choice of lumpectomy. Plast Reconstr Surg 127:525–530. https://doi.org/10.1097/PRS.0b013e3181fed5dc CrossRefPubMed

24.

Colwell AS, Kukreja J, Breuing KH et al (2004) Occult breast carcinoma in reduction mammaplasty specimens: 14-year experience. Plast Reconstr Surg 113:1984–1988. https://doi.org/10.1097/01.PRS.0000122212.37703.6E CrossRefPubMed

25.

Freedman BC, Smith SMR, Estabrook A et al (2012) Incidence of occult carcinoma and high-risk lesions in mammaplasty specimens. Int J Breast Cancer 2012:145630. https://doi.org/10.1155/2012/145630 CrossRefPubMedPubMedCentral

26.

Ambaye AB, MacLennan SE, Goodwin AJ et al (2009) Carcinoma and atypical hyperplasia in reduction mammaplasty: increased sampling leads to increased detection. A prospective study. Plast Reconstr Surg 124:1386–1392. https://doi.org/10.1097/PRS.0b013e3181b988da CrossRefPubMed

27.

Ambaye AB, Goodwin AJ, MacLennan SE et al (2017) Recommendations for pathologic evaluation of reduction mammoplasty specimens: a prospective study with systematic tissue sampling. Arch Pathol Lab Med. 141:1523–1528. https://doi.org/10.5858/arpa.2016-0492-OA CrossRef

28.

Ishag MT, Baschinsky DY, Beliaeva IV et al (2003) Pathologic findings in reduction mammaplasty specimens. Am J Clin Pathol 120:377–380. https://doi.org/10.1309/4KD6-52HN-739X-TLM3 CrossRefPubMed

29.

Buckley JM, Coopey SB, Sharko J et al (2012) The feasibility of using natural language processing to extract clinical information from breast pathology reports. J Pathol Inform 3:23. https://doi.org/10.4103/2153-3539.97788 CrossRefPubMedPubMedCentral

30.

Yala A, Barzilay R, Salama L et al (2017) Using machine learning to parse breast pathology reports. Breast Cancer Res Treat 161:203–211. https://doi.org/10.1007/s10549-016-4035-1 CrossRefPubMed

31.

Ferlay J, Shin H-R, Bray F et al (2010) Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J cancer 127:2893–2917. https://doi.org/10.1002/ijc.25516 CrossRefPubMed

32.

Bartow SA, Pathak DR, Black WC et al (1987) Prevalence of benign, atypical, and malignant breast lesions in populations at different risk for breast cancer. A forensic autopsy study. Cancer 60:2751–2760. https://doi.org/10.1002/1097-0142(19871201)60:11 CrossRefPubMed

33.

Giarelli L, Stanta G, Delendi M et al (1986) Prevalence of female breast cancer observed in 517 unselected necropsies. Lancet 328:864. https://doi.org/10.1016/S0140-6736(86)92901-6 CrossRef

34.

Nielsen M, Thomsen JL, Primdahl S et al (1987) Breast cancer and atypia among young and middle-aged women: a study of 110 medicolegal autopsies. Br J Cancer 56:814–819. https://doi.org/10.1038/bjc.1987.296 CrossRefPubMedPubMedCentral

35.

Picouleau E, Denis M, Lavoue V et al (2012) Atypical hyperplasia of the breast: the black hole of routine breast cancer screening. Anticancer Res 32:5441–5446PubMed

36.

Li CI, Anderson BO, Daling JR, Moe RE (2002) Changing incidence of lobular carcinoma in situ of the breast. Breast Cancer Res Treat 75:259–268. https://doi.org/10.1023/A:1019950918046 CrossRefPubMed

37.

Helvie MA, Hessler C, Frank TS, Ikeda DM (1991) Atypical hyperplasia of the breast: mammographic appearance and histologic correlation. Radiology 179:759–764. https://doi.org/10.1148/radiology.179.3.2027988 CrossRefPubMed

38.

Pope TL, Fechner RE, Wilhelm MC et al (1988) Lobular carcinoma in situ of the breast: mammographic features. Radiology 168:63–66. https://doi.org/10.1148/radiology.168.1.3380984 CrossRefPubMed

39.

Welch HG, Prorok PC, O’Malley AJ, Kramer BS (2016) Breast-cancer tumor size, overdiagnosis, and mammography screening effectiveness. N Engl J Med 375:1438–1447. https://doi.org/10.1056/NEJMoa1600249 CrossRefPubMed

40.

Lundqvist A, Andersson E, Ahlberg I et al (2016) Socioeconomic inequalities in breast cancer incidence and mortality in Europe—a systematic review and meta-analysis. Eur J Public Health 26:804–813. https://doi.org/10.1093/eurpub/ckw070 CrossRefPubMedPubMedCentral

Title: Pathologic findings in reduction mammoplasty specimens: a surrogate for the population prevalence of breast cancer and high-risk lesions
Authors: Francisco Acevedo
V. Diego Armengol
Zhengyi Deng
Rong Tang
Suzanne B. Coopey
Danielle Braun
Adam Yala
Regina Barzilay
Clara Li
Amy Colwell
Anthony Guidi
Curtis L. Cetrulo Jr.
Judy Garber
Barbara L. Smith
Tari King
Kevin S. Hughes
Publication date: 01-01-2019
Publisher: Springer US
Published in: Breast Cancer Research and Treatment / Issue 1/2019
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-018-4962-0

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2019

Immune receptor recombinations from breast cancer exome files, independently and in combination with specific HLA alleles, correlate with better survival rates

A synonymous germline variant PALB2 c.18G>T (p.Gly6=) disrupts normal splicing in a family with pancreatic and breast cancers

COOLHAIR: a prospective randomized trial to investigate the efficacy and tolerability of scalp cooling in patients undergoing (neo)adjuvant chemotherapy for early breast cancer

Racial/ethnic differences in the outcomes of patients with metastatic breast cancer: contributions of demographic, socioeconomic, tumor and metastatic characteristics

Dietary intervention among breast cancer survivors increased adherence to a Mediterranean-style, anti-inflammatory dietary pattern: the Rx for Better Breast Health Randomized Controlled Trial

Correction to: Measuring and understanding adherence in a home-based exercise intervention during chemotherapy for early breast cancer

Keynote webinar | Spotlight on antibody–drug conjugates in cancer