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

  • Epidemiology
  • Published:
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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.

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References

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

    Article  PubMed  Google Scholar 

  2. 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

    Article  PubMed  Google Scholar 

  3. 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

    Article  PubMed  Google Scholar 

  4. 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

    Article  CAS  Google Scholar 

  5. 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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. 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

    Article  PubMed  Google Scholar 

  7. 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 147:1459–1476

    CAS  PubMed  PubMed Central  Google Scholar 

  8. 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 147:1477–1488

    CAS  PubMed  PubMed Central  Google Scholar 

  9. 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

    Article  CAS  PubMed  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  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 13:79–87

    Article  CAS  PubMed  Google Scholar 

  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

    Article  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  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

    Article  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  PubMed Central  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  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

    Article  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  PubMed Central  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  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

    Article  Google Scholar 

  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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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 32:5441–5446

    PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors wish to acknowledge Ann S. Adams for her writing and editorial consultation.

Funding

Departmental.

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Authors and Affiliations

  1. Massachusetts General Hospital, 55 Fruit Street, Yawkey 7, Boston, MA, 02114, USA

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

  2. Dana-Farber Cancer Institute, Boston, MA, USA

    Danielle Braun, Adam Yala, Regina Barzilay, Clara Li & Judy Garber

  3. Harvard T.H Chan School of Public Health, Boston, MA, USA

    Danielle Braun, Adam Yala, Regina Barzilay & Clara Li

  4. Massachusetts Institute of Technology, Boston, MA, USA

    Adam Yala, Regina Barzilay & Clara Li

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  1. Francisco Acevedo
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Corresponding author

Correspondence to Kevin S. Hughes.

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Conflict of interest

All the authors declare that he/she has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the IRB.

Informed consent

As this was a database/medical record study, the need for informed consent was waived by the IRB.

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Acevedo, F., Armengol, V.D., Deng, Z. et al. Pathologic findings in reduction mammoplasty specimens: a surrogate for the population prevalence of breast cancer and high-risk lesions. Breast Cancer Res Treat 173, 201–207 (2019). https://doi.org/10.1007/s10549-018-4962-0

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  • DOI: https://doi.org/10.1007/s10549-018-4962-0

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