Abnormal breast lesions don’t always warrant surgery, study finds

August 3, 2013 | by

Women with two breast conditions known to increase the risk of cancer often have the resulting tissue abnormalities surgically removed in order to lower that risk. But a new study suggests that automatically scheduling a surgery might not be necessary. Rather, researchers found, women should consult with their doctors then, sometimes, just monitor the situation.

New research suggests surgery to remove certain types of breast lesions is not always necessary.

New research suggests that surgical removal of certain types of abnormal breast lesions is not always necessary, even if the lesions are associated with a higher risk of breast cancer.

The conditions atypical lobular hyperplasia and lobular carcinoma in situ cause a noninvasive overgrowth of cells and are typically identified after breast biopsies to assess a suspicious area. Women with either of these abnormalities have a four to 10 times higher risk of developing breast cancer.

But in reviewing 50 cases involving 49 women, age 40 to 73, researchers at the University of Virginia and elsewhere found that when the patient’s pathology report and the radiology report agree on a noncancer diagnosis, the abnormal breast lesions are unlikely to progress to cancer. In those cases, immediate surgery to remove the breast lesions is likely not necessary. The results were published online recently in the journal Radiology.

The news was greeted with some relief by breast cancer surgeons, including Courtney Vito, M.D., assistant clinical professor of surgery at City of Hope. “We know we are over treating some women [with these lesions],” she said in an interview with HealthDay.

But, Vito added, women who decide to forgo immediate surgery should consult a breast surgeon who can help her develop a follow-up plan that takes her unique risks, including family history, into account.

In their review, the researchers analyzed whether the pathology report and radiology report agreed about the woman’s diagnosis – and whether cancer occurred during the follow-up period. Forty-three of the cases were considered benign by both the pathologist and the radiologist. Out of those cases, 38 had surgery to remove the lesions and the remaining five were watched closely by their doctors during the follow-up. None of these women developed breast cancer.

In the seven cases about which the reports did not agree, five of the women had surgery. Two of those were found to have noninvasive cancer. Two others opted not to have surgery; their abnormal breast tissues did not progress to cancer.

The researchers concluded that – as long as the pathology and radiology reports agree – women can skip surgery and choose close monitoring and yearly mammograms along with an MRI or ultrasound as second-line screening tools.

Vito pointed out, however, that the accuracy of pathology and radiology reports is closely tied to doctors’ expertise.