- 12 Breast Cancer Myths Debunked
- Food for Breast Cancer
- How does breast reduction surgery affect risk of breast cancer?
- Postmenopausal women benefit more from breast reduction surgery
- Breast reduction surgery for cancer patients or high risk women
- Selected breast cancer studies
- Can I Lower My Risk of Breast Cancer?
- For all women
- For women at increased risk of breast cancer
- Breast Reduction
- What are the risks of breast reduction surgery?
- Where will my surgery be performed?
- When you go home
- Be careful
- 4 Things to Think About Before You Get a Breast Reduction
- Many Women Get Unnecessary Mammograms Before Breast Reduction Surgery
- Acta Oncologica
12 Breast Cancer Myths Debunked
Chances are you’ve heard at least a few myths about what causes breast cancer or increases your breast cancer risk. A little myth-busting is in order so you can get your breast cancer facts straight.
Myth No. 1: Underwire Bras Cause Breast Cancer
“That’s absolutely untrue,” says breast surgical oncologist Kandace McGuire, MD, of the Breast Cancer Program of Magee Women’s Hospital in Pittsburgh, Pa.
Dr. McGuire explains that this myth is based on an old theory that an underwire bra would reduce lymphatic drainage and increase breast cancer risk. “It was not based on any data whatsoever,” she says.
Until now. A study published in Cancer Epidemiology, Biomarkers & Prevention in September 2014 is the first to use a rigorous scientific study design to investigate whether bra-wearing habits could affect breast cancer risk in postmenopausal women. Among the factors researchers considered were bra type (including underwire) and daily or lifetime use of bras. Their conclusion: There’s no evidence linking bras to breast cancer risk.
So rest assured that constriction of your breasts, whether from an underwire bra or any kind of compression garment, does not affect your breast cancer risk.
Myth No. 2: Antiperspirants Cause Breast Cancer
“There have been no studies to suggest a link between antiperspirants and breast cancer,” says McGuire. There are two possible points of origin for this cancer myth:
- Parabens. These chemical preservatives are used in some antiperspirants and some other products. They may increase estrogen levels, which is linked to breast cancer risk. But there is “no decisive link,” says McGuire. Check ingredient labels if you are concerned. Look for the ingredients methylparaben, propylparaben, butylparaben, or benzylparaben. However, most brands no longer include these ingredients.
- Mammogram preparation. Antiperspirants contain some aluminum, which may show up on mammograms as a false-positive result. “One thing that is important for women to know is that when they go for their mammograms, they shouldn’t wear antiperspirants,” advises McGuire.
Overall, the National Cancer Institute does not advise limiting the use of antiperspirants, but does say more research is needed in this area.
Myth No. 3: Radiation From Screening Tests Causes Cancer
Although mammograms do give off a small amount of radiation, “the radiation dose in a mammogram is less than in a standard chest X-ray,” says McGuire. “It is such a low level that it wouldn’t increase breast cancer risk.” Women should also know that MRIs (magnetic resonance imaging) and ultrasounds, which may also be used to screen for breast cancer in some women, contain no radiation at all.
Myth No. 4: Exposure to Air Causes Cancer to Spread
McGuire shares a myth she often hears from worried patients — cutting into a cancer and exposing it to air causes the cancer to spread. “That is untrue as well,” she stresses. Patients are naturally worried because cancer does have the potential to spread (called metastasis), but it is not caused by your cancer surgeon cutting into a tumor for a biopsy or to remove it.
Myth No. 5: You Have to Have a Family History to Get Cancer
“Women who don’t have a family history of breast cancer are surprised when they get breast cancer,” says McGuire. Family history is a well-established risk factor — so well-established that some women may believe it is the only risk factor, but it’s not. “Less than 10 percent of breast cancer patients get it because of a familial history,” she explains.
Myth No. 6: There’s Nothing You Can Do About an Inherited Risk
A strong family history is a cancer risk factor, but just because women in your family have had breast cancer does not mean you are destined to get it. Genetic testing will help you understand your inherited risk and allow you to make choices about your future care. Additionally, McGuire says that research shows that a low-fat diet combined with physical activity and moderate alcohol consumption (fewer than two drinks per day) reduces breast cancer risk. “If you have a family history, you should do everything that you can to decrease your risk,” she advises.
Myth No. 7: Breast Cancer Occurs Only in Older Women
“Increasing age is a risk factor for breast cancer, so the older you are the more likely you are to get breast cancer,” says McGuire. However, that doesn’t mean younger women aren’t vulnerable. Breast cancer can be diagnosed at any age. “It tends to be more aggressive in younger women,” she adds.
Myth No. 8: Plastic Surgery Causes Breast Cancer
The good news for women who want to enhance or reduce their bust size is that there is no link between breast plastic surgery and increased breast cancer risk. Implants can make mammograms more difficult, but they do not make cancer more likely. Women who have breast reduction surgery may actually see a decrease in breast cancer risk. “Getting a breast reduction can reduce your risk of breast cancer by about 60 percent, depending on how much they take,” says McGuire.
Myth No. 9: Double Mastectomy Prevents a Return of Breast Cancer
Removing a breast that has not had breast cancer does prevent breast cancer in that breast, but removing a breast that already has cancer still leaves you with a 3 to 4 percent risk of recurrence. “Your survival is based on the first cancer,” says McGuire, not on the removal of additional breast tissue.
Myth No. 10: Mammograms Aren’t Accurate Anyway, So Why Bother?
Recent controversy about the right time for women to begin having mammograms — whether they should begin at age 40 or age 50 — has left some women feeling the screening test may not be worthwhile.
Younger women often have denser breast tissue than older women, who have more fat tissue in the breast. “The denser your breasts are, the less accurate your mammogram is going to be,” acknowledges McGuire, but adds, “Having a bad mammogram is better than having none. It’s the only thing that we’ve shown thus far to reduce the mortality from breast cancer.”
Myth No. 11: Self-Exams Aren’t Necessary
Actually, the research is inconclusive on this question. “Most of the women that I talk to in the office are not doing self-exams. But there’s no downside — it’s cheap and easy to do,” says McGuire, who says that only good things can come from being familiar with the shape of your own breasts.
Myth No. 12: Abortion and Miscarriage Increase Breast Cancer Risk
While there is some evidence that having children before the age of 30 can reduce the risk of breast cancer, there is no research to support the idea that the early end of a pregnancy through miscarriage or abortion could increase breast cancer risk.
Armed with these facts — not myths — you will be better able to reduce your risk and plan your treatment if you develop breast cancer.
Nearly 10% of 444 women who had surgery to reduce the size of their breasts had abnormal-looking cells in the breast tissue that was removed. Doctors call these abnormal-looking breast cells atypical hyperplasia. Atypical hyperplasia is not cancer and not life-threatening, but is associated with a higher-than-average risk of developing breast cancer later in life. The results were presented at the 2009 ASCO Breast Cancer Symposium.
Atypical hyperplasia usually is found during breast biopsy. A biopsy typically is done if a suspicious area is found by mammogram, doctor’s physical breast exam, or breast self-exam. If a large number of healthy women had breast biopsies, doctors would expect about 1% of the women to have atypical hyperplasia.
The researchers in this study aren’t sure why atypical hyperplasia was found in a higher percentage (nearly 10%) of the women in the study. An earlier study done by the same researchers also found either early cancer that wasn’t recognized (occult breast cancer) or atypical hyperplasia in the removed breast tissue of 12% of women who had breast reduction surgery.
In this study, women most likely to have atypical hyperplasia:
- were in their 40s at the time of breast reduction surgery; women in their 40s were about 8 times more likely to have atypical hyperplasia than women younger than 30
- had a family history of breast cancer
- had more than the average number of mammograms or other breast imaging tests before reduction surgery
Because women with atypical hyperplasia have a higher-than-average risk of breast cancer, their doctors will likely talk to them about options to reduce that risk. Premenopausal women may consider taking tamoxifen, a hormonal therapy medicine, to reduce risk. Doctors consider a number of factors, such as age and family history, when deciding whether a treatment to lower breast cancer risk makes sense. In this study, all the women with atypical hyperplasia were referred to a medical oncologist or surgeon to have their risk status evaluated. Based on personal and medical history, hormonal therapy medicine to reduce risk was recommended to about 33% of the women. Only one woman chose to take hormonal therapy.
If you’re considering breast reduction surgery, know that your doctor will likely send the removed breast tissue for analysis by a pathologist, even if you have no breast cancer concerns. As this study shows, it’s possible that abnormal results, such as atypical hyperplasia, could be found. If you have breast reduction surgery, it’s a good idea to ask your doctor to go over the results of the pathology report on the removed breast tissue so you can address any areas concerns together.
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Published on October 12, 2009 at 12:00 AM
Food for Breast Cancer
How does breast reduction surgery affect risk of breast cancer?
Breast reduction surgery has been found to reduce the risk of breast cancer by reducing the amount of breast tissue that could develop cancer. The injury to the breast caused by the surgery, and the attendant scar tissue, do not increase cancer risk.
Postmenopausal women benefit more from breast reduction surgery
Generally speaking, breast reduction surgery appears to provide a more immediate decrease in breast cancer risk for postmenopausal women than premenopausal women. For postmenopausal women, breast cancer risk increases with increasing body mass index, waist-hip ratio, waist size, and weight gain.
On the other hand, being overweight (and hence more likely to have large breasts) is protective against breast cancer before menopause, a finding reported by numerous breast cancer studies, but not adequately explained. One study found that a large bra cup size at a young age was associated with a higher risk of premenopausal breast cancer, but only for leaner women with body mass index less than 25. In other words, premenopausal women whose breasts are large primarily because they are overweight do not have a higher risk of breast cancer (and therefore would not be expected to benefit as much from breast reduction surgery).
Breast reduction surgery for cancer patients or high risk women
Breast reduction surgery can make sense for large-breasted women who are diagnosed with early stage breast cancer. Rather than opting for breast conserving surgery such as lumpectomy, such women can elect to have breast reduction surgery, thereby removing the tumor and reducing their risk of new tumors in subsequent years, as well as eliminating the discomfort associated with having large breasts. Breast reduction surgery has also been proposed as an alternative to prophylactic bilateral mastectomy for high risk BRCA1 or BRCA2 breast cancer gene mutation carriers.
Tags: BMI – obesity, breastCancerRisk, breastConservingTreatment, mastectomy, youngAge
Selected breast cancer studies
Breast Cancer Found Incidentally After Reduction Mammaplasty in Young Insured Women Pathologic findings in reduction mammoplasty specimens: a surrogate for the population prevalence of breast cancer and high-risk lesions Routine histopathological examination after female‐to‐male gender‐confirming mastectomy Reduction mammaplasty in patients with history of breast cancer: The incidence of occult cancer and high-risk lesions The role of oncoplastic breast reduction in the conservative management of breast cancer: Complications, survival, and quality of life Oncoplastic reduction mammoplasty for breast cancer in women with macromastia:long term aesthetic, functional and satisfaction outcomes The Management of Breast Cancer Detected by Reduction Mammoplasty The Effects of Reduction Mammaplasty on Serum Leptin Levels and Insulin Resistance Oncoplastic reduction mammoplasty for breast cancer in women with macromastia: Oncological long-term outcomes Reduction mammoplasty is beneficial in women with and without history of breast cancer Breast size and breast cancer: A systematic review Local Recurrence Patterns in Breast Cancer Patients Treated with Oncoplastic Reduction Mammaplasty and Radiotherapy Using therapeutic mammoplasty to extend the role of breast-conserving surgery in women with larger or ptotic breast Reduction Mammaplasty as a Treatment Option for Early Breast Cancer Therapeutic Mammaplasty for Breast Cancer: Oncological and Aesthetic Outcomes Evaluating the feasibility of extended partial mastectomy and immediate reduction mammoplasty reconstruction as an alternative to mastectomy Given breast cancer, does breast size matter? Data from a prospective breast cancer cohort Bilateral reduction mammoplasty following breast cancer: A case-control study The Evaluation of Contralateral Breast Lesions in Breast Cancer Patients Using Reduction Mammoplasty Occult breast carcinoma in breast reduction specimens in European women The role of oncoplastic therapeutic mammoplasty in breast cancer surgery- A review Reduction mammaplasty: An advantageous option for breast conserving surgery in large-breasted patients
Can I Lower My Risk of Breast Cancer?
There is no sure way to prevent breast cancer. But there are things you can do that might lower your risk. Many risk factors are beyond your control, such as being born female and getting older. But other risk factors can be changed and may lower your risk.
For women who are known to be at increased risk for breast cancer, there are additional steps that might reduce the risk of developing breast cancer.
For all women
Get to and stay at a healthy weight: Both increased body weight and weight gain as an adult are linked with a higher risk of breast cancer after menopause. The American Cancer Society recommends you stay at a healthy weight throughout your life and avoid excess weight gain by balancing your food intake with physical activity.
Be physically active: Many studies have shown that moderate to vigorous physical activity is linked with lower breast cancer risk, so it’s important to get regular physical activity. The American Cancer Society recommends that adults get at least 150 minutes of moderate intensity or 75 minutes of vigorous intensity activity each week (or a combination of these), preferably spread throughout the week.
Moderate activity is anything that makes you breathe as hard as you do during a brisk walk. It causes a slight increase in heart rate and breathing. You should be able to talk, but not sing during the activity.
Vigorous activities are performed at a higher intensity. They cause an increased heart rate, sweating, and a faster breathing rate.
Limit or avoid alcohol: Alcohol increases risk of breast cancer. Even low levels of alcohol intake have been linked with an increase in risk. The American Cancer Society recommends that women who drink have no more than 1 alcoholic drink a day. A drink is 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof distilled spirits (hard liquor).
Is there a link between diet/vitamins and breast cancer risk?
The possible link between diet and breast cancer risk is not clear, but this is an active area of study. Some (but not all) studies have suggested that a diet that is rich in vegetables, fruit, poultry, fish, and low-fat dairy products might help lower the risk of breast cancer. It’s also not clear if specific vegetables, fruits, or other foods can lower risk. And most studies have not found that lowering fat intake has much of an effect on breast cancer risk (although some have suggested it might help lower the risk of dying from breast cancer).
But just because the science isn’t clear on this doesn’t mean that there’s no point in eating a healthy diet. A diet low in fat, low in processed and red meat, and high in fruits and vegetables can clearly have many health benefits, including lowering the risk of some other types of cancer.
So far, there’s no strong evidence that taking vitamins or any other type of dietary supplement reduces the risk of breast cancer.
For more on the links between body weight, physical activity, diet, and breast cancer (as well as other cancers), see American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention.
Other factors that might lower risk: Women who choose to breastfeed for at least several months may also get an added benefit of reducing their breast cancer risk.
Using hormone therapy after menopause can increase your risk of breast cancer. To avoid this, talk to your health care provider about non-hormonal options to treat menopausal symptoms.
For women at increased risk of breast cancer
If you are a woman at increased risk for breast cancer (for instance, because you have a strong family history of breast cancer, a known gene mutation that increases breast cancer risk, such as in the BRCA1 or BRCA2 gene, or you have had DCIS or LCIS), there are some things you can do that might help lower your chances of developing breast cancer (or help find it early).
- Genetic counseling and testing for breast cancer risk (if it hasn’t been done already)
- Close observation to look for early signs of breast cancer
- Medicines to lower breast cancer risk
- Preventive (prophylactic) surgery
Your health care provider can help you determine your risk of breast cancer, as well as which, if any, of these options might be right for you.
Genetic counseling and testing
If there are reasons to think you might have inherited a gene change that increases your risk of breast cancer (such having as a strong family history of breast cancer, or a family member with a known gene mutation), you might want to talk to your doctor about genetic counseling to see if you should be tested. To learn more, see Genetic Counseling and Testing for Breast Cancer Risk.
If you decide to be tested and a gene change is found, this might affect your decision about using the options below to help lower your risk for breast cancer (or find it early).
For women at increased breast cancer risk who don’t want to take medicines or have surgery, some doctors might recommend close observation. This approach might include:
- More frequent doctor visits (such as every 6 to 12 months) for breast exams and ongoing risk assessment
- Starting breast cancer screening with yearly mammograms at an earlier age
- Possibly adding another screening test, such as breast MRI
While this approach doesn’t lower breast cancer risk, it might help find it early, when it’s likely to be easier to treat.
Medicines to lower breast cancer risk
Prescription medicines can be used to help lower breast cancer risk in certain women at increased risk of breast cancer.
Medicines such as tamoxifen and raloxifene block the action of estrogen in breast tissue. Tamoxifen might be an option even if you haven’t gone through menopause, while raloxifene is only used for women who have gone through menopause. Other drugs, called aromatase inhibitors, might also be an option for women past menopause. All of these medicines can also have side effects, so it’s important to understand the possible benefits and risks of taking one of them.
To learn more, see:
- Deciding Whether to Use Medicine to Reduce Breast Cancer Risk
- Tamoxifen and Raloxifene for Lowering Breast Cancer Risk
- Aromatase Inhibitors for Lowering Breast Cancer Risk
Preventive surgery for women with very high breast cancer risk
For the small fraction of women who have a very high risk for breast cancer, such as from a BRCA gene mutation, surgery to remove the breasts (prophylactic mastectomy) may be an option. Another option might be to remove the ovaries, which are the main source of estrogen in the body. While surgery can lower the risk of breast cancer, it can’t eliminate it completely, and it can have its own side effects. For more on this topic, see Preventive Surgery to Reduce Breast Cancer Risk.
Before deciding which, if any, of these options might be right for you, talk with your health care provider to understand your risk of breast cancer and how much any of these approaches might affect your risk.
What are the risks of breast reduction surgery?
The decision to have breast reduction surgery is extremely personal. You will have to decide if the benefits will achieve your goals and if the risks of breast reduction surgery and potential complications are acceptable.
Your plastic surgeon and/or plastic surgery staff will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand the procedure you will undergo and any risks or potential complications.
Possible breast reduction surgery risks include:
- Unfavorable scarring
- Changes in nipple or breast sensation, which may be temporary or permanent
- Anesthesia risks
- Bleeding (hematoma)
- Blood clots
- Poor wound healing
- Breast contour and shape irregularities
- Skin discoloration, permanent pigmentation changes, swelling and bruising
- Damage to deeper structures—such as nerves, blood vessels, muscles and lungs—can occur and may be temporary or permanent
- Breast asymmetry
- Fluid accumulation
- Excessive firmness of the breast
- Potential inability to breastfeed
- Potential loss of skin/tissue of breast where incisions meet each other
- Potential, partial or total loss of nipple and areola
- Deep vein thrombosis, cardiac and pulmonary complications
- Pain, which may persist
- Allergies to tape, suture materials and glues, blood products, topical preparations or injectable agents
- Fatty tissue deep in the skin could die (fat necrosis)
- Possibility of revisional surgery
You should know that:
- Breast reduction surgery can interfere with certain diagnostic procedures
- Breast and nipple piercing can cause an infection
- Your ability to breastfeed following reduction mammaplasty may be limited; talk to your doctor if you are planning to nurse a baby
- The breast reduction procedure can be performed at any age, but is best done when your breasts are fully developed
- Changes in the breasts during pregnancy can alter the outcomes of previous breast reduction surgery, as can significant weight fluctuations
The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single breast reduction procedure and another surgery may be necessary.
Where will my surgery be performed?
Breast reduction procedures may be performed in your plastic surgeon’s accredited office-based surgical facility, an ambulatory surgical facility or a hospital. Your plastic surgeon and the assisting staff will fully attend to your comfort and safety.
When you go home
If you experience shortness of breath, chest pains or unusual heartbeats, seek medical attention immediately. Should any of these breast reduction complications occur, you may require hospitalization and additional treatment.
The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single surgical procedure and another surgery may be necessary.
Following your physician’s instructions is key to the success of your surgery. It is important that the surgical incisions are not subjected to excessive force, abrasion or motion during the time of healing. Your doctor will give you specific instructions on how to care for yourself and minimize breast reduction surgery risks.
Be sure to ask questions: It’s very important to address all your questions directly with your plastic surgeon. It is natural to feel some anxiety, whether excitement for the anticipated outcome or preoperative stress. Discuss these feelings with your plastic surgeon.
4 Things to Think About Before You Get a Breast Reduction
In a recent interview with People, Modern Family star Ariel Winter called her breast reduction surgery last year “an instant weight lifted off my chest—both literally and figuratively.” The 18-year-old actress, who went from a 32F to a 34D, added that “there’s a confidence you find when you finally feel right in your body.” (That awesome swagger was on display at the SAG Awards in January when she proudly embraced her surgery scars.)
RELATED: 15 Things That Can Happen After a Breast Reduction
Winter is hardly alone, as more and more women are choosing to reduce their cup size. Between 1997 and 2013, the number of breast reductions rose by 157 percent, according the American Society for Aesthetic Plastic Surgery. “I think the trend is a result of the fact that people are becoming more informed as to what their options are,” says plastic surgeon Daniel Maman, MD, who is an assistant clinical professor of surgery at the Mount Sinai School of Medicine in New York City.
Below, he recommends four things women should think about before getting a breast reduction. The next step, he says, would be to set up a consultation with a plastic surgeon to discuss whether the operation is right for you.
The physical pain of having large breasts
Carrying extra weight on your chest can cause significant discomfort. Ariel Winter said the physical pain is what ultimately led her to choose surgery. Typically felt in the lower back, neck, and shoulders, and even as headaches, that discomfort can have a ripple effect into other areas of a woman’s life. A study published in 2013 found that patients who underwent breast reduction surgery not only experienced less pain, but also a significant improvement in the quality of their sleep and their ability to exercise.
RELATED: 10 Sports Bras for Women with Big Busts
The effect of your size on your self-esteem
“Oftentimes women are just very self-conscious about their breasts,” says Dr. Maman. “They feel like they are unable to wear certain types of clothes that they like to wear.” Indeed, Winter talked about how it felt to be bullied about her appearance online: “I’d just be wearing something anyone else could wear, but I’d read comments saying, ‘She dresses inappropriately.'” Large breasts tend to attract a lot of unwanted attention, which may help explain why so many women who get reductions are typically happy with the outcome. In a 2012 study, one year out from their surgery, 80% of patients rated their results as “good” or “very good.”
The fact that you may not get the breasts you really want
Every body is different, Dr. Maman points out, and the “perfect” breasts you’re picturing may not be realistic on your frame. After the surgery, your boobs will not only be smaller, they may also be a different shape, and in a different position on your chest. Before you go under the knife, it’s really important to get a very clear picture from your surgeon of how your breasts will change, says Dr. Maman. “A lot of times what I will see is a patient comes in and they have really large breasts with loose skin and large areolas that point towards the floor and then show me a picture of a breast of an 18-year-old girl with very small perky breasts,” he explains. “That’s just not achievable.”
RELATED: What the Perfect Breast Looks Like, According to Men and Women
The cost and recovery
Breast reduction surgery is an expensive procedure, though your insurance may cover it if it’s performed to relieve medical symptoms. The recovery time can take anywhere from two to six weeks. Another factor to weigh: If your nipples are removed from your breast, and you’re planning to have a baby in the future, you won’t be able to breastfeed. Even if your nipples remain attached through the surgery, you may still have some difficulty. However, it may not be as bad as you’d think. A study done at McGill University found that a woman’s odds of being able to nurse after the procedure were about the same as those of other moms.
Many Women Get Unnecessary Mammograms Before Breast Reduction Surgery
Each year, thousands of younger women with no known risk of breast cancer get mammograms before having breast reduction surgery.
Patients receive the exam, often at the suggestion of their doctors, when the best recommendation says to avoid routine mammograms before elective breast surgery unless a specific concern exists.
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Although the pre-surgical screening has been a longtime practice among physicians, no professional society recommends routine screening until a woman turns 40.
Erika D. Sears, M.D., M.S., a Michigan Medicine plastic surgeon who studies appropriateness and efficiency in health care, wondered how often the practice takes place.
Her new study published in JAMA Surgery found that nearly one-third of women younger than 40 underwent mammography before breast reduction surgery. Health services researchers culled the records of 52,486 women of all ages being evaluated for breast reduction between 2009 and 2015.
Few may realize the unnecessary screenings come at a price — and not just a monetary one that adds to the nation’s health care bill, Sears says.
“Altering screening mammography for patients younger than 40 years in the setting of evaluation for breast surgery has a risk for subsequent tests and invasive procedures,” says Sears, also an assistant professor of surgery at the University of Michigan.
Testing only when necessary
In recent years, medical organizations have asked their members to identify tests and procedures commonly used in their field whose necessity should be questioned and discussed.
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The American Society of Plastic Surgeons is one of those groups. It stated in 2014 that women undergoing elective breast surgery should not have additional screening beyond existing guidelines unless there was a concern based on their medical history or a physical finding.
But it can be hard to help doctors stop doing something they have done for years.
Our data suggest that the risk of missing a cancer at the examination of breast reduction specimens by macroscopic examination is low. The prevalence of invasive breast cancer in our study was in line with previous reported prevalence ranging from 0% to 0.99% . Overlooked breast cancer is therefore very rare in breast reduction specimens. Invasive breast cancer is even rarer in studies that, like ours, subtracted data for women with prior breast cancer , , , ,7 Goyal A, Coulson SG, Wu JM, et al. Occult breast carcinoma in breast reduction specimens in European women. Breast Cancer Res Treat. 2011;128:749–753., , , ,8 Hassan FE, Pacifico MD. Should we be analyzing breast reduction specimens? A systematic analysis of over 1000 consecutive cases. Aesth Plast Surg. 2012;36:1105–1113., , , ,10 Colwell AS, Kukreja J, Breuing KH, et al. Occult breast carcinoma in reduction mammaplasty specimens: 14-year experience. Plast Reconstr Surg. 2004;113:1984–1988., , , ,11 Desouki MM, Li Z, Hameed O, et al. Incidental atypical proliferative lesions in reduction mammoplasty specimens: analysis of 2498 cases from 2 tertiary women’s health centers. Hum Pathol. 2013;44:1877–1881., , , ,14 Schantz PAM, Jahkola TA, Krogerus LA, et al. Should we routinely analyse reduction mammaplasty specimens? J Plast Recon Aesth Surg. 2017;70:196–202., , , ].
A former Danish autopsy study of 110 younger to middle aged women found a much higher prevalence of invasive breast cancer (2%) and ductal carcinoma in situ (14%). A total of 275 tissue samples were here thoroughly microscopically examined suggesting a correlation between the number of tissue samples and probability of finding histologic abnormalities on a microscopic level.
Many international studies recommend consistent microscopic examination based on findings of high abnormality prevalence in breast reduction specimens alone , , , ,10 Colwell AS, Kukreja J, Breuing KH, et al. Occult breast carcinoma in reduction mammaplasty specimens: 14-year experience. Plast Reconstr Surg. 2004;113:1984–1988., , , ,11 Desouki MM, Li Z, Hameed O, et al. Incidental atypical proliferative lesions in reduction mammoplasty specimens: analysis of 2498 cases from 2 tertiary women’s health centers. Hum Pathol. 2013;44:1877–1881., , , ,14 Schantz PAM, Jahkola TA, Krogerus LA, et al. Should we routinely analyse reduction mammaplasty specimens? J Plast Recon Aesth Surg. 2017;70:196–202., , , ]. Detection of other abnormalities than invasive breast cancer or ductal carcinoma in situ do not have the same clinical consequences in Denmark, therefore these recommendations cannot be applied uncritically. Lobular carcinoma in situ for example is still regarded an incidental finding, although increasing the subsequent risk of carcinoma . København: Danish Breast Cancer Cooperative Group; c1976-2016. 2006. Available from: http://www.dbcg.dk/DBCG%20Retningslinier.htm ]. Comparison with international studies and application of their recommendations are therefore difficult.
Women with benign breast abnormalities, typically found in breast reduction specimens, generally have more precursor prone tissue that can lead to breast cancer , , , ,14 Schantz PAM, Jahkola TA, Krogerus LA, et al. Should we routinely analyse reduction mammaplasty specimens? J Plast Recon Aesth Surg. 2017;70:196–202., , , ]. Second, invasive breast cancer found at the time of operation immediately gets histologically diagnosed by microscopic analysis. Excluding the one case in our study that was diagnosed at the time of the operation from the statistical analysis results in no difference between the incidence rates of breast cancers based on the examination method.
We can’t exclude that a small breast cancer has been removed at the breast reduction without diagnosing it in the subsequent pathology examination. A further limitation is the relatively few numbers of women with invasive breast cancer and ductal carcinoma in situ in this study. Several large international retrospective studies have found fewer observed invasive breast cancer than expected in cohorts of women who underwent breast reduction surgery , , , ,16 Fryzek JP, Ye W, Nyrén O, et al. A nationwide epidemiologic study of breast cancer incidence following breast reduction surgery in a large cohort of Swedish women. Breast Cancer Res Treat. 2006;97:131–134., , , ,17 Brown MH, Weinberg M, Chong N, et al. A cohort study of breast cancer risk in breast reduction patients. Plast Reconstr Surg. 1999; 103:1674–1681., , , ].
Evaluation of each identified breast cancer case is shown in Table 2. The timespan between the operations and the succeeding cancers, combined with tumor characteristics and clinic, makes it unlikely that any of the breast cancers were overlooked at the initial pathology examination (Supplementary material).
Evaluating the examination method
The examination procedure chosen by pathology departments should represent a method not only oncological safe but also one that makes economic sense.
The pathologists in this study found macroscopic abnormalities in 16% of the specimens, which is high when compared to Cook et al. , , , ]. This could reflect that macroscopic examination is performed more thoroughly when subsequent microscopic examination is not standard procedure. Despite this, breast tissue initially not considered suspicious of occult cancer by macroscopic examination can contain abnormalities , , , ,12 Cook IS, Fuller CE. Does histopathological examination of breast reduction specimens affect patient management and clinical follow up? J Clin Pathol. 2004;57:286–289., , , ,18 Nielsen M, Thomsen JL, Primdahl S, et al. Breast cancer and atypia among young and middle-aged women: a study of 110 medicolegal autopsies. Br J Cancer. 1987;56:814–819., , , ].