TUESDAY, July 30 (HealthDay News) -- Women with certain breast
tissue abnormalities that raise their risk for cancer can safely
take a wait-and-see approach rather than rush into surgery, a new
Previous research into two breast conditions -- atypical lobular
hyperplasia (ALH) and lobular carcinoma in situ (LCIS) -- have
turned up conflicting results regarding the need for surgery, said
Dr. Kristen Atkins, associate professor of pathology at the
University of Virginia, Charlottesville.
Both conditions indicate a noninvasive proliferation of cells in
the breast. And each one raises the risk of developing breast
cancer, Atkins and others agree.
But it now appears that when the patient's pathology report and
the radiology report are in agreement, the lesions are unlikely to
progress to cancer, according to the study, which was published
online July 30 in the journal
Women with either condition should be followed closely, the
researchers said. Closer observation might involve repeat imaging
every six months, or yearly mammograms with supplemental MRIs or
The risk of cancer developing "is not to that area [where the
lesions are found]; it's to both breasts over the course of a
lifetime," Atkins said.
Some studies that tried to quantify the increased cancer risk
associated with these lesions are dated. Atkins said the risk is
small and translates to about a 1 percent per year probability of
developing non-invasive ductal carcinoma in situ or invasive cancer
for women with lobular carcinoma in situ, which also is called
lobular intraepithelial neoplasia.
One expert welcomed the findings.
"We know we are overtreating some women [with these lesions]," said Dr. Courtney Vito, an assistant clinical professor of surgical oncology and a breast surgeon at City of Hope Comprehensive Cancer Center in Duarte, Calif. Vito was not involved in the study.
Vito said a woman who decides to skip surgery should consult a
breast surgeon, who can stratify her risks and develop a follow-up
plan that takes into account family history and other risk
Atkins said these lesions typically get discovered during a
biopsy conducted because a radiologist has spotted something of
concern on a mammogram. "We're not really sure how frequently they
occur because they are usually incidental findings," Atkins said.
"A biopsy is usually done for calcifications or a mass and we
happen to find the ALH and LCIS."
The study of 49 women (50 cases), aged 40 to 73, looked at data
from 2000 to 2010 and focused on whether the pathology report and
radiology report agreed and whether cancer occurred during the
follow-up period. Reports would be judged in agreement if the
radiologist and the pathologist concurred on the extent of
calcification and the location, for example.
All of the women in the study had atypical lobular hyperplasia
or lobular carcinoma in situ. Of the total, 43 cases were judged
benign by both the pathologist and the radiologist.
Of the cases with agreement, 38 had surgical excision and five
were watched closely during the follow-up. None of the 43
progressed to cancer.
In seven cases, however, the pathology and radiology reports
were not in agreement. Five of those women had surgery, and two of
them were found to have noninvasive cancer (ductal carcinoma in
situ) when operated on. Two others were followed and did not
progress to cancer.
The researchers concluded that if the reports agree, women can
be monitored closely to avoid surgery, which carries a potential
for disfigurement or other harm.
Vito noted that the research was done at respected centers with
expert researchers. The accuracy of pathology and radiology reports
is highly dependent on the expertise of the doctors involved, she
To learn more about the risk factors for breast cancer, visit
American Cancer Society.
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