Occult Breast Cancer in Breast Reduction Specimens
In 2008, nearly 90,000 women in the United States underwent breast reduction surgery. During a similar 12 month period in 2009, over 192,000 American women were diagnosed with new breast cancers. Occasionally, these two groups of patients overlap. In other words, some women first learn of and are first diagnosed with breast cancer only after their breast reduction tissue specimens are examined and noted by the pathologist to contain breast cancer cells. These cases represent unsuspected carcinoma in breast reduction specimens (their pre-operative mammograms were normal), also known as occult breast cancer. In several recent studies, occult breast cancer occurs in between 0.06 and 4 percent of breast reduction specimens. In breast cancer patients who have never undergone breast reduction surgery, breast conservation (i.e. lumpectomy and radiation) is frequently possible for early tumors (nearing 80%) since the tumor location within the breast is known, and the surgical margins are usually demonstrative. However, when a tumor is incidentally noted in a surgical breast specimen, localizing the tumor area can become somewhat of a challenge. This often obligates patients to mastectomy in order to ensure adequate removal of the tumors. A recent study (PRS Vol 127, No 2, Feb 2011 p525) presented a simple system of surgical specimen markings that helps permit breast-conserving treatments should an occult carcinoma be identified in a breast reduction specimen. Although this technique will not completely eliminate the need for completion mastectomy in some patients, using it can potentially increase the number of patients who would be eligible for breast conservation.