Bilateral breast cancer. Risk reduction by contralateral biopsy

Area of Science:

• Oncology
• Surgical Pathology
• Breast Cancer Management

Background:

• Improved survival for primary breast cancer necessitates better management strategies for the contralateral breast.
• Early detection of second primary breast cancers remains challenging despite known risk factors and mammography.
• Contralateral biopsy is explored as a method to identify occult malignancy in the opposite breast.

Purpose of the Study:

• To evaluate the utility of elective contralateral biopsies in detecting clinically and radiologically occult second breast cancers.
• To assess the pathological findings and surgical management of contralateral breast lesions.
• To analyze the outcomes for patients with second primary breast cancers identified via contralateral biopsy.

Main Methods:

• Performed 62 elective contralateral biopsies in patients undergoing mastectomy for primary breast cancer over a 5-year period.
• Biopsies included mirror-image or upper outer quadrant sampling.
• Surgical management varied based on cancer invasiveness: total mastectomy for noninvasive, modified radical mastectomy for invasive cancers.

Main Results:

• 11.3% of contralateral biopsies revealed radiologically and clinically occult breast cancer.
• Pathological findings included bilateral noninvasive (3 patients), invasive/noninvasive (7 patients), and invasive/invasive (3 patients).
• 82% of patients with occult second breast cancer remained disease-free at a median follow-up of 40 months.

Conclusions:

• Contralateral biopsy is effective in identifying early-stage or preinvasive cancers in the contralateral breast, even in asymptomatic, radiologically normal breasts.
• This proactive approach offers an opportunity to reduce the risk of invasive cancer development and provides crucial diagnostic and prognostic information.
• Early detection through contralateral biopsy can improve survival and management for patients at risk of second primary breast cancers.