Bilateral Breast Cancer Risk Reduction by Contralateral Biopsy

Abstract

Although survival from primary breast cancer has improved with earlier diagnosis and treatment, the management of the opposite breast is still in question. The risk factors for bilaterality are known, and preoperative mammography is occasionally helpful, but identification of early second breast cancer is very limited. Contralateral biopsy may provide a reasonable answer to the problem. During a 5-year period, 62 elective contralateral biopsies were performed in patients having mastectomies for primary breast cancer. This consisted of either a mirror image biopsy or, more commonly, a biopsy of the upper outer quadrant. Thirteen patients had simultaneous contralateral cancers, of whom two had clinically overt bilateral cancers and 11 (18%) had clinically occult malignancy. Seven of these 11 had both radiologically and clinically normal breasts. Thus, 11.3% had radiologically and clinically occult cancer demonstrated by biopsy. Surgical management consisted of total mastectomy with low axillary dissection for noninvasive cancers and modified radical mastectomy for invasive cancers. Pathologic findings of the dominant breast cancer and the contralateral lesion were: bilateral, noninvasive: three patients; invasive, noninvasive: (seven patients), and invasive, invasive: three patients. Although follow-up is short (median of 40 months), 82% of the patients who had clinically occult second-breast cancer remain free of disease. During a previous 8-year period, 37 of 500 primary breast cancer patients (7.4%) developed metachronous (33) or synchronous (4) second-breast primary cancers primarily diagnosed clinically or radiologically. Of these, 35 were invasive and two noninvasive cancers; 41% had nodal metastases. A selected "favorable group," 28 of these patients who were free of disease 3 years after their first cancer, was analyzed. The analysis showed that only 10 (36%) were surviving free of disease at 7 years; 25% were free of disease at 10 years. Although the incidence of clinically-recognized, second-primary breast cancer is relatively low, development of a second invasive cancer severely impairs patient survival. Contralateral biopsy would appear useful to identify patients with early invasive or preinvasive cancer in the second breast, which appears normal after clinical observation or mammography. It provides opportunity to reduce the risk of invasive cancer in that breast, as well as to provide important diagnostic and prognostic information.

Optimal surgical treatment of invasive lobular carcinoma of the breast

“…To facilitate early detection of contralateral breast cancer in ILC, a blind biopsy of the contralateral breast or prophylactic mastectomy was often recommended. A high incidence of contralateral breast cancer in ILC detected by contralateral breast biopsy was reported by Wanebo and colleagues (19). These contralateral biopsies were directed mainly at suspicious lesions detected by clinical or radiologic examination.…”

Survival after bilateral breast cancer: results from a population-based study

“…Some authors did not differentiate between synchronous and metachronous bilateral breast cancer. They reported either similar mortality risks between unilateral and bilateral breast cancer patients [4,14,21] or impaired survival of women with bilateral disease [5,20]. There are several explanations for the disagreement between studies.…”

“…Some studies found worse survival for patients with bilateral breast cancer [13][14][15], others showed similar survival rates for patients with unilateral and bilateral breast cancer [3][4][5][13][14][15][16][17][18][19][20][21]. Unfortunately, many of these studies did not account for important prognostic factors such as systemic therapy.…”

A case-control study of unilateral and bilateral breast carcinoma patients

“…It would, therefore, be optimal to be able to identify the subset of breast carcinoma patients who are at highest risk for bilateral disease. Several past studies have characterized putative clinical and pathologic features, 30 -39 as well as methods, such as contralateral blind biopsy 40,41 or random fine-needle aspiration biopsy 42 for accomplishing this goal. The purpose of the current study was to evaluate risk factors for bilateral disease by using a sample of randomly selected bilateral breast carcinoma patients and comparing them with an age-and stage-matched group of control patients with unilateral disease.…”

“…Early data suggested that contralateral blind biopsies were useful. Wanebo et al 40 looked at contralateral blind biopsy results in 62 patients with unilateral disease diagnosed during 1978 -1983 and found radiographically and clinically occult disease in 11.3%. Simkovich et al 41 found a similar yield of 10% in 130 contralateral biopsies performed between 1970 and 1980.…”