Study Recommends Surveillance Rather Than Surgery for Non-Cancerous Breast Lesions

The risk of upgrade of flat epithelial atypia (FEA) to malignancy is low, while the upgrade to a higher-risk lesion is significant. Therefore, surveillance rather than surgery is a reasonable option for patients, according to a study.

A new study published in the Journal of the American College of Surgeons assessed medical records of 208 patients diagnosed with FEA over a 9-year period in order to identify the upgrade rates from FEA to malignancy. Following mammography, biopsy, and an operation, 5 cases were upgraded to breast cancer at surgery while 30% were upgraded to higher-risk, non-cancerous breast cancer lesion.

“Pathology results at needle biopsy are considered ‘high-risk’ if there are atypical cells but not cancerous cells present,” coauthor Michelle Gadd, MD, FACS, of the department of surgical oncology at Massachusetts General Hospital (MGH), said in a statement. “When high-risk lesions are excised by the breast surgeon, some are found to have adjacent cancerous cells—that is, they are upgraded to cancer at surgery.”

The goal of the research was to develop a way to evaluate the cancer risk in women with pure FEA lesions. Although some lesions have a greater upgrade to cancer risk than others, many, 10-15% of the biopsied lesions result in high-risk lesions. Additionally, mammography, the most effective method for breast cancer diagnosis, has limits and can result in unnecessary biopsies and false positives. Therefore, the upgrades of FEA to cancer in the study had the researchers using clinically reliable predictors.

“We found that the only risk factor associated with a higher risk of upgrade to cancer at surgery was the presence of a genetic mutation associated with breast cancer; however, we had only three patients with known genetic mutations in our study,” said Manisha Bahl, MD, MPH. “The only risk factor associated with a higher risk of upgrade to a ‘higher-risk’ lesion was a personal history of breast cancer.”

Overall, the risk of upgrade of FEA to malignancy was 2.4% while the upgrade rate to a higher risk lesion was nearly 30%, signifying that surveillance rather than surgery of FEA is necessary for patients.

“Surveillance, rather than surgery, is a good option for women with FEA lesions who do not have a genetic mutation and are not interested in chemoprevention,” said Constance D. Lehman, MD, PhD, the senior author on the paper and director of breast imaging at MGH. “Our results support these recommendations, given the overall low risk of upgrade to malignancy.”