Our Summary

This research paper is about non-cancerous breast lumps called “papillomas”, which are often detected through imaging tests. It was previously thought that all these lumps should be removed through surgery due to the risk of them turning into cancer, with previous studies showing a 0 to 29% likelihood of this happening. However, this study has shown that not all papillomas need to be removed and that only certain ones have a higher chance of becoming cancerous.

The researchers looked at the records of 266 patients who had been diagnosed with a benign (non-cancerous) papilloma through a breast biopsy. Among these patients, 182 underwent surgery to remove the lump. They found out that 21 of these patients were later diagnosed with cancer, meaning that only 12% of the lumps removed were cancerous.

The study also identified factors that increased the likelihood of a papilloma becoming cancerous - presence of calcium deposits in the lump, older age of the patient, and lumps larger than 0.5 cm. Therefore, the researchers suggest that not all papillomas need to be removed and that younger patients with lumps showing no high-risk features could be monitored rather than undergoing surgery. This could save low-risk women from unnecessary surgery.

FAQs

  1. What are the factors that increase the likelihood of a non-cancerous breast lump or papilloma becoming cancerous?
  2. What does the study suggest for younger patients with non-cancerous breast lumps that show no high-risk features?
  3. How many of the patients in the study who had their non-cancerous breast lumps removed were later diagnosed with cancer?

Doctor’s Tip

A helpful tip a doctor might tell a patient about breast biopsy is to discuss the specific characteristics of the lump with their healthcare provider. Understanding the size, location, and any other factors that may increase the risk of the lump being cancerous can help the patient make an informed decision about whether or not to undergo surgery. It’s important to have open communication with your doctor and ask any questions you may have about the biopsy results and the recommended course of action.

Suitable For

Patients who are typically recommended for breast biopsy include those with:

  1. Suspicious findings on a mammogram, ultrasound, or MRI, such as a lump or mass in the breast
  2. Abnormal changes in the breast, such as skin dimpling or nipple discharge
  3. A personal history of breast cancer or a strong family history of breast cancer
  4. A history of atypical hyperplasia or lobular carcinoma in situ (LCIS) on previous breast biopsies
  5. Persistent breast pain or discomfort
  6. A palpable lump or thickening in the breast that can be felt during a physical exam

It is important to note that not all breast biopsies result in a cancer diagnosis. Many breast biopsies are performed to determine the nature of a suspicious lump or abnormality in the breast tissue, and the majority of these biopsies reveal non-cancerous findings. It is essential for patients to follow their healthcare provider’s recommendations for breast biopsy based on their individual risk factors and imaging findings.

Timeline

Overall timeline of a patient’s experience before and after a breast biopsy:

Before biopsy:

  1. Patient notices a lump or abnormality in the breast.
  2. Patient consults with a healthcare provider who recommends a breast biopsy.
  3. Patient undergoes pre-biopsy imaging tests such as mammograms or ultrasounds to locate the lump.
  4. Patient schedules a biopsy appointment and receives instructions on how to prepare for the procedure.

During biopsy:

  1. Patient arrives at the clinic or hospital for the biopsy procedure.
  2. Local anesthesia is administered to numb the area.
  3. A small sample of tissue is extracted from the lump using a needle or through a small incision.
  4. The tissue sample is sent to a laboratory for analysis.

After biopsy:

  1. Patient may experience mild pain or discomfort at the biopsy site.
  2. Patient receives the biopsy results from their healthcare provider.
  3. If the biopsy shows a benign papilloma, the patient may be advised to monitor the lump or undergo regular follow-up imaging tests.
  4. If the biopsy shows a cancerous papilloma, the patient may need further treatment such as surgery, radiation therapy, or medication.
  5. Patient may undergo additional tests or procedures to determine the extent of the cancer and develop a treatment plan.
  6. Patient receives ongoing care and support from their healthcare team throughout their treatment and recovery process.

What to Ask Your Doctor

Some questions a patient should ask their doctor about breast biopsy in relation to this study include:

  1. What are the chances of my papilloma turning into cancer based on the specific characteristics of my lump?
  2. Are there any high-risk features in my lump that would indicate a need for surgery?
  3. Can we monitor the lump over time instead of immediately opting for surgery?
  4. What are the potential risks and benefits of removing the papilloma versus monitoring it?
  5. How often should I have follow-up imaging tests or exams to monitor the lump?
  6. Are there any alternative treatments or options for managing the papilloma?
  7. What is the likelihood of complications from the biopsy procedure itself?
  8. How will the results of the biopsy affect my overall breast health and future screenings?
  9. Will my insurance cover the cost of the biopsy and any follow-up care?
  10. Are there any lifestyle changes or precautions I should take to reduce the risk of my papilloma developing into cancer?

Reference

Authors: MacColl C, Salehi A, Parpia S, Hodgson N, Ramonas M, Williams P. Journal: Virchows Arch. 2019 Dec;475(6):701-707. doi: 10.1007/s00428-019-02626-5. Epub 2019 Aug 1. PMID: 31372738