Surgery may reveal early cancer risk

Twelve percent of breast reduction patients may have abnormal pathologies placing them at an increased risk of developing breast cancer, suggests a study by the American Society of Plastic Surgeons, Arlington Heights, III. In addition, the researchers found it more cost effective to screen breast reduction patients of all ages, not just those who are over 40, the age when routine screening mammography is recommended.

Surgeons who perform breast reductions usually have the removed tissue tested for abnormalities. While the screening of each patient may detect breast cancer early, it also escalates the overall cost.

"We are in a tumultuous time in medicine when cost is an important factor. Pressure from insurance companies and general administrators often force physicians to consider the cost of care when treating a patient," admits Kristin Stueber, author of the study.

"However, detecting breast cancer as early as possible reduces treatment costs and saves lives. In the end, we found that, although it may cost more up front to screen each breast reduction patient for cancer, we saved money and helped patients to get treatment sooner."

In the study, 12% of the patients tested, ranging from 14 to 73 years old, had abnormal pathology reports indicating either a premalignant lesion or a lesion that puts the patient at an increased risk of developing breast cancer. Of those with an abnormal outcome, 28% were deemed moderate or high risk. Twenty percent of the high-risk patients had yet to turn 40.

"If we were to limit our pathologic examination of breast tissue to breast reduction patients older than 40, we would fail to identify 20% of moderate to high risk pathology, which is simply not an acceptable risk," Stueber contends. "Besides the potential cost savings in testing, the cost for treating a cancer patient down the road is certainly more than any savings we could produce in the short term."

More than 105,500 women had breast reduction surgery in 2004, according to ASPS statistics. Applying the findings of this study to those numbers, if the medical community only tested women above age 40, it would have missed 633 cases of individuals with moderate to high risk of breast cancer, which is 90% curable when discovered early.

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