Treatment of some breast lesions may wait

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Yesterday we reviewed an article proposing that cancer be redefined and reserved to describe those lesions with a likelihood of lethal progression if left untreated. In a study reported today we have an example of breast lesions atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS) that may require a more conservative approach in terms of treatment options.

Forty-three patients who had mammograms, needle biopsies of suspicious breast lesions, followed by assessment by a pathologist of the tissue removed, were the subjects of a small study. Dr. Kristen A. Atkins and colleagues from the University of Virginia in Charlottesville examined the probability that when both the pathology and radiology agreed the lesions were benign, none of the lesions were upgraded at surgery or on extended follow-up to a more dangerous category.

However, in the seven patients whose radiological and pathological assessments disagreed, two were upgraded to a more concerning diagnosis.

Currently, in the case of patients with ALH or LCIS, the recommendation is to perform more extensive surgery for all cases. This study, however, suggests that, when careful radiologic and pathologic evaluations agree, the patient may be as well served by watchful waiting.

While these results are certainly too preliminary to act upon, commented ACSH s Dr. Gil Ross, they provide an example of how, with careful evaluation, excess treatment of some breast lesions might be avoided. And, as referenced yesterday, some of the unnecessary fear associated with cancer diagnoses and treatments may be abated.