ARRS: Women with benign biopsies overmanaged

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doctor and patient - 94.80 Kb

Contrary to current guidelines, women with benign breast biopsies do not need follow-up at six months, and they may not need close surveillance at all, according to research presented May 3 at the annual meeting of the American Roentgen Ray Society (ARRS) in Vancouver.

Current National Comprehensive Cancer Center Network guidelines recommend women with benign breast biopsies undergo follow-up every six months, 12 months and for up to two years.

Shannon Reed, MD, of Moffitt Cancer Center in Tampa, Fla., and colleagues completed a retrospective chart review of 388 patients enrolled prior to Aug. 31, 2010, in the Lifetime Database for Cancer Risk Assessment and Early Detection, the database for Mammographic Abnormalities and Biomarker in Predicting Breast Cancer or both.

The researchers estimated six-month, one-year and two-year incidence rates of cancer development with 95 percent confidence intervals. No cancer was found at six and 12 months. "Of the 197 follow-up exams performed at 24 months, two women were positive for cancer in a different area than had been previously biopsied," Reed said in a statement.

An annual mammogram, as part of regular preventive care, could replace the need for benign breast disease follow-up of these patients, said Reed. This protocol would reduce radiation exposure and healthcare spending.

Reed and colleagues also reported that close surveillance over the two-year period led to more than 6 percent of women having an additional biopsy performed, all of which were benign. This indicates "overtreatment" of these patients as well as "overmanagement," Reed said.

"The study results are changing the way we practice," said Reed. "We are recommending diagnostic imaging follow-up annually for two years, followed by a return to routine screening."

The researchers plan to study specific risk factors for subsequent imaging abnormalities, biopsy and cancer development  in women with histologically proven benign breast disease, both with and without atypia.