National report — Breast reduction surgery may play an important role in the primary prevention of breast cancer, according to results of a recent review of data on more than 70,000 women published in Plastic and Reconstructive Surgery (2004; 113: 2104).
Reduction mammoplasty appears to lower risk of breast cancer by 50 percent to 70 percent, according to the review, which included evidence from cohort and case-control studies conducted in the United States, Canada, Denmark and Sweden. Individually, all six studies showed a reduction in breast cancer risk in women who received the procedure.
By comparison, clinical studies suggest prophylactic bilateral mastectomy lowers breast cancer risk in high-risk women by 90 percent or more. However, this procedure is disfiguring and potentially psychologically damaging, and thus an unacceptable option for most women.Study co-author V. Leroy Young, M.D., says that while it's always difficult to interpret epidemiologic data, the effect does seem real; because of that, breast reduction should now be considered an "additional preventive alternative" in women with a family history of breast cancer.
"This study pretty convincingly shows that reduction mammoplasty reduces risk of breast cancer," says Dr. Young, chair of the American Society of Plastic Surgeons (ASPS) Committee on Emerging Trends. "When you go through the literature, this reduction in risk is an obvious plus."
This news should be shared with two types of patients, according to Dr. Young.
The first group includes women at high risk of breast cancer who don't want prophylactic mastectomy. American Cancer Society statistics suggest the average woman has a one-in-eight risk of developing breast cancer in her lifetime. However, women with a strong family history of breast cancer may be at increased risk; in one study, researchers found a definable hereditary component in about 25 percent of women who developed breast cancer before age 42. A small number of women (about 0.1 percent) are carriers of BRCA1 and BRCA2, markers of predisposition to developing breast cancer early in life.
The other group is "women who want to have a reduction mammoplasty, but have the general one-in-eight risk of breast cancer," he adds. "Besides the benefit in relief from macromastia, there is a reduction in risk of breast cancer, and that's never really been promoted as an issue. It's a common procedure, and I don't think women are aware of that benefit."
Reduction prevalence Reduction mammoplasty is one of the most common breast procedures that U.S. plastic surgeons perform. In 2002, members of the ASPS performed almost 100,000 breast reduction surgeries, a remarkable increase of 150 percent over the past 10 years. Reasons for that increase may include better public awareness, increased insurance coverage and a large increase in obesity in the population, according to Dennis P. Orgill, M.D., Ph.D.
The available data should "make some patients and surgeons feel more comfortable about breast reduction surgery,"says Dr. Orgill, associate chief of plastic surgery, Brigham and Women's Hospital, Harvard Medical School, Boston.
"Often, patients ask if breast reduction surgery will raise or lower risk (of breast cancer)," says Dr. Orgill, who co-authored an editorial in the same issue of Plastic and Reconstructive Surgery. "Certainly there is a trend in these articles, though not proven, that the procedure would lower the risk."
The literature review Dr. Young and colleagues published was based on two large cohort studies from Canada and Sweden, including about 30,000 women each, and four smaller cohort or case-control studies ranging in size from 559 to 7,720 patients.
Research study The large Canadian study included about 28,000 women who had undergone bilateral breast reduction surgery between 1979 and 1992. With an average follow-up of 6.5 years, investigators observed 101 out of an expected 165.8 breast cancers. The standardized incidence ratio was 0.61 (95 percent CI, 0.50-0.74). The large Swedish study included almost 32,000 women undergoing breast reduction between 1965 and 1993; in this cohort, the standardized incidence ratio was 0.7 (95 percent CI, 0.6-0.8).