Breast reduction may reveal early breast cancer risk

Cancer screening in breast reduction patients, regardless of age, saves money, lives

September 24, 2005
American Society of Plastic Surgeons (ASPS)

12% of breast reduction patients may have abnormal pathologies placing them at an increased risk of developing breast cancer, according to a study presented today at the American Society of Plastic Surgeons (ASPS) Plastic Surgery 2005 conference in Chicago. In addition, the authors found it more cost effective to screen breast reduction patients of all ages, not just those over 40, the age when routine screening mammography is recommended.

Plastic surgeons who perform breast reductions routinely 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 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," said Kristin Stueber, M.D., ASPS Member Surgeon and co-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 300 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, placing them at a significantly higher threat than the general population for developing breast cancer. Two of the 10 high-risk patients were less than 40 years old. Any patient with an abnormal test was referred to a comprehensive breast center to watch for indications of breast cancer.

Based on the study of 300 patients where pathologic examination of each patient's breast tissue was $381.72, there could have been a savings of $81,688 by only testing women above the age of 40, who equaled less than 29% of the patients. However, selective testing would have missed two potential cases of breast cancer.

"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," said Dr. Stueber. "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 last year's numbers, if the medical community only tested women above the age of 40, it would have missed 633 cases of moderate to high risk breast cancer.

Breast cancer is 90% curable when discovered early. An estimated 211,240 new invasive cases of breast cancer are expected to occur in 2005 among women in the United States, according to the American Cancer Society. This year, more than 40,000 women are expected to die from the disease.