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Benign breast disease: the latest considerations on the early diagnosis from the last European Council

Benign breast diseases (BBD; mastopathies) are very frequent in the female population, accounting for 80% of all breast lesions. Breast diseases comprise a large and heterogeneous group of lesions detectable through microscopic findings and imaging tests. This type of lesion is more incident in the second decade of life, stagnating in the fourth decade. Symptoms of BBD include breast pain, lumpiness, and papillary discharge. Mastopathies are divided according to their risk of breast cancer into nonproliferative, proliferative without atypia, and atypical hyperplasia (American College of Pathologists, 1986). Nonproliferative lesions include cysts, papillary apocrine changes, epithelial calcifications, hyperplasias, and fibroadenomas. Available data indicate that p53 gene expression appears to be more frequent among tissues with fibrocystic disease and fibroadenoma (both 22.5%).

Previous studies indicate that a family history of breast cancer is an important factor influencing the development of breast cancer; mutations in the p53 genes and BRCA-1 and/or BRCA-2 are all related to the pathogenesis of breast cancer. Previous studies have confirmed that, after improving risk assessment, there is a relationship between the occurrence of breast cancer and specific benign breast diseases, including sclerosing breast disease, breast fibroids and breast papillomas. The risk of breast cancer has almost doubled in women diagnosed with benign breast disease through screening, according to research presented last week at the XIII European Breast Cancer Conference. The study of more than 700,000 Spanish women who took part in breast screening compared women diagnosed with benign breast disease, including fibroadenomas and cysts, with women without any breast disease.

The increased risk of breast cancer has lasted for at least 20 years, and researchers say this group of women could benefit from more frequent screening to ensure earlier diagnosis for the best chance of survival. The survey involved 778,306 women aged between 50 and 69 who attended breast screening at least once in one of 20 centers in Spain between 1996 and 2015. In Spain all women in this range of age a screening mammogram is offered every two years. The researchers followed the women up to 2017, and during that time, 17,827 women were diagnosed with benign breast disease while 11,708 women were diagnosed with breast cancer. The data showed that among women with benign breast disease, about 25 in 1,000 were later diagnosed with breast cancer. Among women without benign breast disease, about 15 in 1,000 were diagnosed with breast cancer.

The increased risk was found in women with benign breast disease regardless of their age, and the risk persisted for at least 20 years. Women followed for less than four years were 99% more likely to be diagnosed with breast cancer, and women followed for 12-20 years were 96% more likely to be diagnosed with breast cancer. Dr Roman commented: ‘This suggests that benign breast disease is a key indicator that a woman has a higher risk of breast cancer, rather than simply being something that could turn into cancer. In fact, we often find benign disease in one breast and then cancer develops in the other breast. We can use this knowledge to help optimize the screening we offer to women. For example, if a woman is diagnosed with breast disease and has other high risk factors, she may benefit from more frequent screening.”

As one can see, breast cancer and its early diagnosis is a topical issue that does not stop. Indeed, the president of the European Breast Cancer Council, Professor David Cameron, from the University of Edinburgh Cancer Research Centre, added: ‘Screening can help diagnose breast cancer at an early stage, when the chances of survival are higher. This large study shows that women in a screening program who are diagnosed with benign breast disease, appear to have a higher risk of receiving a breast cancer diagnosis in the long term and may therefore benefit from enhanced screening “Mammograms quite often detect signs of breast disease that isn’t cancer, such as cysts and fibroadenomas, and it’s important to remember that most women with these conditions will not develop breast cancer.”

  • Edited by Dr. Gianfrancesco Cormaci, PhD, specialist in Clinical Biochemistry.

Scientific references

Román M et al. Intl J Environ Res Pub Health 2022;

Liu H, Shi S et al. Transl Cancer Res. 2022; 11(5): 1344.

Escala-Garcia M, Morra A et al. BMC Med 2020; 18:327.

Coughlin SS. Breast Cancer Res Treat 2019; 177:537-48.

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Dott. Gianfrancesco Cormaci

Medico Chirurgo, Specialista; PhD. a CoFood s.r.l.
- Laurea in Medicina e Chirurgia nel 1998 (MD Degree in 1998) - Specialista in Biochimica Clinica nel 2002 (Clinical Biochemistry residency in 2002) - Dottorato in Neurobiologia nel 2006 (Neurobiology PhD in 2006) - Ha soggiornato negli Stati Uniti, Baltimora (MD) come ricercatore alle dipendenze del National Institute on Drug Abuse (NIDA/NIH) e poi alla Johns Hopkins University, dal 2004 al 2008. - Dal 2009 si occupa di Medicina personalizzata. - Guardia medica presso strutture private dal 2010 - Detentore di due brevetti sulla preparazione di prodotti gluten-free a partire da regolare farina di frumento enzimaticamente neutralizzata (owner of patents concerning the production of bakery gluten-free products, starting from regular wheat flour). - Responsabile del reparto Ricerca e Sviluppo per la società CoFood s.r.l. (Leader of the R&D for the partnership CoFood s.r.l.) - Autore di articoli su informazione medica e salute sul sito www.medicomunicare.it (Medical/health information on website) - Autore di corsi ECM FAD pubblicizzati sul sito www.salutesicilia.it
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