CHANGING EMPHASIS IN BREAST DIAGNOSIS - THE SURGEONS ROLE IN EVALUATING MAMMOGRAPHIC ABNORMALITIES

BACKGROUND: The increasing number of mammograms performed has resulted in a substantial increase in surgical referral for mammographic abnor malities with or without clinically apparent change. This increase cha llenges surgeons to examine their criteria for biopsy. STUDY DESIGN: I performed a retrospective review of data from 2,936 women referred fo r breast assessment, Data from women younger or older than 50 years wh o were clinically normal or who had a clinically apparent lesion were evaluated to determine the effect of mammographic diagnosis on the bio psy rate, rate of carcinoma diagnosed per biopsy performed, and preval ence of carcinoma in the categories of mammographic results. RESULTS: Although the rates of biopsy and detection of carcinoma were different in younger and older women, the influence of mammographic diagnosis w as similar. Regardless of age and presence or absence of a clinical ab normality, few breast carcinomas were detected in women whose mammogra ms showed normal breasts or benign lesions. Mammograms that showed mal ignant changes, even among women assessed as clinically normal, signif icantly influenced the rate of biopsy and the diagnoses of breast carc inoma. CONCLUSIONS: Women who are assessed as clinically normal and ha ve mammograms that show benign lesions and women who have a breast pro blem judged clinically as benign and mammographic results that are nor mal or show a benign lesion can be observed with confidence that the r isk of breast carcinoma is low. By careful selection, 40 percent of wo men who are assessed as clinically normal and younger than 50 years an d 20 percent of women older than 50 years can be observed rather than undergo biopsy, even though the mammogram is considered to show malign ant changes. A clinical abnormality combined with a mammographic findi ng of malignancy almost always requires performance of a biopsy. Becau se of the large number of women referred for surgical evaluations who have normal results on a mammogram or whose mammograms show a benign p roblem, a conservative approach is appropriate to reduce the number of biopsies performed in women of all ages.