Mucocele-like lesions of the breast - A radiological and clinicopathological analysis

INTRODUCTION

Mucocele-like lesions (MLL) of the breast are rare entities which are considered to harbor uncertain malignant potential. Current UK guidelines recommend vacuum assisted excision (VAE) of all such lesions regardless of whether they display epithelial atypia. This study sought to review the key histological and radiological features of MLLs and compare their differing outcomes based on the presence of epithelial atypia.

METHODS

Pathology records of a single breast cancer screening center were retrospectively searched for all biopsy diagnosed MLLs over an 11-year period. Upgrade rates to malignancy (positive predictive values) were calculated by reviewing histology from the initial core biopsy and comparing with the corresponding excision specimen. Radiological images were simultaneously reviewed to provide radiological-pathological correlation.

RESULTS

Three of 11 patients (27.3%) with atypical MLLs on biopsy had malignant outcomes at excision, compared with only 1 of 36 patients (2.8%) with non-atypical MLLs. The majority of MLLs (93%) were identified as microcalcifications on mammographic imaging. No specific radiological features were predictive of malignancy.

CONCLUSIONS

Our data suggest that MLLs without atypia are potentially overtreated with current protocols and could be managed conservatively with radiological follow up. Radiological-pathological correlation is essential.

Breast cancer risk status influences uptake, retention and efficacy of a weight loss programme amongst breast cancer screening attendees: two randomised controlled feasibility trials

Background

Excess body weight and sub-optimal lifestyle are modifiable causes of breast cancer and other diseases. There is little evidence that behaviour change is possible within screening programmes and whether this is influenced by prior knowledge of disease risk. We determined whether breast cancer risk influences uptake, retention and efficacy of a weight control programme in the UK National Health Service Breast Screening Programme, and whether additional cardiovascular disease and type 2 diabetes risk information improves uptake and retention further.

Method

Overweight/obese women in the UK National Health Service Breast Screening Programme identified at high, moderately increased, average and low-risk of breast cancer were randomised to receive individualised breast cancer risk information (breast cancer prevention programme), or individualised breast cancer, cardiovascular disease (QRISK2) and type 2 diabetes (QDiabetes, HbA1c) information (multiple disease prevention programme). Personalised breast cancer risk feedback was given before randomisation in Study-1, and after randomisation in Study-2.

Results

Recruitment was 9% (126/1356) in Study-1 and 7% (52/738) in Study-2. With respect to breast cancer risk, odds ratio of uptake for high/moderately increased vs low risk women was 1.99 (95% CI 1.24–3.17, P = 0.004) in Study-1 and 3.58 (95% CI 1.59–8.07, P = 0.002) in Study-2. Odds ratio of retention for high/moderately increased -risk vs. low risk women was 2.98 (95% CI 1.05–8.47, P = 0.041) in Study-1 and 3.88 (95% CI 1.07–14.04, P = 0.039) in Study-2. Weight loss of ≥5% at 12 months was achieved by 63% high/moderate vs. 43% low-risk women in Study-1 (P = 0.083) and 39% vs. 8% in Study-2 (P = 0.008). Uptake, retention and weight loss were equivalent in both the breast cancer prevention programme and the multiple disease prevention programme in both studies.

Conclusions

Women who are informed that they are at increased breast cancer risk were significantly more likely to join and remain in the programmes and consequently lose more weight across both studies. High risk women are more likely engage in a lifetyle prevention programme and also have the greatest potential benefit fom risk reduction strategies.

Trial registration

ISRCTN91372184 Registered 28 September 2014.