Prevalence of silent breast cancer in autopsy specimens, as studied by the disease being held by image-guided biopsies: The pilot study and literature review

Abstract

Breast cancer epidemiological patterns vary in European countries, which present different incidence rates. Data have suggested that the reduction in breast cancer mortality is not only due to the early detection of the disease, but is, in almost equal part, due to screening and to the advances that have been made in molecular medicine and the development of novel therapies. The aim of the present study is to quantify the actual number of cases of breast cancer present in both of the sexes by calculating the prevalence of silent breast cancer in corpses. To achieve this quantification, bilateral subcutaneous radical mastectomies are performed in corpses of either sex above 40 years of age that lacked any clinical manifestation of the disease, and where the breast cancer or its complications was not the cause of death. Only five publications exist in the international literature based on medico-legal autopsies that were designed to define the 'natural reservoir' of the disease. To the best of our knowledge, the present study is the first one to appraise breast tissue via imaging by means of orienting the biopsy incision. In conclusion, to the best of our knowledge, the design of the present study is the first of its type, where image-guided biopsies are used to define the prevalence of silent breast cancer. The study aims to demonstrate that the 'disease reservoir' is, in reality, higher than was originally considered to be so. Furthermore, the study aims to contribute towards an improved definition of the disease by determining which tumour profiles potentially do not benefit from aggressive treatments (for example, in case where a high prevalence of low-grade ductal carcinoma in situ is to be detected). According to our pilot study, this analysis represents a feasible protocol.

Keywords: breast cancer epidemiology; breast cancer overtreatment; breast cancer prevalence; cancer and forensic autopsies; silent breast cancer.

Figure 1.

Left female breast sample.

Figure 2.

Mammography device and placing.

Figure 3.

Ultrasonographic aspect of the tissue.

Figure 4.

Mammography of the tissue.

Figure 5.

Details of the data collection document. BMI, body mass index; BI-RADS, breast imaging reporting and data system; Mic, microcalcification; CDI, invasive ductal carcinoma; CLI, invasive lobular carcinoma; CDis, ductal carcinoma in situ; CLis, lobular carcinoma in situ; HER2, human epidermal growth factor receptor 2; ER, estrogen receptor; PR, progesterone receptor; AR, androgen receptor.