Risk management recommendations and patient acceptance vary with high-risk breast lesions

Introduction: Lobular carcinoma in situ (LCIS), atypical ductal and lobular hyperplasia (AH) increase breast cancer risk. We examined risk management recommendations (RMR) and acceptance in AH/LCIS. Methods: All patients with AH/LCIS on core needle biopsy from 2013 to 2016 at our institution were identified; cancer patients were excluded. Univariate and multivariate analysis examined factors associated with management. Results: 98 % of patients were evaluated by breast surgeons and 53 % underwent risk model calculation (RC). 77 % had new RMR. RMR of MRI screening (MRI), genetic counselling (GC) and medical oncology (MO) referral were 41 %, 18 %, 77 %, respectively. MRI screening was more likely recommended in those with strong family history (p = 0.01), and high RC (p < 0.001). Uptake of at least one RMR did not occur in 84 % of patients. Use of RC correlated with MO acceptance (p = 0.049). Conclusions: Diagnosis of atypia has the potential to change risk management for most, however only 16 % of patients accepted all RMR. (C) 2021 Published by Elsevier Inc.

Automated summary

The study found that in patients with AH/LCIS, most patients received evaluation from breast surgeons, but only a small percentage accepted all risk management recommendations. MRI screening was more likely recommended in those with strong family history and high risk calculations, but 84% of patients did not receive any risk management recommendations.