High-Risk Benign Breast Lesions: An Ontario Health (Cancer Care Ontario) Recommendations Report

TL;DR

This report provides expert recommendations for managing high-risk benign breast lesions to reduce breast cancer risk.

Contribution

The paper introduces a multidisciplinary guideline for managing high-risk benign breast lesions with expert consensus.

Findings

High-risk benign breast lesions increase the risk of developing breast cancer.

A multidisciplinary working group developed evidence-based recommendations for managing these lesions.

The recommendations were reviewed by experts across Canada to ensure clinical relevance.

Abstract

High-risk benign breast lesions are abnormalities found in breast tissue that are associated with an increased risk of breast cancer. A working group of specialists, including surgeons, pathologists, and radiologists, who treat breast cancer was developed, and relevant publications were reviewed. Recommendations were then developed for each high-risk benign breast lesion based on this evidence as well as working group expert opinions. This document was reviewed by relevant experts across Canada and is relevant to all healthcare providers with an interest in breast cancer and cancer prevention.

High-risk benign breast lesions are histological abnormalities that present in breast tissue, typically identified by screening or diagnostic imaging. The presence of invasive or in situ breast cancer can be confirmed or ruled out within these lesions, and the risk of developing breast cancer can be reduced by their appropriate management. These potential high-risk lesions reviewed include atypical ductal hyperplasia, mucocele-like lesions, papillary lesions with or without atypia, radial scar/complex sclerosing lesion with or without atypia, atypical lobular hyperplasia, classical lobular carcinoma in situ, pleomorphic/florid lobular carcinoma in situ, flat epithelial atypia, columnar cell change, fibroepithelial lesions with stromal cellularity, spindle cell lesions/mesenchymal lesions, and microglandular adenosis. The lack of a clear consensus on the management of many of these lesions led the Ontario Health (Cancer Care Ontario) (OH-CCO) Breast Cancer Pathway Map Working Group and Breast Cancer Advisory Committee to identify the need for a recommendation document. A multidisciplinary working group was formed, with members representing surgical oncology, radiology, pathology, medical oncology, and genetic counselling. The working group developed a list of high-risk benign lesions to be included in this recommendation report. An updated literature review was completed, and these publications were reviewed by the working group, and recommendations were drafted. When evidence was lacking, the expert opinion was included. These draft recommendations were subjected to an extensive review by experts both within Cancer Care Ontario and across Canada. The recommendations included in this report are relevant to clinicians, primary care physicians, oncologists, radiologists, and pathologists who treat breast cancer and manage breast conditions.