Henry Ford Hospital Medical Journal


A search for malignant and premalignant lesions in 162 contralateral biopsy and/or mastectomy specimens yielded 45 (27.8%,) malignancies and 54 (33%) premalignant lesions (atypical epithelial hyperplasia, Wellings grades III and IV). In those with no palpable or mammographic suspicion of malignancy, the cancer incidence was 73.8%. Eight malignancies occurred one month to three years after antecedent biopsies which revealed premalignant lesions. No cancer has been detected after biopsies which revealed hyperplasia of grade II or less. Cancer size at time of discovery varied significantly with the method of detection: average 2.7 cm by palpation; 1.6 cm by mammography; 0.5 cm by biopsy. Axillary metastasis was present in 30%, 20%, and 70%, respectively. Axillary metastasis from occult contralateral cancer occurred in three instances where none was found from ipsilateral, clinically evident cancers; synchronous in two; asynchronous in one by eight years. In a subgroup of one hundred prophylactic biopsies performed by the author, patients with Wolfe P2-DY patterns (vs. N1-P1) had a high incidence of malignancy (20%, vs. 72.5%) and at a younger age (average; 53 vs. 73 years). Routine contralateral biopsy synchronous with ipsilateral mastectomy is recommended. Patients with contralateral severe epithelial atypia should have the option of prophylactic mastectomy.