Prevalence of incidental breast cancer and precursor lesions in autopsy studies: a systematic review and meta-analysis.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of observational autopsy studies (by design-strength analogy).
PubMed 29197354 · doi:10.1186/s12885-017-3808-1
What was done
Authors conducted a systematic review and meta-analysis (PubMed and Embase searched from inception to April 2016, plus forward and backward citation tracking) of autopsy studies of women with no history of breast pathology. Included studies conducted systematic histological examination of at least one breast and allowed calculation of prevalence of incidental breast cancer or precursor lesions. Data were pooled using logistic regression models with random intercepts.
What was found
Thirteen studies (1948–2010) comprising 2,363 autopsies and 99 cases of incidental cancer or precursor lesions were included. The estimated mean prevalence of incidental cancer or precursor lesions was 19.5%, consisting of 0.85% invasive cancer, 8.9% in-situ cancer, and 9.8% atypical hyperplasia. Thorough histological sampling (≥20 sections) was strongly associated with finding in-situ cancer (OR = 126.8, p < 0.001) and atypical hyperplasia (OR = 21.3, p < 0.001), but not invasive cancer (OR = 1.1, p = 0.75).
Why it matters
A substantial reservoir of undetected in-situ cancer and atypical hyperplasia exists in the general female population. Screening programs utilizing increasingly sensitive diagnostic tools risk detecting these indolent lesions, potentially increasing overdiagnosis.
Limits
The total pool of cases was small (99 cases across 2,363 autopsies) and drawn from heterogeneous studies published over six decades across 10 countries. Detection rates depended heavily on tissue sampling intensity (number of histological sections), and the abstract lacks details on the age distribution or clinical causes of death.
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- context Nearly every person has cancer cells living in their body at any given time.