Correspondence

Radial Scars and Breast Cancer

N Engl J Med 1999; 341:210July 15, 1999

Article

To the Editor:

Jacobs et al. (Feb. 11 issue)1 found that radial scars were an independent risk factor for breast cancer. We are surprised that the authors did not report any synchronous carcinoma associated with the 99 radial scars they examined. We recently reviewed 32 histologically confirmed radial-scar specimens obtained from 31 women who were treated in our center, where all stellate lesions are excised for histologic diagnosis. Cancer was associated with the radial scar in 31 percent of the women. The malignant lesions included six invasive carcinomas and four cases of ductal carcinoma in situ.

Our findings and those reported in other studies2,3 suggest that radial scars may represent an early stage of development of some breast cancers. The presence of the various stages of mammary carcinogens, such as hyperplasia, atypical epithelial hyperplasia, ductal carcinoma in situ, and invasive carcinoma, in association with radial scars supports our hypothesis.

K. Mokbel, F.R.C.S.
R.K. Price, M.B., B.S.
R. Carpenter, F.R.C.S.
St. Bartholomew's Hospital, London EC1A 7BE, United Kingdom

3 References

1. 1

   Jacobs TW, Byrne C, Colditz G, Connolly JL, Schnitt SJ. Radial scars in benign breast-biopsy specimens and the risk of breast cancer. N Engl J Med 1999;340:430-436
   Full Text | Web of Science | Medline

2. 2

   Sloane JP, Mayers MM. Carcinoma and atypical hyperplasia in radial scars and complex sclerosing lesions: importance of lesion size and patient age. Histopathology 1993;23:225-231
   CrossRef | Web of Science | Medline

3. 3

   Frouge C, Tristant H, Guinebretiere JM, et al. Mammographic lesions suggestive of radial scars: microscopic findings in 40 cases. Radiology 1995;195:623-625
   Web of Science | Medline

Author/Editor Response

The authors reply:

To the Editor: Mokbel and colleagues were surprised that we did not report any synchronous carcinomas associated with radial scars. The purpose of our case–control study was to examine the risk of subsequent breast cancer in women who had had benign breast lesions on a prior biopsy. Therefore, by virtue of the design of the study, none of the prior breast-biopsy specimens from these patients contained carcinoma, including those with radial scars.

Mokbel and colleagues further note that they have observed carcinoma in association with some radial scars, a finding previously reported by others.1-3 This association appears to be more frequent in the case of radial scars that are large enough to be detected by mammography than for those identified as incidental microscopical findings.1-3 The results of our case–control study and these morphologic studies support a relation between radial scars and breast cancer.

The observations of Mokbel and colleagues and others1-3 suggest that some larger radial scars may, by chance, be associated with carcinoma or may represent direct precursors of breast cancer, albeit not necessarily obligate precursors. However, the nature of the relation between radial scars and breast cancer is likely to be complex and may differ depending on the size of the lesion and other factors, such as the patient's age.1

Timothy W. Jacobs, M.D.
James L. Connolly, M.D.
Stuart J. Schnitt, M.D.
Beth Israel Deaconess Medical Center, Boston, MA 02215

3 References

1. 1

   Sloane JP, Mayers MM. Carcinoma and atypical hyperplasia in radial scars and complex sclerosing lesions: importance of lesion size and patient age. Histopathology 1993;23:225-231
   CrossRef | Web of Science | Medline

2. 2

   Frouge C, Tristant H, Guinebretiere JM, et al. Mammographic lesions suggestive of radial scars: microscopic findings in 40 cases. Radiology 1995;195:623-625
   Web of Science | Medline

3. 3

   Douglas-Jones AG, Pace DP. Pathology of R4 spiculated lesions in the breast screening programme. Histopathology 1997;30:214-220
   CrossRef | Web of Science | Medline

Citing Articles (1)

Citing Articles

1. 1

   J.A. Patterson, M. Scott, N. Anderson, S.J. Kirk. (2004) Radial scar, complex sclerosing lesion and risk of breast cancer. Analysis of 175 cases in Northern Ireland. European Journal of Surgical Oncology (EJSO) 30:10, 1065-1068
   CrossRef