XXXX . Risk reduction by contralateral biopsy.

@entity1 @entity0 @entity5 @entity75 @entity3
Although survival from primary @entity0 has improved with earlier diagnosis and treatment, the management of the opposite breast is still in question. The risk factors for bilaterality are known, and preoperative mammography is occasionally helpful, but identification of early second @entity0 is very limited. Contralateral biopsy may provide a reasonable answer to the problem. During a 5-year period, 62 elective contralateral biopsies were performed in @entity1 having mastectomies for primary @entity0 . This consisted of either a mirror image biopsy or, more commonly, a biopsy of the upper outer quadrant. Thirteen @entity1 had simultaneous @entity5 , of whom two had clinically overt bilateral cancers and 11 (18%) had clinically occult malignancy. Seven of these 11 had both radiologically and clinically normal breasts. Thus, 11.3% had radiologically and clinically occult @entity5 demonstrated by biopsy. Surgical management consisted of total mastectomy with low axillary dissection for noninvasive @entity5 and modified radical mastectomy for invasive @entity5 . Pathologic findings of the dominant @entity0 and the @entity75 were: bilateral, noninvasive: three @entity1 ; invasive, noninvasive: (seven @entity1 ), and invasive, invasive: three @entity1 . Although follow-up is short (median of 40 months), 82% of the @entity1 who had clinically occult second-breast cancer remain free of disease. During a previous 8-year period, 37 of 500 primary @entity0 @entity1 (7.4%) developed metachronous (33) or synchronous (4) second-breast primary cancers primarily diagnosed clinically or radiologically. Of these, 35 were invasive and two noninvasive @entity5 ; 41% had nodal metastases. A selected "favorable group," 28 of these @entity1 who were free of disease 3 years after their first @entity5 , was analyzed. The analysis showed that only 10 (36%) were surviving free of disease at 7 years; 25% were free of disease at 10 years. Although the incidence of clinically-recognized, second-primary @entity0 is relatively low, development of a second @entity3 severely impairs @entity1 survival. Contralateral biopsy would appear useful to identify @entity1 with early invasive or preinvasive @entity5 in the second breast, which appears normal after clinical observation or mammography. It provides opportunity to reduce the risk of @entity3 in that breast, as well as to provide important diagnostic and prognostic information.
