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  • Title: Analysis of benign breast lesions in blacks.
    Author: Oluwole SF, Freeman HP.
    Journal: Am J Surg; 1979 Jun; 137(6):786-9. PubMed ID: 453472.
    Abstract:
    A clinicopathologic analysis of 202 benign breast lesions in black women is presented. The study shows that the peak incidence of fibroadenoma occurs at an earlier age in black than in white patients. Fibrocystic disease is most frequent in both black and white patients between 25 and 45 years of age. It is noteworthy that nulliparous adolescent blacks have a higher risk of fibroadenoma developing and our findings confirm the observation made by Funderburk et al [5] and Nigro and Organ [6] that the incidence of fibroadenoma in blacks is high. The low incidence of fibrocystic disease in our patients does not reflect the clinical incidence of the disease because most patients with fibrocystic disease do not undergo biopsy. We are unable to draw any conclusions about the relation between the use of oral contraceptives and the incidence of benign breast disease. In conclusion, a review of the literature and an analysis of our data suggest a relatively higher incidence of fibroadenoma among black patients. In contrast to the finding in the white population, it appears that in blacks fibroadenoma is more common than carcinoma of the breast. The pathologic diagnosis of 282 consecutive breast lesions seen in 255 black patients over a 3-year period (January 1975-December 1977) at Harlem Hospital Center were reviewed and analyzed. The most common lesion was fibroadenoma, accounting for 34.7% of all lesions and 48% of benign breast lesions, followed by carcinoma (28%) and fibrocystic disease (17%). Other major benign breast lesions in order of frequency were intraductal papilloma, sclerosing adenosis, chronic mastitis, and fat necrosis. One each of the following rare lesions was observed: papillomatosis, ducatal ectasia, cystosarcoma phylloides, and granular cell tumor. Multiple lesions were found in 1 or both breasts in 15% of all benign breast disease cases, with fibroadenoma being the most common lesion. 94% of the patients presented with a breast mass, 5% with nipple discharge, 5% with pain, and 2% with a history of trauma to the breast. The lesions varied in size from 0.5-10 cm, and had been present for a few days to 20 years before medical treatment was sought. The upper quadrant of the breast was the most common site for lesions. Peak age incidence for all benign breast lesions was 20-35 years; for fibroadenoma, peak age incidence was 16-25 years and for fibrocystic disease, 40-50 years. The surgical literature shows that in a predominantly white population, peak age of incidence for benign lesions is 30-49 years; this disparity in age distribution may be due to the high percentage of adolescent patients with fibroadenoma in the Harlem Hospital series. Median age of patients with breast carcinoma in this series is 61 years. 24 patients (13.7%) with benign breast disease had taken oral contraceptives before the breast biopsies were performed. However, the study population is to small and follow-up time to short to draw any conclusion regarding the relation of oral contraceptive use to the subsequent development of breast cancer. This study shows that compared to the white population, fibroadenoma is more frequent than cancer in black women while cancer is more frequent than fibroadenoma in white women.
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