Breast cancer is one of the most feared female cancers. Risk factors for breast cancer include age, genetics, family history, race (higher in white women), onset of menstruation before 12 years, late onset of menopause, alcohol use, estrogen therapy and history of benign breast disease.
Women who have received a diagnosis of benign breast disease often feel reassured. However, it is not widely known that women with a history of benign breast disease have a significantly increased the risk of developing breast cancer later. Benign breast disease may be an incidental finding when a screening mammogram is done or if a suspicious lump is discovered by the woman or her physician. Biopsies are special investigations which are usually done thereafter, to either exclude or confirm cancer. Women who have had a biopsy with benign findings have so-called ‘benign breast disease’ (BBD), meaning ‘non-cancerous’. There are various types of BBD, and these include conditions such as fibrocystic disease, fibro-adenomas and pseudo-lumps. These benign breast conditions are further classified into histological types as follows:
- Proliferative without atypia
Histologically proven benign breast disease increases a woman’s relative risk for subsequent cancer development. Various studies have consistently demonstrated that women with a BBD histological type ‘atypia’ are almost four times at higher risk of breast cancer. Non-proliferative BBD carries an approximate risk of 1,24 and proliferative without atypia carries a risk of approximately 1,88.
But follow-up guidelines for mammogram and clinical breast examination after a benign breast biopsy are lacking.
Since certain types of BBD are associated with increased risk of cancer, this is of importance to the insurance sector. Many female applicants would consider a diagnosis of BBD as an unremarkable outcome that may not warrant a declaration on application. This may be assumption for the underwriter as well. This may be attributed to the false sense of reassurance a ‘benign’ biopsy confers.From the underwriting perspective, it is important to recognise the increased risk of cancer for the different histological types of BBD. This will be of great value in that the appropriate rating may be applied at underwriting stage.
There are various risk assessment tools that are available online that can calculate a woman’s risk of breast cancer. These tools may be used to determine risk at underwriting stage and may be accessed at http://www.halls.md/breast/risk.htm.
It is apparent that the question of malignancy in the breast is not an absolute yes or no scenario. Special histological types of breast cancer are recognised that pose little threat to life. However, a benign biopsy that reveals abnormal growth also warrants a discussion of risk of cancer and further follow up options by the physician. Putting that risk in perspective is important from a health perspective for the woman. But it is also significant for underwriting purposes.