Lipoma in dogs: how common are they and what breeds are affected?

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Lipoma in dogs: how common are they and what breeds are affected?
CONTINUING EDUCATION I SMALL ANIMAL

         Lipoma in dogs: how common are they
         and what breeds are affected?

         Lipomas are often clinically unremarkable but can be alarming to owners. Although
         perceived as common in dogs, no studies have specifically investigated risk factors
         associated with their occurrence. Here, Dan O’Neill MVB BSc (hons) GPCert (SAP)
         GPCert (FelP) GPCert (Derm) GPCert (B&PS) MSc (VetEpi) FRCVS, pathobiology and
         population sciences, The Royal Veterinary College, reviews a study, which explored
         anonymised electronic patient records of dogs attending practices participating in
         VetCompass to report the prevalence and risk factors for primary-care veterinary
         diagnosis of lipoma
                                                                          disorder of purebred dogs in the UK in an owner-reported
                                                                          survey.6 Lipomas were the 12th most commonly reported
                                                                          disorder in dogs in the south of England with a prevalence
                                                                          of 3.5% reported from a sample of 3,884 dogs under primary
                                                                          veterinary care.7 Fatty tumours were reported as the most
                                                                          common tumour diagnosed by cytology in Dutch Golden
                                                                          Retrievers.8 Lipomas were the most common benign tumour
                                                                          (24%) identified in the Danish Cancer Registry9 and were the
                                                                          second most common tumour recorded in insured dogs in the
                                                                          UK with an incidence rate of 337 per 100,000 dogs per year.10
                                                                          Despite the evidence showing relatively frequent occurrence
                                                                          in dogs, there is very little published evidence on risk factors
                                                                          for lipomas. Advancing age, overweight dogs and females
                                                                          have been suggested as having increased risk.11 Dobermann
                                                                          Pinscher and Labrador Retriever have also been reported as
                                                                          predisposed breeds.12
         Figure 1: Lipoma in a dog. Photo: Lynda Rutherford.
                                                                          Primary-care veterinary clinical data is now recognised
                                                                          as a valuable research resource that benefit from
         Lipomas (Figure 1) are masses of mesenchymal origin,             contemporaneous recording of medical records at the time
         comprising of adipocytes.1-3 Although subcutaneous lipomas       of the clinical event, and from the recording of cohort data
         are often clinically asymptomatic4, they can cause deleterious   over time and at a veterinary level of precision.13,14 This study
         consequences for the patients and anxiety for the owners if      aimed to fill the information gap on the epidemiology of
         they become sizable or interfere with locomotion.1,4,5 Lipomas   lipoma by estimating the prevalence of lipoma, and evaluating
         of the dermis and subcutaneous tissues are reported to be        demographic risk factors for lipoma in the dog population
         common in older dogs1 and were the third most common             under primary veterinary care in the UK.

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         THE DATA                                                                   their breed and sex within the overall study population. This
         The VetCompass Programme harvests anonymised clinical                      variable allowed the effect of adult bodyweight to be assessed
         record data that primary-care veterinary practices already                 within each breed/sex combination.
         record15 for epidemiological research.7 Information collected              The one-year period prevalence with 95% confidence
         included patient demographic (species, breed, date of birth,               intervals (CI) described the probability of evidence in the
         sex, neuter status, colour, insurance status and bodyweight)               clinical records that confirmed the presence of lipoma at any
         and clinical information (free-form text clinical notes, VeNom             time during the one-year 2013 study period. Multivariable
         summary diagnosis terms16 and treatment, with relevant dates)              logistic regression modelling was used to evaluate univariable
         data fields. To date, 1,500 (30%) of UK vet practices collaborate          associations between risk factors (purebred, breed, Kennel
         within VetCompass, sharing clinical data on 10 million animals             Club breed group, adult bodyweight, bodyweight relative
         and making this the world’s largest university-based database              to breed/sex mean, age, sex-neuter and insurance) and
         of clinical heath records for companion animal research.                   diagnosis of lipoma during 2013. Statistical significance was
         The study included dogs under veterinary care within the                   set at P< 0.05.
         VetCompass database for a one-year period from January 1,
                                                                                    THE RESULTS
         2013 to December 31, 2013. Dogs ‘under veterinary care’ were
                                                                                    The denominator population comprised 384,284 dogs under
         defined as any dog with either at least one electronic patient
                                                                                    veterinary care at 215 clinics in the UK during 2013. A random
         record (EPR) recorded from January 1 to December 31, 2013
                                                                                    sample of 36.5% of the dogs were checked to confirm
         or, alternatively, at least one EPR both before and after 2013.
                                                                                    2,765 lipoma cases. After accounting for the subsampling
         Case-inclusion criteria required that a final diagnosis of lipoma
                                                                                    protocol, the estimated one-year period prevalence for lipoma
         (or synonym) was recorded in the EPR for a mass at any
                                                                                    diagnosis in dogs overall was 1.94% (95% CI: 1.87-2.01). The
         body location that was present during the 2013 study period.
                                                                                    breeds with the highest lipoma prevalence were Weimaraner
         Breed included individual breeds represented by over 4,000
                                                                                    (7.84%), Dobermann Pinscher (6.96%), German Pointer
         dogs in the overall study or with ≥15 lipoma cases, a grouped
                                                                                    (5.23%), Springer Spaniel (5.19%), and Labrador Retriever
         category of all remaining purebreds and a general grouping
                                                                                    (5.15%) (Figure 2).
         of crossbred dogs. Sex-neuter described the status recorded
                                                                                    Dogs with lipoma had a median adult bodyweight of 26.00kg
         at the final EPR. Insurance variable described whether a dog
                                                                                    (IQR: 16.80-35.20) compared with 16.50kg (IQR: 9.00-28.00)
         was insured at any point during the study period. Age (years)
                                                                                    for non-cases. The median age dogs with lipoma was 10.02
         was calculated for all dogs at the final date of the study period
                                                                                    years (IQR: 8.25-12.04) compared with 4.18 years (IQR: 1.80-
         (December 31, 2013). Bodyweight relative to bree-mean
                                                                                    7.59) for non-cases. The most commonly affected breeds
         variable characterised the adult bodyweight of individual dogs
                                                                                    were Labrador Retriever (545, 19.71% of all confirmed cases),
         as either below or equal/above the mean adult bodyweight for

                                                      Figure 2: Lipoma prevalence in dog breeds in the UK

                                   Pug
                            Chihuahua
                              Shih Tzu
                           Lhasa Apso
                    Yorkshire Terrier
              German Shepherd Dog
       Cavalier King Charles Spaniel
                                Bichon
                 Breed not recorded
         West Highland White Terrier
            Staffordshire Bull Terrier
                 Jack Russell Terrier
                    Other purebreds
                                 Boxer
                       Border Terrier
                            Rottweiler
                           Crossbreed
                   Patterdale Terrier
                      Cocker Spaniel
                            Dalmatian
                Miniature Schnauzer
                                Beagle
                    Golden Retriever
                          Border Collie
                          Cairn Terrier
                  Labrafor Retriever
                    Springer Spaniel
                     German Pointer
               Dobermann Pinscher
                          Weimaraner

                                          0.0   1.0      2.0        3.0       4.0          5.0       6.0        7.0        8.0       9.0        10.0

                                                                            One-year period prevalence (%)

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         Springer Spaniel (182, 6.58%), Cocker Spaniel (130,
                                                                   Table 1: Final breed multivariable logistic regression model for risk factors associated with
         4.70%) and Staffordshire Bull Terrier (116, 4.20%),       diagnosis of lipoma in dogs attending primary-care veterinary practices in the VetCompass
         along with crossbred dogs (757, 27.38%).                  Programme in the UK. *CI confidence interval.
         After accounting for the effects of the other variables
         evaluated, eight breeds showed increased odds of          Variable        Category                   Odds ratio      95% CI*             P-value
         lipoma compared with crossbred dogs. The breeds           Breed           Crossbreed                 1.00            -
         with the highest odds included the Dobermann
         Pinscher (OR: 3.55), Weimaraner (OR: 3.16), Labrador                      Dobermann Pinscher         3.55            2.49-5.06           < 0.001
         Retriever (OR: 2.19) and Springer Spaniel (OR:                            Weimaraner                 3.16            2.26-4.42           < 0.001
         2.15). There were 11 breeds with reduced odds of
         lipoma compared with crossbreds. Individual dogs                          Labrador Retriever         2.19            1.96-2.46           < 0.001
         with an adult bodyweight that was equal or higher                         Springer Spaniel           2.15            1.82-2.54           < 0.001
         than their breed/sex mean had 1.96 times the
         odds of lipoma compared with dogs that weighed                            Beagle                     2.03            1.39-2.97           < 0.001
         below their breed/sex mean. Advancing age was
                                                                                   German Pointer             2.03            1.27-3.25           0.003
         strongly associated with increasing odds of lipoma.
         Compared with dogs aged 3.0 to
SMALL ANIMAL I CONTINUING EDUCATION

                                                                                  Dobermann Pinscher, Weimaraner, Labrador
           Age (years)
CONTINUING EDUCATION I SMALL ANIMAL

         These protected breeds do not include a single Gundog Group           osteosarcoma.30,35,36 There is little prior evidence on the effects
         breed and have noticeably different body conformation to the          of sex and neuter status on the risk of lipoma. The current
         predisposed breeds, tending to be smaller in bodysize and             study identified reduced risk of lipoma in entire females and
         to have less pronounced proportional difference between               entire males compared with neutered females and neutered
         the thorax and abdomen. Further research the genetics of              males, even after taking age into account. This could indicate
         adipose, and differential fat function and accumulation across        some protective effects of female and male sex hormones.
         the predisposed and protected dog breeds identified in the            However, post-neutering changes in fat distribution and
         current study is warranted and may lead to substantial new            decreased energy requirements have been demonstrated and
         discovery of lipoma pathogenetic pathways.                            the effects of neutering on lipoma risk may be mediated by
         Body condition score data were not available in the current           obesity as a confounder rather than directly.37
         study so no conclusive inference can be drawn from these              Insured dogs had 1.78 times greater odds of lipoma diagnosis
         results on associations between obesity and lipoma. However,          compared with uninsured dogs. This association is likely to
         data were available that characterised the adult bodyweight           reflect increased diagnostic recognition mediated by owner
         of individual dogs as either below or equal/above the mean            and financial factors rather than any intrinsic increased
         adult bodyweight for their breed and sex within the overall           disease risk in insured dogs. Relaxation on financial
         study population. This variable allowed the effect of low             constraints to presentation for veterinary care, diagnostic
         versus high adult bodyweight to be assessed after taking              procedures and surgical management through insurance has
         into account breed and sex. Among other reasons, a high               similarly been shown to increase diagnostic probability in
         bodyweight could reflect enhanced muscular mass, a large              many other conditions.38-43
         body frame or overweight/obesity. Dogs weighing at or above           This study was limited by the use of externally recorded
         the mean for their breed and sex had 1.97 times the odds of           clinical data which may have led to some disease status
         diagnosis with lipoma. This supports the study hypothesis             misclassification. This study may have underrepresented
         and suggests value in future exploration of lipoma association        lipoma because true cases that were not presented for
         with obesity/overweight since the latter is a modifiable risk         veterinary care during 2013 were not included as cases.
         factor. This approach is also supported by published evidence         Alternatively, lipoma could be over-represented because the
         of predisposition to obesity in some of the breeds that were          study did not require laboratory confirmation of lipoma cases;
         also identified with high odds of lipoma in the current study         although the characteristic presenting phenotype of lipoma
         including Cocker Spaniel24 and Labrador Retrievers.25 This study      cases suggests that diagnosis based on clinical examination
         also identified a substantial and strong trend towards increasing     alone is likely to have a high positive predictive value.44
         odds of lipoma as adult bodyweight increased. This may reflect
         a true increase in odds of cellular metaplasia or neoplasia with      CONCLUSIONS
         increasing bodyweight. Osteosarcoma in dogs has similarly             Lipoma is confirmed as a common clinical diagnosis with a
         been linked to increasing bodyweight, although the biological         one-year prevalence of 1.94%. Strong breed associations for
         mechanisms may be different for the different neoplasms.26            both lipoma predisposition and protection were identified that
         Advancing age has previously been identified as a risk factor         can assist with breed health reforms as well as contributing
         for neoplasia in general.26,27 It is possible that the same is true   to the basic scientific understanding of lipoma development.
         for risk of lipoma development. The current study reports the         Heavier, older, neutered and insured dogs also had higher
         median age of lipomas cases was 10.02 years compared with             odds of diagnosis. Lipoma detection should be included as
         the median age of 4.18 years for non-lipoma dogs. The odds            a routine part of veterinary clinical exanimation, especially in
         of lipoma also increased markedly as dogs aged, with dogs             breeds identified as high-risk here.
         aged nine-12 years having 17.52 times the odds compared with
         dogs aged less than three years. There is a strong case to be
         made that lipoma should be included as one of the accepted              AUTHOR AND SOURCE
         common diseases of aging in dogs. 28 Risk factors for lipoma            This article is a summary of a fuller report: ‘O’Neill, DG,
         development in people are reported to be similar to the                 Corah, CH, Church, DB, Brodbelt, DC and Rutherford,
         findings of our study in dogs although there is also a paucity of       L. (2018). Lipoma in dogs under primary veterinary care
         literature on the occurrence of lipomas in people. In humans,           in the UK: prevalence and breed associations. Canine
         the incidence of lipomas is increased in patients with obesity,         Genetics and Epidemiology, 5(1), 9. Available (open
         hyperlipidemia, and diabetes mellitus.29                                access) at https://cgejournal.biomedcentral.com/
         The influences of sex hormones on tumour development                    articles/10.1186/s40575-018-0065-9
         is complex; neuter status has been reported with differing
         effects on different tumour types and to influence the risk
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                 READER QUESTIONS AND ANSWERS
           1.    WHICH CELL TYPES COMPRISE LIPOMAS?                       4)    WHICH BREED HAD THE HIGHEST WITHIN-BREED
           A.    Adipocytes                                                     PREVALENCE OF LIPOMA?
           B.    Lymphocytes                                              A.    Weimaraner
           C.    Leucocytes                                               B.    Dobermann Pinscher
           D.    Kupffer cells                                            C.    German Pointer
           E.    Melanocytes                                              D.    Springer Spaniel
                                                                          E.    Labrador Retriever
           2)    THE CLINICAL RECORDS OF HOW MANY ANIMALS ARE
                 CURRENTLY WITHIN VETCOMPASS?                             5)    AFTER ACCOUNTING FOR OTHER FACTORS SUCH AS
           A.    10,000                                                         AGE, SEX, NEUTER, INSURANCE AND BODYWEIGHT,
           B.    100,000                                                        WHICH BREED HAD THE HIGHEST ODDS OF LIPOMA?
           C.    1,000,000                                                A.    Weimaraner
           D.    10,000,000                                               B.    Dobermann Pinscher
           E.    100,000,000                                              C.    German Pointer
                                                                          D.    Springer Spaniel
           3)    WHAT WAS THE OVERALL ONE-YEAR PERIOD                     E.    Labrador Retriever
                 PREVALENCE FOR LIPOMA DIAGNOSIS IN DOGS?
           A.    0.04%
                 0.94%
                                                                                                             ANSWERS: 1A, 2D, 3C, 4A, 5B.
           B.
           C.    1.94%
           D.    2.94%
           E.    4.94%

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