Breast cancer risk associated with proliferative breast disease and atypical hyperplasia

Abstract

Background. Women with proliferative breast disease (PD) have been observed to have an increased risk of breast cancer. The authors evaluated the effect of PD on breast cancer risk in a case–control study among participants of the Breast Cancer Detection Demonstration Project (BCDDP). Methods. More than 280,000 women were screened in the BCDDP at 29 centers. Study subjects were selected from BCDDP participants who underwent biopsy that revealed benign breast tissue. There were five BCDDP centers for which histologic slides were available on more than 85% of the benign biopsy specimens. Case patients for this study were the 95 women from these five centers who had breast cancer develop during follow‐up. Two matched control patients who did not have breast cancer develop were selected for each case. The biopsy slides were reviewed by two pathologists who were blinded with regard to cancer outcome. Results. Women with atypical hyperplasia (AH) had 4.3 times the breast cancer risk of women without PD (95% confidence interval [CI], 1.7–11). In women with PD lacking AH, the relative risk was 1.3 (95% CI, 0.77–2.2). A family history of breast cancer (FH) increased breast cancer risk 2.4 times (95% CI, 1.4–4.3). The joint occurrence of FH and AH had a strong synergistic effect on breast cancer risk. Conclusions. AH is a reliable marker of increased breast cancer risk among women undergoing breast biopsy.

History of benign breast disease and risk of breast cancer among women in China: a case–control study

“…Consistent with other studies (28,30), we found that women with fibroadenoma who have undergone surgical treatment are two times less likely to develop breast cancer as compared to those who did not undergo surgery for the same disease. The increased risk of breast cancer among those surgically treated for 'other BBD' in this study may imply that women with higher risk categories of BBD are highly susceptible to breast cancer as has been reported previously (11,20,35). Future studies may need to address whether early detection and intervention for any type of BBD reduces the risk breast cancer and should be recommended.…”

“…Based on these types of pathologic diagnoses for BBD, the Cancer Committee of the College of American Pathologists recommended 4 risk categories of BBD in 1985, Appendix I (9,10). The association of the high risk categories (3 and 4) of BBD (eg, atypical hyperplasia and carcinoma in situ) with invasive breast cancer risk is well established (8,11,12). However, the ANDI (Aberrations of Normal Development and Involution) classification of BBD and recent studies have suggested that the risk of breast cancer may also be associated with the two lower risk categories (1 and 2) of BBD that include fibroadenoma, cysts, mastitis, fibrosis, adenosis and hyperplasia without atypia (10,13,14).…”

Establishing a molecular continuum in breast cancer DNA microarrays and benign breast disease

“…Women with moderate to florid hyperplasia, papilloma with fibrovascular core, or well-developed sclerosing adenosis in a biopsy specimen have a slightly increased risk of developing breast cancer relative to comparable women who have had no breast biopsy. The demonstration of either ductal or lobular atypical hyperplasia is consistent with a fourfold to fivefold increased risk of developing invasive cancer (2,3). Family history of breast carcinoma doubles this risk (8 -10 times).…”

Breast cancer risk associated with estrogen receptor expression in epithelial hyperplasia lacking atypia and adjacent lobular units

“…3,4 The earliest lesion associated with breast cancer is epithelial hyperplasia lacking atypia (EHLA), which has a 1.5-to 2-fold increased risk of development of breast cancer. [5][6][7][8] A slight increase in ER-positive cells has been described in these earliest lesions. 3 In our study, we investigated the relationship between ER␣ expression in EHLA and subsequent risk of invasive breast cancer.…”