The role of chemoprevention in modifying the risk of breast cancer in women with atypical breast lesions

Abstract

Women with atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), lobular carcinoma in situ (LCIS), and severe ADH are at increased risk of breast cancer, but a systematic quantification of this risk and the efficacy of chemoprevention in the clinical setting is still lacking. The objective of this study is to evaluate a woman's risk of breast cancer based on atypia type and to determine the effect of chemoprevention in decreasing this risk. Review of 76,333 breast pathology reports from three institutions within Partners Healthcare System, Boston, from 1987 to 2010 using natural language processing was carried out. This approach identified 2,938 women diagnosed with atypical breast lesions. The main outcome of this study is breast cancer occurrence. Of the 2,938 patients with atypical breast lesions, 1,658 were documented to have received no chemoprevention, and 184/1,658 (11.1 %) developed breast cancer at a mean follow-up of 68 months. Estimated 10-year cancer risks were 17.3 % with ADH, 20.7 % with ALH, 23.7 % with LCIS, and 26.0 % with severe ADH. In a subset of patients treated from 1999 on (the chemoprevention era), those who received no chemoprevention had an estimated 10-year breast cancer risk of 21.3 %, whereas those treated with chemoprevention had a 10-year risk of 7.5 % (p < 0.001). Chemoprevention use significantly reduced breast cancer risk for all atypia types (p < 0.05). The risk of breast cancer with atypical breast lesions is substantial. Physicians should counsel patients with ADH, ALH, LCIS, and severe ADH about the benefit of chemoprevention in decreasing their breast cancer risk.

Adherence to Endocrine Therapy in Breast Cancer Adjuvant and Prevention Settings

“…Women who received no chemoprevention had 10-year breast cancer incidence of 21.3% compared with 7.5% (P < 0.001) in women who did receive chemoprevention (53).…”

Mammography Decision Aid Reduces Decisional Conflict for Women in Their Forties Considering Screening

“…These risk factors include having a previous biopsy indicating breast cancer or a highrisk lesion, such as atypical ductal hyperplasia; deleterious BRCA gene mutations or other genetic syndromes associated with breast cancer; high radiation exposure to the chest before age 30; and extensive family history of breast cancer. [3][4][5][6] However, for women with lower degrees of risk, 7 benefits and harms of screening are less clear, and decision making may be conflicted. [8][9][10] Decisional conflict has not been fully addressed by existing patient decision aids designed for average-risk women.…”

Adverse Histopathology and Imaging Findings in Reduction Mammaplasty Day-surgery Patients

“…In Finland, chemoprevention has not been recommended for patients with premalignant lesions. Coopey et al (23) studied the benefit of chemoprevention in women with a diagnosis of atypical breast lesions including ADH, ALH, LCIS, and severe ADH. They reported estimated 10-year cancer risks of 17.3% with ADH, 20.7% with ALH, 23.7% with LCIS, and 26.0% with severe ADH.…”