We evaluated risk factors for benign breast disease by using a case-control study method. The series was taken from participants in breast cancer screening programs during 1978-1986 in Miyagi Prefecture, Japan. All benign breast lesions diagnosed during this period were reviewed and reclassified into proliferative and non-proliferative types based on the Dupont and Page classification. Data on 382 benign breast disease cases (130 proliferative-type cases and 252 nonproliferative-type cases) and 1,489 screening year-, age-and screening area-matched normal controls were used for analysis. Nulliparity or low parity and family history of breast cancer in mother or sisters were significantly associated with an increased risk of proliferative type. Premenopausal status was significantly associated with an increased risk of non-proliferative type. No significant association with history of lactation for the last child was observed in either type, but the risk of proliferative type increased with increasing duration of lactation (P=0.08). A comparison between the present findings and the risk factors for breast cancer indicated epidemiologic similarities between proliferative benign and malignant breast lesions in general. The associations of these two lesions with lactation patterns were, however, dissimilar. Key words: Benign breast disease -Breast cancer -Risk factorsMany epidemiologic studies of breast cancer have shown that a history of benign breast disease (BBD) increases the risk of breast cancer.1-4) An excess risk of developing breast cancer among women with BBD has been demonstrated, mainly based on retrospective cohort studies that followed women with biopsy-defined BBD. [5][6][7][8] In addition, most studies found that the magnitude of the risk varies according to the histopathological type. Thus, it seems important to identify risk factors for BBD according to histopathological type and to compare them with those for breast cancer, in order to cast light on the relationship between two conditions. However, in contrast to the many epidemiologic studies of breast cancer, there have been few of BBD.9-21) Furthermore, there are remarkable inconsistencies among the results of these epidemiologic studies of BBD, possibly because of differences in histopathological classification and the relatively small sample sizes of the studies. 22,23) Recently, Dupont and Page proposed a standardized histopathological classification of BBD, which is widely accepted. 6,[24][25][26] Several studies have already reported the risk of breast cancer among women with BBD, based on this classification. 6,[27][28][29][30] In this study, we evaluated risk factors for BBD according to histopathological type, using the Dupont and Page classification, and compared them with those for breast cancer. Study subjects were selected from participants in breast cancer screening programs and a case-control study method was applied. MATERIALS AND METHODS Study subjectsThe series in this study consisted of participants in breast cancer screening p...

Here we present a case of malignant phyllodes tumor which was composed almost exclusively of a fibrosarcomatous component. A 52-year-old Japanese female noted a rapid increase of her right breast tumor. On admission, multiple lung metastases were detected by imaging. Right simple mastectomy was performed. The tumor, 10 x 10 cm in the largest dimension, had somewhat of a pushing margin, and showed a flesh-like appearance with marked necrosis. Microscopically, the tumor showed proliferation of atypical ovoid- or spindle-shaped cells in a myxoid matrix. Multiple sectioning revealed that the tumor had only focal occurrence of elongated tubular structures, and the occurrence of a small component of benign phyllodes tumor, leading to the aforementioned final diagnosis. Spindle cell carcinoma was excluded on the basis of the HE findings and the lack of immunoreactivity for cytokeratin when using a broad spectrum antibody mixture. Although the patient received adjuvant chemotherapy, no responsiveness was obtained. The patient died 4 months following surgery. We reviewed 15 malignant phyllodes tumors with metastases reported in Japan. The estimated 2.2-year survival rate following detection of metastasis was 11%, thus confirming the aggressiveness of the disease.

Expression of beta 1-6 branched oligosaccharides in human breast cancer cells was investigated in vivo and in vitro. Lectin histochemical and lectin blotting analyses of surgically resected specimens were performed using L-PHA (phaseolus vulgaris leukoagglutinin) lectin, which binds to beta 1-6 oligosaccharides. The glycoproteins bearing beta 1-6 oligosaccharides of breast cancer tissues were found to be 170 kD and 120 kD in molecular weight, and the former appeared to be an epitope of carcinoembryonic antigen (CEA). The beta 1-6 oligosaccharides were expressed in both cancer cell lines at the outer layer of the colonies when cultured in type I collagen, but not in agarose gel. No correlation was observed between beta 1-6 expression and cell cycle. The beta 1-6 oligosaccharides did not coincide with breast cancer-associated antigens, such as CEA, MUC1, and cathepsin D. The beta 1-6 oligosaccharides of these cell lines were markedly inhibited when swainsonine, a mannosidase II inhibitor, was added to the culture medium. The 120 kD molecule, which was obtained from MCF-7 cells cultured in type I collagen gel, was consistent with that of breast cancer tissues and was similar to lysosome-associated membrane glycoproteins (LAMPs). The results suggest that the glycoproteins bearing beta 1-6 branched oligosaccharides in human breast cancer incorporate an epitope of CEA and human LAMPs and that the expression of LAMPs may depend on their surrounding matrices and may play an important role in cancer invasion or metastasis.

To investigate the risk of breast cancer development in women with benign breast disease (BBD), 387 screen-detected BBD women and 1,489 normal women, taken from participants in the breast cancer screening program during 1978-1986, were followed through 1991. While 2,811 personyears in the BBD group and 11,018 person-years in the normal group were accumulated, 5 women in the BBD group and 6 women in the normal group developed breast cancer. Using the MantelHaenszel method, relative risks (RR) were estimated for all women with BBD and women in some BBD types. Significantly elevated risk of breast cancer was observed in all women with BBD (RR = = = =3.26, 95% confidence interval (CI) 1.08-9.83). Women with proliferative BBD were at high risk of breast cancer (RR = = = =8.48, 95%CI 2.99-24.10), but no increased risk was observed for women with non-proliferative BBD (RR = = = =0.93, 95%CI 0.11-7.66). These results are consistent with those in high-risk countries for breast cancer. In the management of women with BBD, histopathological diagnosis of the breast lesion is essential and women with proliferative BBD should be followed up carefully. Key words:Benign breast disease -Breast cancer risk -Cancer registry -Retrospective cohort study -Screening It has been reported that a history of benign breast disease (BBD) increases breast cancer risk, [1][2][3][4] but recent studies have shown that the risks for subsequent breast cancer in BBD patients who have had a biopsy are different among different histopathological types. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] While the histopathological classification systems used in these studies were not the same, there was a consistent finding that atypical hyperplasia (AH) presents high risk for the development of breast cancer. 20) Although Japan is one of the countries with low risk for breast cancer, the incidence rate of female breast cancer is gradually increasing. 21) A number of epidemiological studies of breast cancer have recently been conducted and the characteristics of Japanese women with breast cancer have been clarified. 3,4,[22][23][24][25] However, there have been few studies on the prognosis in BBD patients 18) and the relation of BBD to breast cancer risk is unclear in Japan.We have reported similarities of background characteristics between proliferative BBD (including AH) and breast cancer, using data obtained from breast cancer screening participants.26) The present study was conducted in order to evaluate the subsequent breast cancer risk among the BBD patients described in the previous report. Accumulations and comparisons of data among countries with different risk for breast cancer seem necessary for elucidating the association of BBD lesions with breast cancer risk. This study provides additional data from a low-risk country for breast cancer. MATERIALS AND METHODSStudy subjects and histopathological classification This study was conducted by using data obtained from breast cancer screening participants during 1978-1986. The breast cancer...

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