Benign Breast Disease and Breast Cancer Risk in the Percutaneous Biopsy Era

Abstract

ImportanceBenign breast disease (BBD) comprises approximately 75% of breast biopsy diagnoses. Surgical biopsy specimens diagnosed as nonproliferative (NP), proliferative disease without atypia (PDWA), or atypical hyperplasia (AH) are associated with increasing breast cancer (BC) risk; however, knowledge is limited on risk associated with percutaneously diagnosed BBD.ObjectivesTo estimate BC risk associated with BBD in the percutaneous biopsy era irrespective of surgical biopsy.Design, Setting, and ParticipantsIn this retrospective cohort study, BBD biopsy specimens collected from January 1, 2002, to December 31, 2013, from patients with BBD at Mayo Clinic in Rochester, Minnesota, were reviewed by 2 pathologists masked to outcomes. Women were followed up from 6 months after biopsy until censoring, BC diagnosis, or December 31, 2021.ExposureBenign breast disease classification and multiplicity by pathology panel review.Main OutcomesThe main outcome was diagnosis of BC overall and stratified as ductal carcinoma in situ (DCIS) or invasive BC. Risk for presence vs absence of BBD lesions was assessed by Cox proportional hazards regression. Risk in patients with BBD compared with female breast cancer incidence rates from the Iowa Surveillance, Epidemiology, and End Results (SEER) program were estimated.ResultsAmong 4819 female participants, median age was 51 years (IQR, 43-62 years). Median follow-up was 10.9 years (IQR, 7.7-14.2 years) for control individuals without BC vs 6.6 years (IQR, 3.7-10.1 years) for patients with BC. Risk was higher in the cohort with BBD than in SEER data: BC overall (standard incidence ratio [SIR], 1.95; 95% CI, 1.76-2.17), invasive BC (SIR, 1.56; 95% CI, 1.37-1.78), and DCIS (SIR, 3.10; 95% CI, 2.54-3.77). The SIRs increased with increasing BBD severity (1.42 [95% CI, 1.19-1.71] for NP, 2.19 [95% CI, 1.88-2.54] for PDWA, and 3.91 [95% CI, 2.97-5.14] for AH), comparable to surgical cohorts with BBD. Risk also increased with increasing lesion multiplicity (SIR: 2.40 [95% CI, 2.06-2.79] for ≥3 foci of NP, 3.72 [95% CI, 2.31-5.99] for ≥3 foci of PDWA, and 5.29 [95% CI, 3.37-8.29] for ≥3 foci of AH). Ten-year BC cumulative incidence was 4.3% for NP, 6.6% for PDWA, and 14.6% for AH vs an expected population cumulative incidence of 2.9%.Conclusions and RelevanceIn this contemporary cohort study of women diagnosed with BBD in the percutaneous biopsy era, overall risk of BC was increased vs the general population (DCIS and invasive cancer combined), similar to that in historical BBD cohorts. Development and validation of pathologic classifications including both BBD severity and multiplicity may enable improved BC risk stratification.

Multiplicity of benign breast disease lesions and breast cancer risk in African American women

“…examined subsequent risk among women who received a percutaneous biopsy with benign findings and considered multiple lesions within the Dupont and Page classification system. They noted a higher risk for both non-proliferative lesions (3 or greater, HR=1.47, 95% CI: 1.14-1.88) as well as proliferative lesions without atypia (3 or greater, HR=2.14, 95% CI: 1.29-3.53) ( 12 ). As the majority of breast biopsies are now percutaneous versus surgical excisions, determining whether risk is similar regardless of biopsy type is critical when considering how informative this variable is when modeling BC risk.…”

A novel fusion framework of deep bottleneck residual convolutional neural network for breast cancer classification from mammogram images

“…Numerous imaging modalities have been created to help lower the death rate associated with breast cancer and to assist in the early detection and treatment of the disease ( 5 ). Breast exams, mammograms, and biopsy are just a few of the numerous examinations used in the detection and diagnosis of breast cancer ( 6 ). The more popular method for detecting breast cancer is mammography ( 7 ).…”