Benign breast disease heterogeneity: association with histopathology, age, and ethnicity

Abstract

Benign breast biopsies with concurrent multiple benign lesions with different histopathologic diagnoses were termed heterogeneous benign breast disease (HBBD). Multiplicity of benign breast disease (BBD) lesions in a biopsy is a risk factor for progression to breast cancer (BC). Elucidation of the biological characteristics and clinical implications of HBBD may also be relevant to the refinement of risks for BC in women with a BBD diagnosis. In this study, we investigated the association of HBBD with histopathology, age, and ethnicity. A cohort of 4,341 women, 1,208 African Americans and 3,133 Caucasians, diagnosed with BBD, was identified after examination of an excisional breast biopsy. BBD biopsies were categorized as nonproliferative (NP, low risk or risk 1 lesions), proliferative without atypia (P, intermediate risk or risk 2 lesions), and proliferative with atypia (AH, high risk or risk 3 lesions). A BBD biopsy with only a single BBD lesion was termed simple BBD (SBBD). BBD biopsies with multiple lesions were further classified as single level HBBD (SL-HBBD) if the concurrent lesions were within the same risk level, or as multiple level HBBD (ML-HBBD) if lesions fell into more than one risk group. In this cohort, 69% of women with a BBD diagnosis fit the HBBD criteria. Among women with HBBD, ML-HBBD was almost three times more prevalent than SL-HBBD and was significantly more likely to be composed of risk 2 and risk 3 lesions. The likelihood of HBBD was 57% higher in Caucasian American women than in African American women with BBD (OR 1.57; 95% CI 1.37, 1.81). The average lesion number in HBBD was directly proportional to increasing lesion risk (p < 0.001). Compared to women with risk 1 lesions, the likelihood of HBBD was 5.59 (95% CI 4.85 to 6.44) and 17.0 (95% CI 10.2 to 28.5) times higher when risk 2 and risk 3 lesions, respectively, were present. Women in the age range of 46-55 years and >55 years had a 3.12 (95% CI 2.59, 3.75) and a 2.28 (95% CI 1.94, 2.68) fold higher likelihood of HBBD compared to those ≤45 years. Significant interaction was found between concurrent lesion levels and age (p < 0.01). The likelihood of HBBD was considerably higher across all age groups for risk 3 lesions. Compared to the reference (risk 1, age ≤45), the likelihood of HBBD for risk 2 lesions was 4.4 times greater (95% CI 3.70, 5.33) in women ≤45 years, but that likelihood increased to 17.6 (95% CI 12.8, 24.2) and 13.4 (95% CI 10.1, 17.9) times in women of 46-55 and >55 years, respectively. HBBD is more prevalent in Caucasian American women than in African American women. Women with higher risk BBD lesions are more likely to have HBBD. Lesion

Benign breast lesions in an African population: A 25-year histopathological review of 1864 cases

“…This is consistent with the 1% documented in Caucasians and comparable to the 3.9, and 4% recorded in Ife and Kano 413. A much higher figure of 14% reported from Port Harcourt is however similar to the 12% observed in Uganda 1220. Gynecomastia in this study showed a mean age of 33.2 years, with a peak incidence in the third decade and ages ranging from 15 to 77 years.…”

“…Sclerosing adenosis, a lobulocentric lesion of disordered acini, myoepithelial, and connective tissues, may be difficult to distinguish grossly from infiltrating carcinoma and may occur in association with other epithelial hyperplasia including epithelial hyperplasia and intraductal papilloma. It may also coexist with invasive and in situ carcinoma 1020. A biopsy with histological diagnosis is therefore indicated in such cases particularly in low resource settings as ours where mammographic services may not be available.…”

Benign breast diseases in Warri Southern Nigeria: A spectrum of histopathological analysis

“…[6,7] Data of relatively very high frequency of gynecomastia, constituting 12% of overall BBDs also was documented in Uganda. [17] In this study, all inflammatory breast diseases constituted 6.4% of BBDs. This is congruous with reports from other Africa series where it constituted 6% and 4.6%, respectively.…”

Risk factors for breast cancer from benign breast disease in a diverse population

“…Furthermore, because the majority of published studies of BBD and BC risks have been based on predominantly homogenous CA populations (2, 11–16), our understanding of risk factors in the AA population is limited by the dearth of ethnically diverse BBD cohorts. The Detroit BBD cohort, drawn from a multi-ethnic population with nearly 28% of eligible AA women, begins to address this issue (3, 4, 17). …”