Risk Factors for Breast Cancer in Women with Proliferative Breast Disease

Abstract

To assess the importance of various risk factors for breast cancer in women with benign proliferative breast lesions, we reevaluated 10,366 consecutive breast biopsies performed in women who had presented at three Nashville hospitals. The median duration of follow-up was 17 years for 3303 women, 1925 of whom had proliferative disease. This sample contained 84.4 per cent of the patients originally selected for follow-up. Women having proliferative disease without atypical hyperplasia had a risk of cancer that was 1.9 times the risk in women with nonproliferative lesions (95 per cent confidence interval, 1.2 to 2.9). The risk in women with atypical hyperplasia (atypia) was 5.3 times that in women with nonproliferative lesions (95 per cent confidence interval, 3.1 to 8.8). A family history of breast cancer had little effect on the risk in women with nonproliferative lesions. However, the risk in women with atypia and a family history of breast cancer was 11 times that in women who had nonproliferative lesions without a family history (95 per cent confidence interval, 5.5 to 24). Calcification elevated the cancer risk in patients with proliferative disease. Although cysts alone did not substantially elevate the risk, women with both cysts and a family history of breast cancer had a risk 2.7 times higher than that for women without either of these risk factors (95 per cent confidence interval, 1.5 to 4.6). This study demonstrates that the majority of women (70 per cent) who undergo breast biopsy for benign disease are not at increased risk of cancer. However, patients with a clinically meaningful elevation in cancer risk can be identified on the basis of atypical hyperplasia and a family history of breast cancer.

Lobular neoplasia on core‐needle biopsy—Clinical significance

“…Because LCIS is a more advanced lesion than is ALH, a difference in breast carcinoma incidence rates between patients with LCIS and patients with ALH would be expected, and studies with long-term follow-up have in fact demonstrated that the risk of developing breast carcinoma is greater for patients with LCIS than for pa- tients with ALH. 21,27 Nonetheless, the diagnostic criteria that have been described by various investigators for LCIS and ALH are somewhat subjective, and the limited amount of breast tissue obtained by core biopsy can make accurate distinction between LCIS and ALH difficult. In the current study, ALH and LCIS were grouped together under the umbrella of lobular neoplasia.…”

“…to confirm the diagnosis of ADH, ALH, LCIS, DCIS, or invasive malignancy using the criteria established by Page and Anderson. 18,21,27 Each excision sample was classified, based on the histologic findings in the most significant lesion, as malignant (DCIS and/or IBC) or not malignant (ADH, ALH, LCIS, or other benign findings). Whenever a discrepancy existed between the histologic features of the core biopsy sample and the histologic features of the excision biopsy sample, the slides in question were re-reviewed by a study pathologist (D.C.A.)…”

Breast cancer in Mexico: a pressing priority

“…There are competing hypotheses to explain the rise of breast cancerlater and fewer pregnancies, less breastfeeding, hormone replacement therapy, environmental risk factors, nutrition, epidemiological transition, among others. [25][26][27]29,32,33 At the same time, there are also several possible and overlapping explanations for the decline in cervical cancer rates, including increased screening and treatment programmes, the decline in birth rates, and increases in coverage of health education. 28,34,35 While more research might better explain the causal factors behind each of these trends, the basic facts are clear: breast cancer rates have risen while cervical cancer rates have fallen, and it is breast rather cervical cancer that today accounts for more deaths overall among Mexican women.…”

Signal transduction in mammary tumorigenesis: a transgenic perspective

“…Women with proliferative disorders of increasing severity (atypical hyperplasias to in situ carcinomas to invasive carcinomas) are at an increased risk of subsequent breast cancer development when compared to women with normal epithelium or those with proliferative disorders lacking atypia (Dupont and Page, 1985). Thus, it appears that mammary tumorigenesis, like colorectal tumor formation (Fearon and Vogelstein, 1990;Vogelstein and Kinzler, 1993), may arise in a step-wise fashion involving the acquisition of several distinct genetic perturbations each contributing to full malignancy.…”

“…Mammary tumors are graded into four morphological groups, each having characteristic disease and clinical outcomes. Karyotypic and epidemiological analyses of these stages suggest that breast carcinoma become increasingly aggressive due to the acquisition of several successive distinct genetic changes (Dupont and Page, 1985). Genetically these alterations can be loosely grouped into two large categories: gain of function and loss of function mutations.…”