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Magnitude and laterality of breast cancer risk according to histologic type of atypical hyperplasia
Author(s) -
Collins Laura C.,
Baer Heather J.,
Tamimi Rulla M.,
Connolly James L.,
Colditz Graham A.,
Schnitt Stuart J.
Publication year - 2007
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.22408
Subject(s) - medicine , breast cancer , atypical hyperplasia , atypia , odds ratio , hyperplasia , breast biopsy , biopsy , breast disease , confidence interval , cancer , gynecology , pathology , mammography
BACKGROUND. Atypical hyperplasia (AH) in a benign breast biopsy is associated with an increased breast cancer risk. However, the influence of the histologic type of AH on the magnitude and laterality of breast cancer risk is poorly defined. METHODS. The authors conducted a case‐control study of benign breast disease and breast cancer risk nested within the Nurses' Health Study (395 cases, 1610 controls). Benign breast biopsy slides were reviewed and categorized as showing nonproliferative lesions, proliferative lesions without atypia, or AH. Slides that showed AH were categorized further as atypical ductal hyperplasia (ADH) or atypical lobular hyperplasia (ALH). RESULTS. The odds ratio (OR) for breast cancer among all women with AH was 4.1 (95% confidence interval [95% CI], 2.9–5.8). However, among premenopausal women, breast cancer risk was higher for women with ALH (OR, 7.3; 95% CI, 3.8–14.2) than for women with ADH (OR, 3.1; 95% CI, 2.0–4.8). Overall, 58.9% of invasive breast cancers that developed in women with AH were in the ipsilateral breast, and the frequency of ipsilateral breast cancer was similar for women with ALH (61.3%) and women with ADH (55.9%; P = .66). CONCLUSIONS. Women with AH in a benign breast biopsy were at a substantially increased risk for the development of breast cancer. Among premenopausal women, the risk appeared to be greater for those with ALH than those with ADH. Because only ≈60% of cancers that develop in women with AH occur in the ipsilateral breast, for the purposes of clinical management, these lesions are viewed best as markers of a generalized (bilateral) increase in breast cancer risk. Cancer 2007. © 2006 American Cancer Society.