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Clinicopathologic features of breast cancers that develop in women with previous benign breast disease
Author(s) -
Visscher Daniel W.,
Frost Marlene H.,
Hartmann Lynn C.,
Frank Ryan D.,
Vierkant Robert A.,
McCullough Ann E.,
Winham Stacey J.,
Vachon Celine M.,
Ghosh Karthik,
Brandt Kathleen R.,
Farrell Ann M.,
Tarabishy Yaman,
Hieken Tina J.,
Haddad Tufia C.,
Kraft Ruth A.,
Radisky Derek C.,
Degnim Amy C.
Publication year - 2016
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.29766
Subject(s) - medicine , atypical hyperplasia , breast cancer , atypia , breast disease , ductal carcinoma , biopsy , sentinel lymph node , estrogen receptor , oncology , lobular carcinoma , hyperplasia , cohort , gynecology , cancer , pathology
BACKGROUND Women with benign breast disease (BBD) have an increased risk of developing breast cancer (BC). Nearly 30% of all BCs develop in women with prior BBD. Information regarding features of the expected number of BCs after BBD would enhance individualized surveillance and prevention strategies for these women. In the current study, the authors sought to characterize BCs developing in a large cohort of women with BBD. METHODS The current study cohort included 13,485 women who underwent breast biopsy for mammographic or palpable concerns between 1967 and 2001. Biopsy slides were reviewed and classified as nonproliferative disease, proliferative disease without atypia, or atypical hyperplasia. BCs were identified by follow‐up questionnaires, medical records, and Tumor Registry data. BC tissues were obtained and reviewed. RESULTS With median follow‐up of 15.8 years, 1273 women developed BC. The majority of BCs were invasive (81%), of which 61% were ductal, 13% were mixed ductal/lobular, and 14% were lobular. Approximately two‐thirds of the BC cases were intermediate or high grade, and 29% were lymph node positive. Cancer characteristics were similar across the 3 histologic categories of BBD, with a similar frequency of ductal carcinoma in situ, invasive disease, tumor size, time to invasive BC, histologic type of BC, lymph node positivity, and human epidermal growth factor receptor 2 positivity. Women with atypical hyperplasia were found to have a higher frequency of estrogen receptor‐positive BC (91%) compared with women with proliferative disease without atypia (80%) or nonproliferative disease (85%) ( P = .02). CONCLUSIONS A substantial percentage of all BCs develop in women with prior BBD. The majority of BCs after BBD are invasive tumors of ductal type, with a substantial number demonstrating lymph node positivity. Of all the BCs in the current study, 84% were estrogen receptor positive. Prevention therapy should be strongly encouraged in higher‐risk women with BBD. Cancer 2016;122:378–385. © 2015 American Cancer Society .