Stratification of Breast Cancer Risk in Women With Atypia: A Mayo Cohort Study
- 1 July 2007
- journal article
- breast cancer
- Published by American Society of Clinical Oncology (ASCO) in Journal of Clinical Oncology
- Vol. 25 (19), 2671-2677
- https://doi.org/10.1200/jco.2006.09.0217
Abstract
Purpose: Atypical hyperplasia is a well-recognized risk factor for breast cancer, conveying an approximately four-fold increased risk. Data regarding long-term absolute risk and factors for risk stratification are needed. Patients and Methods: Women with atypical hyperplasia in the Mayo Benign Breast Disease Cohort were identified through pathology review. Subsequent breast cancers were identified via medical records and a questionnaire. Relative risks (RRs) were estimated using standardized incidence ratios, comparing the observed number of breast cancers with those expected based on Iowa Surveillance, Epidemiology, and End Results (SEER) data. Age, histologic factors, and family history were evaluated as risk modifiers. Plots of cumulative breast cancer incidence provided estimates of risk over time. Results: With mean follow-up of 13.7 years, 66 breast cancers (19.9%) occurred among 331 women with atypia. RR of breast cancer with atypia was 3.88 (95% CI, 3.00 to 4.94). Marked elevations in risk were seen with multifocal atypia (eg, three or more foci with calcifications [RR, 10.35; 95% CI, 6.13 to 16.4]). RR was higher for younger women (< 45; RR, 6.76; 95% CI, 3.24 to 12.4). Risk was similar for atypical ductal and atypical lobular hyperplasia, and family history added no significant risk. Breast cancer risk remained elevated over 20 years, and the cumulative incidence approached 35% at 30 years. Conclusion: Among women with atypical hyperplasia, multiple foci of atypia and the presence of histologic calcifications may indicate “very high risk” status (> 50% risk at 20 years). A positive family history does not further increase risk in women with atypia.Keywords
This publication has 21 references indexed in Scilit:
- Benign Breast Disease and the Risk of Breast CancerThe New England Journal of Medicine, 2005
- Breast cancer risk associated with proliferative breast disease and atypical hyperplasiaCancer, 1993
- Interobserver Reproducibility in the Diagnosis of Ductal Proliferative Breast Lesions Using Standardized CriteriaThe American Journal of Surgical Pathology, 1992
- Combined histologic and cytologic criteria for the diagnosis of mammary atypical ductal hyperplasiaHuman Pathology, 1992
- Risk of Breast Cancer after Benign Breast DiseasesAmerican Journal of Epidemiology, 1992
- Projecting Individualized Probabilities of Developing Breast Cancer for White Females Who Are Being Examined AnnuallyJNCI Journal of the National Cancer Institute, 1989
- Relative risk of breast cancer varies with time since diagnosis of atypical hyperplasiaHuman Pathology, 1989
- A PROSPECTIVE STUDY OF THE DEVELOPMENT OF BREAST CANCER IN 16,692 WOMEN WITH BENIGN BREAST DISEASEAmerican Journal of Epidemiology, 1988
- Atypical hyperplastic lesions of the female breast. A long-term follow-up studyCancer, 1985
- Risk Factors for Breast Cancer in Women with Proliferative Breast DiseaseThe New England Journal of Medicine, 1985