Benign Breast Disease and the Risk of Breast Cancer
Lynn C. Hartmann, M.D., Thomas A. Sellers, Ph.D., Marlene H. Frost, Ph.D., Wilma L. Lingle, Ph.D., Amy C. Degnim, M.D., Karthik Ghosh, M.D., Robert A. Vierkant, M.A.S., Shaun D. Maloney, B.A., V. Shane Pankratz, Ph.D., David W. Hillman, M.S., Vera J. Suman, Ph.D., Jo Johnson, R.N., Cassann Blake, M.D., Thea Tlsty, Ph.D., Celine M. Vachon, Ph.D., L. Joseph Melton, III, M.D., and Daniel W. Visscher, M.D.
Background Benign breast disease is an important risk factorfor breast cancer. We studied a large group of women with benignbreast disease to obtain reliable estimates of this risk.
Methods We identified all women who received a diagnosis ofbenign breast disease at the Mayo Clinic between 1967 and 1991.Breast-cancer events were obtained from medical records andquestionnaires. To estimate relative risks, we compared thenumber of observed breast cancers with the number expected onthe basis of the rates of breast cancer in the Iowa Surveillance,Epidemiology, and End Results registry.
Results We followed 9087 women for a median of 15 years. Thehistologic findings were nonproliferative lesions in 67 percentof women, proliferative lesions without atypia in 30 percent,and atypical hyperplasia in 4 percent. To date, 707 breast cancershave developed. The relative risk of breast cancer for the cohortwas 1.56 (95 percent confidence interval, 1.45 to 1.68), andthis increased risk persisted for at least 25 years after biopsy.The relative risk associated with atypia was 4.24 (95 percentconfidence interval, 3.26 to 5.41), as compared with a relativerisk of 1.88 (95 percent confidence interval, 1.66 to 2.12)for proliferative changes without atypia and of 1.27 (95 percentconfidence interval, 1.15 to 1.41) for nonproliferative lesions.The strength of the family history of breast cancer, availablefor 4808 women, was a risk factor that was independent of histologicfindings. No increased risk was found among women with no familyhistory and nonproliferative findings. In the first 10 yearsafter the initial biopsy, an excess of cancers occurred in thesame breast, especially in women with atypia.
Conclusions Risk factors for breast cancer after the diagnosisof benign breast disease include the histologic classificationof a benign breast lesion and a family history of breast cancer.
Source Information
From the Divisions of Medical Oncology (L.C.H., M.H.F., J.J.), Experimental Pathology (W.L.L.), General Surgery (A.C.D.), General Internal Medicine (K.G.), Biostatistics (R.A.V., S.D.M., V.S.P., D.W.H., V.J.S.), Epidemiology (C.M.V., L.J.M.), and Anatomic Pathology (D.W.V.), Mayo Clinic College of Medicine, Rochester, Minn.; H. Lee Moffitt Cancer Center and Research Institute, Tampa, Fla. (T.A.S.); Wayne State University, Detroit (C.B.); and the University of California, San Francisco, San Francisco (T.T.).
Address reprint requests to Dr. Hartmann at Mayo Clinic College of Medicine, Rochester, MN 55905.
Benign Breast Disease and Breast Cancer
Koss L. G., Fineberg S., Kristiansen I. S., Christensen P. M., Gyrd-Hansen D., Visscher D. W., Degnim A. C., Hartmann L. C., Elmore J. G., Gigerenzer G.
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N Engl J Med 2005;
353:1856-1858, Oct 27, 2005.
Correspondence
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