Refining Risk Assessment in Women With Benign Breast Disease: An Ongoing Dilemma
Menée auprès d'une cohorte de 1 414 femmes ayant subi plusieurs biopsies mammaires dont les résultats sont négatifs, cette étude évalue l'association entre l'évolution histologique du tissu mammaire et le risque de développer un cancer du sein
More than three decades ago, Dupont and Page published their seminal study relating breast cancer risk to the histologic findings in benign breast biopsies (1). The key observations of that study were that women whose biopsy showed proliferative lesions without atypia had about a twofold increase in the risk of subsequent breast cancer and those with atypical hyperplasia had about a fivefold increase in breast cancer risk when compared with women with nonproliferative lesions. As summarized in Table 1, subsequent studies from other groups have yielded strikingly similar findings, despite differences in the study design, patient populations, and pathologists involved in the histologic classification of the benign breast biopsies (1–5). As a result of these studies, which in aggregate have included more than 17 000 women, atypical hyperplasia is considered a high-risk lesion and is included in risk assessment models such as the Gail/Breast Cancer Risk Assessment Tool (BCRAT) (6,7) and the International Breast Cancer Intervention Study (IBIS) model (8); proliferative lesions without atypia are also included in the IBIS model. Further, the finding of proliferative lesions in a benign breast biopsy, especially atypical hyperplasia, can result in more intensive screening and pharmacologic risk reduction with selective estrogen receptor modulators or aromatase inhibitors (9). Table 1.Relative risk of breast cancer according to histologic category of benign breast diseases* Study Study design No. of subjects Nonproliferative disease Proliferative disease without atypia Atypical hyperplasia RR (95% CI) RR (95% CI) RR (95% CI) Nashville (1) Retrospective cohort 3303 1 (ref) 1.9 (1.2 to 2.9) 5.3 (3.1 to 8.8) Breast Cancer Detection Demonstration Project (5) Case-control 507 cases; 1014 controls 1 (ref) 1.3 (0.77 to 2.2) 4.3 (1.7 to 11.0) Nurses’ Health Study (2) Case-control 488 cases; 1907 controls 1 (ref) 1.6 (1.3 to 2.1) 4.5 (3.2 to 6.2) Multicenter study (3) Case-control 615 cases; 624 controls 1 (ref) 1.5 (1.1 to 1.9) 5.3 (2.3 to 12.2) Mayo Clinic (4) Retrospective cohort 9087 1.3 (1.2 to 1.4) 1.9 (1.7 to 2.1) 4.2 (3.3 to 5.4) Study Study design No. of subjects Nonproliferative disease Proliferative disease without atypia Atypical hyperplasia RR (95% CI) RR (95% CI) RR (95% CI) Nashville (1) Retrospective cohort 3303 1 (ref) 1.9 (1.2 to 2.9) 5.3 (3.1 to 8.8) Breast Cancer Detection Demonstration Project (5) Case-control 507 cases; 1014 controls 1 (ref) 1.3 (0.77 to 2.2) 4.3 (1.7 to 11.0) Nurses’ Health Study (2) Case-control 488 cases; 1907 controls 1 (ref) 1.6 (1.3 to 2.1) 4.5 (3.2 to 6.2) Multicenter study (3) Case-control 615 cases; 624 controls 1 (ref) 1.5 (1.1 to 1.9) 5.3 (2.3 to 12.2) Mayo Clinic (4) Retrospective cohort 9087 1.3 (1.2 to 1.4) 1.9 (1.7 to 2.1) 4.2 (3.3 to 5.4) *CI = confidence interval; RR = relative risk.
Journal of the National Cancer Institute , éditorial en libre accès, 2016