Breast Cancer Risk and Histologic Findings in Serial Benign Biopsies
As reported by Visscher et al in the Journal of the National Cancer Institute, changes in the histologic category between initial and subsequent biopsies had a significant effect on the risk for breast cancer among women with serial benign biopsy findings.
Study Details
The study involved 1,414 women in the Mayo Clinic Benign Breast Disease Cohort (N =13,466) with serial benign breast biopsies. The median time between biopsies was 5.6 years. Initial biopsy findings were nonproliferative in 61%, proliferative disease without atypia in 34%, and atypical hyperplasia in 5%. Overall, 140 women (9.9%) developed breast cancer.
Histologic Change and Risk Estimates
Overall, breast cancer risk in women with serial biopsies, stratified by histologic category in later biopsies, was similar to that in women with a single biopsy. On multivariate analysis, women with nonproliferative findings on initial biopsy and either proliferative disease without atypia or atypical hyperplasia on second biopsy were at increased risk for breast cancer (hazard ratio [HR] = 1.77, P = .03) compared with women with nonproliferative findings on initial and second biopsies. Among women with proliferative disease without atypia on initial biopsy, breast cancer risk was increased in those with second biopsy showing atypical hyperplasia (HR = 1.49, 95% confidence interval [CI] = 0.73–3.05) and decreased in those with second biopsy showing nonproliferative findings (HR = 0.49, 95% CI = 0.25–0.98; P = .04 overall) compared with women with second biopsy showing no change. Among 65 women with atypical hyperplasia on initial biopsy, breast cancer developed in 7 of 23 patients (30%) with atypia vs 8 of 42 patients (19%) without atypia on second biopsy (HR = 0.57, 95% CI = 0.10–3.32).
The investigators concluded: “We found that breast cancer risk increases in women with progressive epithelial proliferation over time and decreases in women whose biopsies show less proliferation. This finding has important implications for effective clinical management of the 100,000 women per year who have multiple benign breast biopsies.”
This work was supported by the National Cancer Institute, Bankhead-Coley Foundation, and Mayo Clinic Breast Cancer–SPORE.
Daniel W. Visscher, MD, of the Mayo Clinic, Rochester, is the corresponding author of the Journal of the National Cancer Institute article.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
