Study finds which women with benign breast disease face greatest risk down the road
By Amanda Gardner
HealthDay Reporter
WEDNESDAY, July 20 (HealthDay News) -- Women with benign breast disease face an elevated risk for developing breast cancer, but a new study clarifies which women within that group have higher and lower risks.
"It has been known for a long time that women with benign breast disease had an increased risk of breast cancer," said study author Dr. Lynn Hartmann, a medical oncologist with the Mayo Clinic in Rochester, Minn. "Our contribution is to provide more precise risk estimates."
The study appears in the July 21 issue of the New England Journal of Medicine.
According to an accompanying editorial, some 20 percent of U.S. women have undergone a breast biopsy within a decade of starting annual screening. Women who have had a biopsy are at about a 50 percent increased risk of developing breast cancer.
But it has not been clear how risk may differ within this group of women.
"Clearly there are gradations within that large group of women," Hartmann said. "We're trying to take a first step towards doing a better job of risk prediction for women."
Hartman and her colleagues looked at 9,087 women with benign breast disease who had been followed for a median of 15 years.
Overall, the women in the group were at about a 56 percent increased risk of developing breast cancer, a risk that persisted for 25 years after the biopsy was performed.
When the different lesions seen in the women were divided into categories, however, a different picture emerged.
"Clearly, the subsequent risk varies quite significantly within those," Hartmann said.
Women with non-proliferative cysts were at no increased risk. "Not in the near term, not in the long term," Hartmann emphasized. Women with cysts who also had a strong family history were at increased risk, however.
At the other end of the spectrum, women with atypia or atypical hyperplasia (too many cells, and too many abnormal cells) faced more than four times the increased risk of later breast cancer.
In between those two extremes were women with "proliferative findings" (too many cells, but the cells still looked normal) who were at about twice the increased risk.
Family history was an independent risk factor.
"This is excellent work," said Dr. Jay Brooks, chairman of hematology/oncology at the Ochsner Clinic Foundation in New Orleans. "This shows us that it's very important to have the pathology of the abnormality reviewed to make sure it's correct, to take a very detailed family history and then counsel women on how to reduce their risk of developing breast cancer."
This last thing is something the medical profession does not do enough of, Brooks added. "This is a very significant study that should tell physicians how to help women understand their risk for developing breast cancer and the many ways that we can offer them to prevent the disease."
SOURCES: Lynn C. Hartmann, M.D., medical oncologist, Mayo Clinic, Rochester, Minn.; Jay Brooks, M.D., chairman, hematology/oncology, Ochsner Clinic Foundation, New Orleans; July 21, 2005, New England Journal of Medicine
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