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ABSTRACT: Atypical lobular hyperplasia as a unilateral predictor
of breast cancer risk: a retrospective cohort study
Background: Clinical decisions about atypical lobular hyperplasia
are based on the belief that later invasive breast-cancer risk is
equal in both breasts. We aimed to show laterality and subsequent
risk implications of invasive breast cancer in women with atypical
lobular hyperplasia.
Methods: We did a retrospective cohort study of 252 women who had
undergone 261 benign surgical biopsies that showed atypical lobular
hyperplasia from 1950 to 1985, as part of the Nashville Breast
Studies. Primary outcomes were development of invasive breast cancer
and laterality of cancer compared with side of the biopsied breast.
Findings: 50 (20%) of 252 women treated by biopsy only developed
invasive breast cancer. Relative risk of breast cancer in women with
atypical lobular hyperplasia was 3.1 (95% CI 2.3-4.3, p<0.0001). Of
these 50 women, the breast with invasive cancer was the same breast
diagnosed with atypical lobular hyperplasia (ipsilateral) in 34
(68%) and the contralateral breast in 12 (24%). The ratio of
ipsilateral/ contralateral cancers for atypical lobular hyperplasia
without other atypical lesions was 17/5. For six women with atypical
lobular hyperplasia plus atypical ductal hyperplasia, the ratio was
1/1.
Interpretation: Invasive carcinoma after atypical lobular hyperplasia
is about three times more likely to arise in the breast diagnosed
with atypical lobular hyperplasia than in the opposite breast without
these initial findings. Our findings suggest a model of premalignancy
for atypical lobular hyperplasia intermediate between a local precursor
and a generalised risk for both breasts.
[01/10/2003; The Lancet (UK; Free Registration Required)]
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