Sanders Melinda E, Page David L, Simpson Jean F, Schuyler Peggy A, Dale Plummer W, Dupont William D
Department of Pathology, Vanderbilt University Medical Center and Medical School, Nashville, TN 37232, USA.
Cancer. 2006 Apr 1;106(7):1453-61. doi: 10.1002/cncr.21730.
Radial scars (RS) are benign breast lesions that have been implicated as independent risk factors for invasive breast carcinoma (IBC).
A retrospective cohort study of 9556 women who underwent biopsy between 1950-1986 and enrolled in the Nashville Breast Cohort was performed to investigate the association between RS in a benign breast biopsy and the risk of IBC. The risk associated with RS and coexistent proliferative disease (PD) was assessed adjusting for age at biopsy using a Cox hazards regression analysis with time-dependent covariates.
RS were identified in 880 women (9.2%). The average follow-up time was 20.4 years. Sixty-two women (7.0%) with RS developed IBC compared with 5.5% of controls. The relative risk of IBC associated with RS was 1.82 (95% confidence interval [95% CI], 1.2-2.7) at 10 years. Restricting the analysis to women age > 49 years increased the risk to 2.14 (95% CI, 0.6-2.8). These risks decreased with increasing years of follow-up. Approximately 92% of women with RS also had PD, but RS were present in only 1.3% of biopsies without PD. Analyses stratifying relative risk with regard to PD found RS to minimally elevate the relative risk of subsequent IBC.
RS in the absence of PD is uncommon. Although the presence of RS in a benign breast biopsy mildly elevates the risk of IBC risk, the current analysis indicated that this risk can be largely attributed to the category of coexistent PD. In women with both RS and atypical hyperplasia, recommendations for interventions beyond biopsy should be based on the extent of atypical hyperplasia.
放射状瘢痕（RS）是乳腺良性病变，被认为是浸润性乳腺癌（IBC）的独立危险因素。
对1950年至1986年间接受活检并纳入纳什维尔乳腺队列的9556名女性进行回顾性队列研究，以调查良性乳腺活检中RS与IBC风险之间的关联。使用具有时间依赖性协变量的Cox风险回归分析，在调整活检年龄的情况下，评估与RS和共存增殖性疾病（PD）相关的风险。
880名女性（9.2%）发现有RS。平均随访时间为20.4年。62名（7.0%）有RS的女性发生了IBC，而对照组为5.5%。10年时，与RS相关的IBC相对风险为1.82（95%置信区间[95%CI]，1.2 - 2.7）。将分析限制在年龄>49岁的女性中，风险增加到2.14（95%CI，0.6 - 2.8）。这些风险随着随访年限的增加而降低。约92%有RS的女性也有PD，但在无PD的活检中RS仅占1.3%。按PD分层相对风险的分析发现RS对后续IBC的相对风险升高幅度极小。
无PD的RS并不常见。虽然良性乳腺活检中存在RS会轻度增加IBC风险，但目前的分析表明，这种风险在很大程度上可归因于共存的PD类别。对于同时有RS和非典型增生的女性，活检以外干预措施的建议应基于非典型增生的程度。
