Collins Laura C, Baer Heather J, Tamimi Rulla M, Connolly James L, Colditz Graham A, Schnitt Stuart J
Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215, USA.
Cancer. 2007 Jan 15;109(2):180-7. doi: 10.1002/cncr.22408.
Atypical hyperplasia (AH) in a benign breast biopsy is associated with an increased breast cancer risk. However, the influence of the histologic type of AH on the magnitude and laterality of breast cancer risk is poorly defined.
The authors conducted a case-control study of benign breast disease and breast cancer risk nested within the Nurses' Health Study (395 cases, 1610 controls). Benign breast biopsy slides were reviewed and categorized as showing nonproliferative lesions, proliferative lesions without atypia, or AH. Slides that showed AH were categorized further as atypical ductal hyperplasia (ADH) or atypical lobular hyperplasia (ALH).
The odds ratio (OR) for breast cancer among all women with AH was 4.1 (95% confidence interval [95% CI], 2.9-5.8). However, among premenopausal women, breast cancer risk was higher for women with ALH (OR, 7.3; 95% CI, 3.8-14.2) than for women with ADH (OR, 3.1; 95% CI, 2.0-4.8). Overall, 58.9% of invasive breast cancers that developed in women with AH were in the ipsilateral breast, and the frequency of ipsilateral breast cancer was similar for women with ALH (61.3%) and women with ADH (55.9%; P = .66).
Women with AH in a benign breast biopsy were at a substantially increased risk for the development of breast cancer. Among premenopausal women, the risk appeared to be greater for those with ALH than those with ADH. Because only approximately 60% of cancers that develop in women with AH occur in the ipsilateral breast, for the purposes of clinical management, these lesions are viewed best as markers of a generalized (bilateral) increase in breast cancer risk.
良性乳腺活检中的非典型增生（AH）与乳腺癌风险增加相关。然而，AH的组织学类型对乳腺癌风险的大小和患侧性的影响尚不明确。
作者在护士健康研究中开展了一项关于良性乳腺疾病与乳腺癌风险的病例对照研究（395例病例，1610例对照）。对良性乳腺活检切片进行复查，并分类为显示非增殖性病变、无异型性的增殖性病变或AH。显示AH的切片进一步分类为非典型导管增生（ADH）或非典型小叶增生（ALH）。
所有患有AH的女性患乳腺癌的比值比（OR）为4.1（95%置信区间[95%CI]，2.9 - 5.8）。然而，在绝经前女性中，患有ALH的女性患乳腺癌的风险高于患有ADH的女性（OR，7.3；95%CI，3.8 - 14.2）（OR，3.1；95%CI，2.0 - 4.8）。总体而言，患有AH的女性发生的浸润性乳腺癌中有58.9%位于同侧乳腺，患有ALH的女性（61.3%）和患有ADH的女性（55.9%；P = 0.66）同侧乳腺癌的发生频率相似。
良性乳腺活检中有AH的女性患乳腺癌的风险大幅增加。在绝经前女性中，患有ALH的女性风险似乎高于患有ADH的女性。由于AH女性发生的癌症中只有约60%发生在同侧乳腺，出于临床管理目的，这些病变最好被视为乳腺癌风险普遍（双侧）增加的标志物。
