Collins Laura C, Aroner Sarah A, Connolly James L, Colditz Graham A, Schnitt Stuart J, Tamimi Rulla M
Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
Cancer. 2016 Feb 15;122(4):515-20. doi: 10.1002/cncr.29775. Epub 2015 Nov 13.
Women with atypical hyperplasia (AH) on a benign breast biopsy specimen are at increased risk for the development of breast cancer. However, the relation between the type and extent of AH (atypical ductal hyperplasia [ADH] vs atypical lobular hyperplasia [ALH]) and the magnitude of the breast cancer risk is not well defined.
A nested case-control study of benign breast disease and breast cancer risk was conducted. Women with breast cancer and prior benign breast biopsy findings (488 cases) were matched to women with prior benign breast biopsy findings who were free from breast cancer (1907 controls). Benign breast biopsy slides were reviewed and categorized as nonproliferative, proliferative without atypia, or AH (ADH or ALH). The number of foci of AH was also recorded.
Among women with ADH, the interrelation between the extent of atypia and breast cancer risk was not significant (odds ratio [OR] for 1 or 2 foci, 3.5; 95% confidence interval [CI], 2.2-5.6; OR for ≥3 foci, 2.7; 95% CI, 1.4-5.1; P = .41). Similarly, although the risk with ALH was higher for those with ≥3 foci than for those with <3 foci, the difference was not statistically significant (OR for 1 or 2 foci, 5.2; 95% CI, 2.7-10.0; OR for ≥3 foci, 8.0; 95% CI, 4.5-14.2; P = .19).
This analysis demonstrates that the extent of ADH or ALH does not significantly contribute to breast cancer risk. The lack of a significant dose-response relation between the extent and type of atypia and breast cancer risk suggests that it would be premature to use the extent of atypia to influence management decisions for women with ADH or ALH.
乳腺良性活检标本中存在非典型增生（AH）的女性患乳腺癌的风险增加。然而，AH的类型和范围（非典型导管增生[ADH]与非典型小叶增生[ALH]）与乳腺癌风险大小之间的关系尚未明确界定。
开展了一项关于乳腺良性疾病与乳腺癌风险的巢式病例对照研究。患有乳腺癌且有既往乳腺良性活检结果的女性（488例病例）与有既往乳腺良性活检结果且无乳腺癌的女性（1907例对照）进行匹配。对乳腺良性活检切片进行复查，并分类为非增殖性、无异型增生的增殖性或AH（ADH或ALH）。还记录了AH的病灶数量。
在患有ADH的女性中，异型增生程度与乳腺癌风险之间的相互关系不显著（1个或2个病灶的比值比[OR]为3.5；95%置信区间[CI]为2.2 - 5.6；≥3个病灶的OR为2.7；95% CI为1.4 - 5.1；P = 0.41）。同样，尽管≥3个病灶的ALH患者的风险高于<3个病灶的患者，但差异无统计学意义（1个或2个病灶的OR为5.2；95% CI为2.7 - 10.0；≥3个病灶的OR为8.0；95% CI为4.5 - 14.2；P = 0.19）。
该分析表明，ADH或ALH的程度对乳腺癌风险没有显著影响。异型增生的程度和类型与乳腺癌风险之间缺乏显著的剂量反应关系，这表明利用异型增生程度来影响ADH或ALH女性的管理决策为时过早。
