Jensen R A, Page D L, Dupont W D, Rogers L W
Department of Pathology, Vanderbilt University Medical School, Nashville, Tennessee 37232.
Cancer. 1989 Nov 15;64(10):1977-83. doi: 10.1002/1097-0142(19891115)64:10<1977::aid-cncr2820641002>3.0.co;2-n.
To assess sclerosing adenosis (SA) as an independent risk factor for subsequent invasive breast cancer (IBC), the authors reviewed 10,366 benign breast biopsy specimens (BB) obtained between 1950 and 1968 and identified 547 cases of SA meeting strict histologic criteria of expanded lobular units with whorled compressed acini. Of those women targeted for follow-up (3303, of whom 349 had SA), 84% were successfully followed for an average of 17 years. The relative risk for IBC among patients with SA regardless of the presence of atypical hyperplasia (AH) was 2.1. This risk decreased to 1.7 when patients with AH were excluded, and rose to 6.7 when only those patients with SA and AH were analyzed. The coexistence of a family history of IBC in a first-degree relative did not further elevate risk above that of SA alone when women with AH were excluded. Sclerosing adenosis was found to be positively associated with atypical lobular hyperplasia (ALH) as ALH was present in biopsy specimens with SA 2.7 times more frequently than in other biopsy specimens. Perimenopausal age, histologic calcification, and family history of IBC (FH) were also positively associated with SA. Sclerosing adenosis was most frequent in the perimenopausal period and had a weak association with family history of IBC. No association with atypical ductal hyperplasia (ADH) was identified. The authors conclude sclerosing adenosis represents an independent risk factor for subsequent invasive breast cancer apart from its association with ALH, and the risk (excluding patients with coexistent atypical hyperplasia) is in the range of 1.7, times thereby justifying inclusion of sclerosing adenosis as a component of a group of histopathologically defined lesions termed "proliferative breast disease without atypia" which implies a relative cancer risk of 1.5 to 2.0.
为评估硬化性腺病（SA）作为后续浸润性乳腺癌（IBC）的独立危险因素，作者回顾了1950年至1968年间获取的10366份良性乳腺活检标本（BB），并确定了547例符合严格组织学标准的SA病例，这些病例具有扩大的小叶单位和漩涡状压缩腺泡。在那些被纳入随访的女性中（3303例，其中349例有SA），84%的女性成功随访了平均17年。无论是否存在非典型增生（AH），SA患者发生IBC的相对风险为2.1。排除AH患者后，该风险降至1.7，而仅分析有SA和AH的患者时，风险升至6.7。当排除AH女性时，一级亲属中有IBC家族史的情况并不会使风险进一步高于单独SA患者的风险。发现硬化性腺病与非典型小叶增生（ALH）呈正相关，因为在有SA的活检标本中ALH出现的频率比其他活检标本高2.7倍。围绝经期年龄、组织学钙化和IBC家族史（FH）也与SA呈正相关。硬化性腺病在围绝经期最常见，与IBC家族史的关联较弱。未发现与非典型导管增生（ADH）有关联。作者得出结论，硬化性腺病除了与ALH相关外，还代表后续浸润性乳腺癌的独立危险因素，其风险（不包括同时存在非典型增生的患者）在1.7左右，因此有理由将硬化性腺病纳入一组组织病理学定义的病变，称为“无非典型增生的增生性乳腺病”，这意味着相对癌症风险为1.5至2.0。
