Rubin E, Visscher D W, Alexander R W, Urist M M, Maddox W A
Department of Radiology, University of Alabama Medical Center, Birmingham 35233.
Cancer. 1988 May 15;61(10):2077-82. doi: 10.1002/1097-0142(19880515)61:10<2077::aid-cncr2820611024>3.0.co;2-m.
A recent study of risk factors for breast cancer indicated elevated risks of 5.3 and 1.9 times, respectively, for women with biopsy specimens showing atypical hyperplasia (AH) and proliferative disease without atypia. These risks increase to 11 and 3.2 times, respectively, in women who also have a family history of breast cancer. This study reviews lesions detected mammographically in a series of patients with documented risk factors. The pathologic specimens of 100 consecutive localization breast biopsies performed for nonpalpable abnormalities detected mammographically were reviewed and classified according to the criteria of Dupont and Page in order to determine the incidence of AH and proliferative breast disease. The mammographic characteristics and historical risk factors of these women also were correlated. Twenty percent of the biopsy specimens showed carcinomas, 55% of which were noninvasive. AH was found in an additional 10% of the biopsy specimens, whereas proliferative disease without atypia occurred in 21% of the biopsy specimens. Forty-nine percent of the biopsy specimens showed nonproliferative changes. This study demonstrated that mammography, in addition to its ability to detect small nonpalpable cancers, identifies a high percentage (31% in this series) of women with pathologic lesions known to have an elevated risk for subsequent breast cancer. The current impetus for large-scale mammographic screening of asymptomatic women mandates the development of rational therapeutic protocols to accommodate the widening spectrum of high-risk pathologic lesions found in these selected populations.
最近一项关于乳腺癌风险因素的研究表明，活检标本显示非典型增生（AH）的女性患癌风险分别升高5.3倍，患增生性疾病但无异常的女性患癌风险升高1.9倍。对于有乳腺癌家族史的女性，这些风险分别增至11倍和3.2倍。本研究回顾了一系列有记录风险因素的患者经乳房X线检查发现的病变。对因乳房X线检查发现的不可触及异常而连续进行的100例局部乳腺活检的病理标本，按照杜邦和佩奇的标准进行回顾和分类，以确定AH和增生性乳腺疾病的发生率。还将这些女性的乳房X线特征与既往风险因素进行了关联分析。20%的活检标本显示为癌，其中55%为非浸润性癌。另外10%的活检标本发现有AH，而21%的活检标本出现了无异常的增生性疾病。49%的活检标本显示为非增生性改变。本研究表明，乳房X线检查除了能够检测出不可触及的小癌外，还能识别出高比例（本系列中为31%）已知后续患乳腺癌风险升高的有病理病变的女性。当前对无症状女性进行大规模乳房X线筛查的趋势，要求制定合理的治疗方案，以适应在这些特定人群中发现的范围不断扩大的高风险病理病变。
