Carter C L, Corle D K, Micozzi M S, Schatzkin A, Taylor P R
Cancer Prevention Studies Branch, National Cancer Institute, Bethesda, MD 20892-4200.
Am J Epidemiol. 1988 Sep;128(3):467-77. doi: 10.1093/oxfordjournals.aje.a114995.
The authors studied the relation between benign breast disease and subsequent breast cancer in 16,692 women with biopsy-diagnosed benign breast disease who had participated in the Breast Cancer Detection Demonstration Project throughout the United States. Women were classified into one of five benign breast disease categories: atypical hyperplasia, proliferative disease without atypia, nonproliferative disease, fibroadenoma, and other benign breast disease. A total of 485 incident cases of breast cancer were identified in the women from August 1973 to February 1986 after a median follow-up period of 8.3 years from the diagnosis of benign breast disease. Age-adjusted incidence rates were calculated for benign breast disease types stratified by family history and calcification status. Relative risk (RR) estimates of breast cancer for women in the five benign breast disease categories, compared with the screened women who did not develop recognizable breast disease (normal subjects), were computed using the proportional hazards model. Results indicated that risk was associated with the degree of epithelial atypia. Over all age groups, women with nonproliferative disease, proliferative disease without atypia, and atypical hyperplasia displayed progressively increasing risks of 1.5, 1.9, and 3.0, respectively, compared with normal subjects, with 95% confidence intervals (CI) exceeding unity. Particularly high risk was seen among women under age 46 years with atypical hyperplasia (RR = 5.7, 95% CI 3.0-10.6). Women with fibroadenoma as the only indication of their benign breast disease had a relative risk of 1.7, with a lower 95% confidence limit of 1.0. No increased risk was seen for women with other benign breast disease. Positive family history (RR = 1.8) and calcification (RR = 1.2) significantly increased a woman's risk proportionately over the risk associated with each benign breast disease subtype. The authors conclude that the risk of developing breast cancer varies by category of benign breast disease and is directly related to the degree of epithelial atypia.
作者对16692名经活检诊断为良性乳腺疾病且参与了全美国乳腺癌检测示范项目的女性，研究了良性乳腺疾病与后续乳腺癌之间的关系。女性被分为五种良性乳腺疾病类别之一：非典型增生、无异型性的增生性疾病、非增生性疾病、纤维腺瘤和其他良性乳腺疾病。从1973年8月至1986年2月，在这些女性中总共确诊了485例乳腺癌病例，自良性乳腺疾病诊断后中位随访期为8.3年。按家族史和钙化状态分层计算了各良性乳腺疾病类型的年龄调整发病率。使用比例风险模型计算了五类良性乳腺疾病女性患乳腺癌的相对风险（RR）估计值，并与未发生可识别乳腺疾病的筛查女性（正常受试者）进行比较。结果表明，风险与上皮异型程度相关。在所有年龄组中，与正常受试者相比，患有非增生性疾病、无异型性的增生性疾病和非典型增生的女性风险分别逐渐增加至1.5、1.9和3.0，95%置信区间（CI）超过1。46岁以下患有非典型增生的女性风险尤其高（RR = 5.7，95%CI 3.0 - 10.6）。仅以纤维腺瘤作为良性乳腺疾病唯一指征的女性相对风险为1.7，95%置信下限为1.0。患有其他良性乳腺疾病的女性未观察到风险增加。阳性家族史（RR = 1.8）和钙化（RR = 1.2）与每种良性乳腺疾病亚型相关的风险相比，显著按比例增加了女性的风险。作者得出结论，患乳腺癌的风险因良性乳腺疾病类别而异，且与上皮异型程度直接相关。
