Webber W, Boyd N
J Natl Cancer Inst. 1986 Aug;77(2):397-404.
After almost a century of research the relationship of benign breast disease to breast cancer risk is still controversial. The present investigation assessed this controversy by examining all published cohort studies that examined the risk of breast cancer in subjects with benign breast disease for their compliance with widely accepted standards for the conduct of etiologic research. Most of these studies describe the breast cancer incidence in women who have had breast biopsies. The 16 standards included a description of the population studied, a definition of benign breast disease, an account of follow-up, and a description of the analysis of risk. Of the 36 studies examined, 22 reported finding an increase in breast cancer risk in women with benign breast disease and all met more methodologic standards than the 11 studies reporting no increase in risk (3 studies reported no conclusions). In particular, none of the 11 "negative" studies calculated the number of cancers expected in the population studied, whereas all 22 "positive" studies did so. There is thus considerable statistical support from well-conducted studies for the view that benign breast disease is associated with an increase in breast cancer risk. By contrast, there is no credible support for the contrary view, which is often based on small studies in which no cancers were observed or on studies whose conclusions are not supported by an appropriate analysis of the data they contain.
经过近一个世纪的研究，良性乳腺疾病与乳腺癌风险之间的关系仍存在争议。本调查通过审查所有已发表的队列研究来评估这一争议，这些研究调查了患有良性乳腺疾病的受试者患乳腺癌的风险，以确定它们是否符合病因学研究广泛接受的标准。这些研究大多描述了接受过乳房活检的女性的乳腺癌发病率。这16项标准包括对所研究人群的描述、良性乳腺疾病的定义、随访情况的说明以及风险分析的描述。在所审查的36项研究中，22项报告发现患有良性乳腺疾病的女性患乳腺癌的风险增加，并且所有这些研究比11项报告风险未增加的研究（3项研究未得出结论）符合更多的方法学标准。特别是，11项“阴性”研究中没有一项计算所研究人群中预期的癌症数量，而所有22项“阳性”研究都进行了计算。因此，有充分证据的研究为良性乳腺疾病与乳腺癌风险增加相关这一观点提供了相当多的统计学支持。相比之下，对于相反的观点则没有可靠的支持，这种观点通常基于未观察到癌症的小型研究，或者基于其结论未得到对所包含数据的适当分析支持的研究。
