Brown Nicole L, Pritchard Susan, Harkness Elaine F, Lim Yit, Gandhi Ashu, Evans Dafydd Gareth, Howell Anthony, Howell Sacha J
Manchester University NHS Foundation Trust, Wythenshawe Hospital, Southmoor Road, Manchester, UK.
Division of Informatics, Imaging and Data Sciences, The University of Manchester, Manchester, UK.
BJC Rep. 2024 Dec 18;2(1):90. doi: 10.1038/s44276-024-00113-2.
Atypical ductal hyperplasia (ADH) and lobular neoplasia (LN) increase subsequent breast cancer (BC) risk. However, optimal surveillance and risk reduction regimes remain uncertain. We report management and outcomes of women with ADH and LN to provide data on potential screening/prevention strategies.
Women diagnosed with screen detected ADH and/or LN between 2010-2018 at our institution were identified and demographic data, MDT decisions and BC diagnoses extracted from electronic patient records in 2019 and 2023.
Of 107 women, 74 were discharged to the NHS Breast Screening Programme and 33 were offered enhanced screening (ES). The proportion offered ES increased significantly over time (p = 0.037). 15/105 (14.3%) developed BC (median follow-up 117 months), 9 screen-detected and 6 symptomatic, with 3 interval cancers diagnosed 12-25 months following their last screen. 3/15 were lymph node positive and 13/14 invasive cancers were estrogen receptor (ER) positive. BC incidence rate was 1499.6/100,000 women/year (SIR = 4.7), lower in the first 5 years of follow-up compared with post 5 years.
In women with ADH/LN most BCs occur beyond 5 years. ES regimens should therefore extend to at least 10 years and be at least biennial. Preventative therapy should be considered given the high BC SIR and ER positivity of subsequent tumours.
不典型导管增生（ADH）和小叶肿瘤（LN）会增加后续患乳腺癌（BC）的风险。然而，最佳的监测和风险降低方案仍不明确。我们报告了ADH和LN女性的管理情况及结果，以提供有关潜在筛查/预防策略的数据。
确定了2010年至2018年在我们机构经筛查诊断为ADH和/或LN的女性，并于2019年和2023年从电子病历中提取了人口统计学数据、多学科团队（MDT）决策和BC诊断结果。
107名女性中，74名被转至英国国家医疗服务体系（NHS）乳腺癌筛查项目，33名接受了强化筛查（ES）。随着时间的推移，接受ES的比例显著增加（p = 0.037）。105名女性中有15名（14.3%）患BC（中位随访117个月），9例为筛查发现，6例有症状，3例间隔癌在最后一次筛查后12至25个月被诊断出。15例中有3例淋巴结阳性，14例浸润性癌中有13例雌激素受体（ER）阳性。BC发病率为1499.6/10万女性/年（标准化发病比[SIR]=4.7），随访前5年低于5年后。
ADH/LN女性的大多数BC发生在5年之后。因此，ES方案应至少延长至10年，且至少每两年进行一次。鉴于后续肿瘤的高BC SIR和ER阳性，应考虑预防性治疗。
