Dupont W D, Page D L, Parl F F, Vnencak-Jones C L, Plummer W D, Rados M S, Schuyler P A
Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232-2637.
N Engl J Med. 1994 Jul 7;331(1):10-5. doi: 10.1056/NEJM199407073310103.
Fibroadenomas are benign breast tumors that are commonly diagnosed in young women and are associated with a slight increase in the risk of breast cancer. These lesions vary considerably in their histologic characteristics. We assessed the correlation between the histologic features of fibroadenomas and the risk of subsequent breast cancer.
We conducted a retrospective cohort study of a consecutive series of patients with fibroadenoma diagnosed between 1950 and 1968. Follow-up data were obtained for 1835 patients (90 percent of those eligible). Fibroadenomas with cysts, sclerosing adenosis, epithelial calcifications, or papillary apocrine changes were classified as complex. The rate of subsequent breast cancer among the patients was compared with the rates in two control groups, women listed in the Connecticut Tumor Registry and women chosen from among the patients' sisters-in-law.
The risk of invasive breast cancer was 2.17 times higher among the patients with fibroadenoma than among the controls (95 percent confidence interval, 1.5 to 3.2). The relative risk increased to 3.10 among patients with complex fibroadenomas (95 percent confidence interval, 1.9 to 5.1) and remained elevated for decades after diagnosis. Patients with benign proliferative disease in the parenchyma adjacent to the fibroadenoma had a relative risk of 3.88 (95 percent confidence interval, 2.1 to 7.3). Patients with a family history of breast cancer in whom complex fibroadenoma was diagnosed had a relative risk of 3.72, as compared with controls with a family history (95 percent confidence interval, 1.4 to 10). Two thirds of the patients had noncomplex fibroadenomas and no family history of breast cancer and did not have an increased risk.
Fibroadenoma is a long-term risk factor for breast cancer. The risk is increased in women with complex fibroadenomas, proliferative disease, or a family history of breast cancer.
纤维腺瘤是常见于年轻女性的良性乳腺肿瘤，与乳腺癌风险略有增加相关。这些病变的组织学特征差异很大。我们评估了纤维腺瘤的组织学特征与后续患乳腺癌风险之间的相关性。
我们对1950年至1968年间连续诊断为纤维腺瘤的一系列患者进行了回顾性队列研究。获得了1835例患者（90%符合条件者）的随访数据。伴有囊肿、硬化性腺病、上皮钙化或乳头状大汗腺改变的纤维腺瘤被归类为复杂性纤维腺瘤。将患者中后续患乳腺癌的发生率与两个对照组（康涅狄格肿瘤登记处列出的女性以及从患者嫂子中挑选出的女性）的发生率进行比较。
纤维腺瘤患者发生浸润性乳腺癌的风险比对照组高2.17倍（95%置信区间为1.5至3.2）。复杂性纤维腺瘤患者的相对风险增至3.10（95%置信区间为1.9至5.1），且在诊断后数十年仍保持升高。纤维腺瘤邻近实质内有良性增生性疾病的患者相对风险为3.88（95%置信区间为2.1至7.3）。诊断为复杂性纤维腺瘤且有乳腺癌家族史的患者相对风险为3.72，与有家族史的对照组相比（95%置信区间为1.4至10）。三分之二的患者患有非复杂性纤维腺瘤且无乳腺癌家族史，其风险未增加。
纤维腺瘤是乳腺癌的长期风险因素。复杂性纤维腺瘤、增生性疾病或有乳腺癌家族史的女性风险增加。
