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Editorial: Refining Risk Assessment in Women With Benign Breast Disease: An Ongoing Dilemma
Journal of the National Cancer Institute ( IF 9.9 ) Pub Date : 2017-03-17 , DOI: 10.1093/jnci/djx036
Stuart J Schnitt 1 , Monica Morrow 2 , Nadine M Tung 3
Affiliation  

More than three decades ago, Dupont and Page published their seminal study relating breast cancer risk to the histologic findings in benign breast biopsies (1). The key observations of that study were that women whose biopsy showed proliferative lesions without atypia had about a twofold increase in the risk of subsequent breast cancer and those with atypical hyperplasia had about a fivefold increase in breast cancer risk when compared with women with nonproliferative lesions. As summarized in Table 1, subsequent studies from other groups have yielded strikingly similar findings, despite differences in the study design, patient populations, and pathologists involved in the histologic classification of the benign breast biopsies (1–5). As a result of these studies, which in aggregate have included more than 17 000 women, atypical hyperplasia is considered a high-risk lesion and is included in risk assessment models such as the Gail/Breast Cancer Risk Assessment Tool (BCRAT) (6,7) and the International Breast Cancer Intervention Study (IBIS) model (8); proliferative lesions without atypia are also included in the IBIS model. Further, the finding of proliferative lesions in a benign breast biopsy, especially atypical hyperplasia, can result in more intensive screening and pharmacologic risk reduction with selective estrogen receptor modulators or aromatase inhibitors (9).
Table 1.

Relative risk of breast cancer according to histologic category of benign breast diseases*

Study Study design No. of subjects Nonproliferative disease Proliferative disease without atypia Atypical hyperplasia 
RR (95% CI) RR (95% CI) RR (95% CI) 
Nashville (1) Retrospective cohort 3303 1 (ref) 1.9 (1.2 to 2.9) 5.3 (3.1 to 8.8) 
Breast Cancer Detection Demonstration Project (5) Case-control 507 cases; 1014 controls 1 (ref) 1.3 (0.77 to 2.2) 4.3 (1.7 to 11.0) 
Nurses’ Health Study (2) Case-control 488 cases; 1907 controls 1 (ref) 1.6 (1.3 to 2.1) 4.5 (3.2 to 6.2) 
Multicenter study (3) Case-control 615 cases; 624 controls 1 (ref) 1.5 (1.1 to 1.9) 5.3 (2.3 to 12.2) 
Mayo Clinic (4) Retrospective cohort 9087 1.3 (1.2 to 1.4) 1.9 (1.7 to 2.1) 4.2 (3.3 to 5.4) 
Study Study design No. of subjects Nonproliferative disease Proliferative disease without atypia Atypical hyperplasia 
RR (95% CI) RR (95% CI) RR (95% CI) 
Nashville (1) Retrospective cohort 3303 1 (ref) 1.9 (1.2 to 2.9) 5.3 (3.1 to 8.8) 
Breast Cancer Detection Demonstration Project (5) Case-control 507 cases; 1014 controls 1 (ref) 1.3 (0.77 to 2.2) 4.3 (1.7 to 11.0) 
Nurses’ Health Study (2) Case-control 488 cases; 1907 controls 1 (ref) 1.6 (1.3 to 2.1) 4.5 (3.2 to 6.2) 
Multicenter study (3) Case-control 615 cases; 624 controls 1 (ref) 1.5 (1.1 to 1.9) 5.3 (2.3 to 12.2) 
Mayo Clinic (4) Retrospective cohort 9087 1.3 (1.2 to 1.4) 1.9 (1.7 to 2.1) 4.2 (3.3 to 5.4) 
*

CI = confidence interval; RR = relative risk.

Table 1.

Relative risk of breast cancer according to histologic category of benign breast diseases*

Study Study design No. of subjects Nonproliferative disease Proliferative disease without atypia Atypical hyperplasia 
RR (95% CI) RR (95% CI) RR (95% CI) 
Nashville (1) Retrospective cohort 3303 1 (ref) 1.9 (1.2 to 2.9) 5.3 (3.1 to 8.8) 
Breast Cancer Detection Demonstration Project (5) Case-control 507 cases; 1014 controls 1 (ref) 1.3 (0.77 to 2.2) 4.3 (1.7 to 11.0) 
Nurses’ Health Study (2) Case-control 488 cases; 1907 controls 1 (ref) 1.6 (1.3 to 2.1) 4.5 (3.2 to 6.2) 
Multicenter study (3) Case-control 615 cases; 624 controls 1 (ref) 1.5 (1.1 to 1.9) 5.3 (2.3 to 12.2) 
Mayo Clinic (4) Retrospective cohort 9087 1.3 (1.2 to 1.4) 1.9 (1.7 to 2.1) 4.2 (3.3 to 5.4) 
Study Study design No. of subjects Nonproliferative disease Proliferative disease without atypia Atypical hyperplasia 
RR (95% CI) RR (95% CI) RR (95% CI) 
Nashville (1) Retrospective cohort 3303 1 (ref) 1.9 (1.2 to 2.9) 5.3 (3.1 to 8.8) 
Breast Cancer Detection Demonstration Project (5) Case-control 507 cases; 1014 controls 1 (ref) 1.3 (0.77 to 2.2) 4.3 (1.7 to 11.0) 
Nurses’ Health Study (2) Case-control 488 cases; 1907 controls 1 (ref) 1.6 (1.3 to 2.1) 4.5 (3.2 to 6.2) 
Multicenter study (3) Case-control 615 cases; 624 controls 1 (ref) 1.5 (1.1 to 1.9) 5.3 (2.3 to 12.2) 
Mayo Clinic (4) Retrospective cohort 9087 1.3 (1.2 to 1.4) 1.9 (1.7 to 2.1) 4.2 (3.3 to 5.4) 
*

CI = confidence interval; RR = relative risk.



中文翻译:

社论:对患有乳腺良性疾病的妇女进行风险评估:一个持续的难题

三十多年前,杜邦(Dupont)和佩奇(Page)发表了关于乳腺癌风险与良性乳腺活检组织学发现相关的开创性研究(1)。该研究的主要观察结果是,活检显示无异型增生性病变的妇女与非增生性病变的女性相比,其随后患乳腺癌的风险增加了约两倍,非典型增生的女性的乳腺癌风险增加了约5倍。如表1所示,尽管研究设计,患者人群和良性乳腺活检组织学分类所涉及的病理学家存在差异,其他组的后续研究也得出了惊人的相似结果(1-5)。这些研究的结果是,总共包括17,000多名妇女,非典型增生被认为是高风险病灶,并包括在风险评估模型中,例如盖尔/乳腺癌风险评估工具(BCRAT)(6,7)和国际乳腺癌干预研究(IBIS)模型(8);没有异型性的增生性病变也包括在IBIS模型中。此外,在良性乳腺活检中发现增生性病变,尤其是非典型增生,可导致选择性雌激素受体调节剂或芳香化酶抑制剂的更深入筛查和药理风险降低(9)。
表格1。

根据良性乳腺疾病的组织学类别,患乳腺癌的相对风险*

学习 学习规划 学科数 非增生性疾病 无异型性增生性疾病 非典型增生 
RR(95%CI) RR(95%CI) RR(95%CI) 
纳什维尔(1) 回顾性队列 3303 1(参考) 1.9(1.2至2.9) 5.3(3.1至8.8) 
乳腺癌检测示范项目(5) 病例对照 507宗; 1014个控件 1(参考) 1.3(0.77至2.2) 4.3(1.7至11.0) 
护士健康研究(2) 病例对照 488宗;1907年控制 1(参考) 1.6(1.3至2.1) 4.5(3.2至6.2) 
多中心研究(3) 病例对照 615宗; 624个控件 1(参考) 1.5(1.1至1.9) 5.3(2.3至12.2) 
梅奥诊所(4) 回顾性队列 9087 1.3(1.2至1.4) 1.9(1.7至2.1) 4.2(3.3至5.4) 
学习 学习规划 学科数 非增生性疾病 无异型性增生性疾病 非典型增生 
RR(95%CI) RR(95%CI) RR(95%CI) 
纳什维尔(1) 回顾性队列 3303 1(参考) 1.9(1.2至2.9) 5.3(3.1至8.8) 
乳腺癌检测示范项目(5) 病例对照 507宗; 1014个控件 1(参考) 1.3(0.77至2.2) 4.3(1.7至11.0) 
护士健康研究(2) 病例对照 488宗;1907年控制 1(参考) 1.6(1.3至2.1) 4.5(3.2至6.2) 
多中心研究(3) 病例对照 615宗; 624个控件 1(参考) 1.5(1.1至1.9) 5.3(2.3至12.2) 
梅奥诊所(4) 回顾性队列 9087 1.3(1.2至1.4) 1.9(1.7至2.1) 4.2(3.3至5.4) 
*

CI =置信区间;RR =相对风险。

表格1。

根据良性乳腺疾病的组织学类别,患乳腺癌的相对风险*

学习 学习规划 学科数 非增生性疾病 无异型性增生性疾病 非典型增生 
RR(95%CI) RR(95%CI) RR(95%CI) 
纳什维尔(1) 回顾性队列 3303 1(参考) 1.9(1.2至2.9) 5.3(3.1至8.8) 
乳腺癌检测示范项目(5) 病例对照 507宗; 1014个控件 1(参考) 1.3(0.77至2.2) 4.3(1.7至11.0) 
护士健康研究(2) 病例对照 488宗;1907年控制 1(参考) 1.6(1.3至2.1) 4.5(3.2至6.2) 
多中心研究(3) 病例对照 615宗; 624个控件 1(参考) 1.5(1.1至1.9) 5.3(2.3至12.2) 
梅奥诊所(4) 回顾性队列 9087 1.3(1.2至1.4) 1.9(1.7至2.1) 4.2(3.3至5.4) 
学习 学习规划 学科数 非增生性疾病 无异型性增生性疾病 非典型增生 
RR(95%CI) RR(95%CI) RR(95%CI) 
纳什维尔(1) 回顾性队列 3303 1(参考) 1.9(1.2至2.9) 5.3(3.1至8.8) 
乳腺癌检测示范项目(5) 病例对照 507宗; 1014个控件 1(参考) 1.3(0.77至2.2) 4.3(1.7至11.0) 
护士健康研究(2) 病例对照 488宗;1907年控制 1(参考) 1.6(1.3至2.1) 4.5(3.2至6.2) 
多中心研究(3) 病例对照 615宗; 624个控件 1(参考) 1.5(1.1至1.9) 5.3(2.3至12.2) 
梅奥诊所(4) 回顾性队列 9087 1.3(1.2至1.4) 1.9(1.7至2.1) 4.2(3.3至5.4) 
*

CI =置信区间;RR =相对风险。

更新日期:2017-03-17
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