Understanding the Premalignant Potential of Atypical Hyperplasia through Its Natural History: A Longitudinal Cohort Study is

Atypical hyperplasia is a high-risk premalignant lesion of the breast, but its biology is poorly understood. Many believe that atypical ductal hyperplasia (ADH) is a direct precursor for low-grade ductal breast cancer, whereas atypical lobular hyperplasia (ALH) serves as a risk indicator. These assu...

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Bibliographic Details
Published in:Cancer prevention research (Philadelphia, Pa.) Pa.), 2014-02, Vol.7 (2), p.211-217
Main Authors: HARTMANN, Lynn C, RADISKY, Derek C, FROST, Marlene H, SANTEN, Richard J, VIERKANT, Robert A, BENETTI, Lorelle L, TARABISHY, Yaman, GHOSH, Karthik, VISSCHER, Daniel W, DEGNIM, Amy C
Format: Article
Language:English
Subjects:
Adult
Aged
Biological and medical sciences
Biopsy
Breast - pathology
Breast Neoplasms - epidemiology
Breast Neoplasms - pathology
Carcinoma, Ductal, Breast - epidemiology
Carcinoma, Ductal, Breast - pathology
Carcinoma, Intraductal, Noninfiltrating - epidemiology
Carcinoma, Intraductal, Noninfiltrating - pathology
Disease Progression
Female
Fibrocystic Breast Disease - epidemiology
Fibrocystic Breast Disease - pathology
Humans
Hyperplasia - epidemiology
Hyperplasia - pathology
Longitudinal Studies
Medical sciences
Middle Aged
Miscellaneous
Precancerous Conditions - epidemiology
Precancerous Conditions - pathology
Prevention and actions
Public health. Hygiene
Public health. Hygiene-occupational medicine
Time Factors
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Summary:Atypical hyperplasia is a high-risk premalignant lesion of the breast, but its biology is poorly understood. Many believe that atypical ductal hyperplasia (ADH) is a direct precursor for low-grade ductal breast cancer, whereas atypical lobular hyperplasia (ALH) serves as a risk indicator. These assumptions underlie current clinical recommendations. We tested these assumptions by studying the characteristics of the breast cancers that develop in women with ADH or ALH. Using the Mayo Benign Breast Disease Cohort, we identified all women with ADH or ALH from 1967 to 2001 and followed them for later breast cancers, characterizing side of breast cancer versus side of atypia; time to breast cancer; type, histology, and grade of breast cancer, looking for patterns consistent with precursors versus risk indicators. A total of 698 women with atypical hyperplasia were followed a mean of 12.5 years; 143 developed breast cancer. For both ADH and ALH, there is a 2:1 ratio of ipsilateral to contralateral breast cancer. The ipsilateral predominance is marked in the first 5 years, consistent with a precursor phenotype for both ADH and ALH. For both, there is a predominance of invasive ductal cancers with 69% of moderate or high grade. Twenty-five percent are node positive. Both ADH and ALH portend risk for ductal carcinoma in situ and invasive breast cancers, predominantly ductal, with two thirds moderate or high grade. The ipsilateral breast is at especially high risk for breast cancer in the first 5 years after atypia, with risk remaining elevated in both breasts long term. ADH and ALH behave similarly in terms of later breast cancer endpoints.
ISSN:1940-6207
1940-6215
DOI:10.1158/1940-6207.capr-13-0222