Breast Cancer Risk and Progressive Histology in Serial Benign Biopsies

Authors: Visscher, DW et al.

Source: J Natl Cancer Inst (2017) 109(10): djx035

www.ncbi.nlm.nih.gov/pubmed/28376198

Benign breast disease (BBD) is a very common finding upon breast biopsy in the United States. There are specific categories within BBD that have specific known breast cancer risks. For example, fibrosis or fibroadenomas increase risk minimally. Proliferative disease without atypia (PDWA), such as usual hyperplasia, increase risk twofold. Atypical hyperplasia (AH) increases breast cancer risk by four times.

Women who undergo multiple breast biopsies over time may have changing breast cancer risk. It is unclear how, or if, cellular changes over time may convert BBD to breast cancer. Knowing how a woman’s BBD changes may provide insight into how breast cancer develops. This group investigated how specific features of multiple BBD biopsies impact breast cancer risk. Over 1400 women who had multiple breast biopsies were studied.

Second biopsies were significantly more likely to show PDWA or AH compared to initial biopsies. Women whose subsequent biopsies (not the first biopsy) showed PDWA or AH were more likely to develop breast cancer than women whose subsequent biopsies showed no proliferation (NP). When initial biopsy results showed PDWA and subsequent biopsy results showed NP, breast cancer risk declined. Changes in biopsy results were about twice as likely to progress to a higher risk category than to a lower one.

Additionally, among women with NP at initial biopsy, age 45-55, having fewer than 5 years between biopsies, the presence of columnar cell alteration and having bilateral breast biopsies were all associated with changes in breast biopsy result categories (NP to PDWA or AH) over time.

The results of the study support the idea that, over time, there is a progression of change in breast tissue that can ultimately develop into cancer. Breast cancer risk can evolve over time. Patients with benign breast biopsies should be made aware of this, and be kept under surveillance.