Personal History of Proliferative Breast Disease With Atypia and Risk of Multifocal Breast Cancer

Authors: Nutter E.L. et al.
Source: Cancer April 1, 2018 doi:10.1002/cncr.31202
www.ncbi.nlm.nih.gov/pubmed/29266172

Multifocal breast cancer (MFBC) is disease where more than one malignant tumor is present within a single quadrant of the breast. This differs from multicentric breast cancer, which defines tumors present in more than one quadrant. Some studies show that women with MFBC have worse prognosis than women with single tumors.

PBDAs refer to atypical ductal and atypical lobular hyperplasia. These two diagnoses are known to increase breast cancer risk fourfold. The authors note that, while the association between PBDAs and breast cancer is well-known, there may be a more specific association between PBDAs and MFBC.

Over 3,500 women from the New Hampshire Mammography Network who had been diagnosed with breast cancer consented to participate in this study. Their records were reviewed for prior biopsy results.

A small percentage of the participants had been diagnosed with PBDAs prior to their cancer diagnosis. Interestingly, these women were younger and had denser breasts compared to women who did not have histories of PBDAs. Moreover, the women with histories of PBDAs were significantly more likely to be diagnosed with MFBC compared to women who had no history of breast biopsies. Women diagnosed with ductal carcinoma in situ were more likely to develop MFBC compared to women diagnosed with invasive breast cancer.

The investigators’ finding that PBDAs were significantly associated with MFBC may have significant health implications. Some studies have shown that survival among women with MFBC is worse compared to women with unifocal disease. Women diagnosed with PBDAs may therefore benefit from enhanced screening or more extensive preoperative evaluations to rule out multifocal disease.