An analysis of breast cancer risk in women with single, multiple, and atypical papilloma

Jason T. Lewis, Lynn C. Hartmann, Robert A. Vierkant, Shaun D. Maloney, V. Shane Pankratz, Teresa M. Allers, Marlene H. Frost, Daniel W Visscher

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Abstract

Breast papillomas may be single or multiple and associated with atypical ductal or lobular hyperplasias (ADH/ALH). The risk of breast carcinoma development in patients with papillomas, particularly those with multiple or atypical lesions, is incompletely defined. Fibrocystic lesions were histopathologically classified in a benign breast disease cohort of 9155 who underwent biopsy from 1967 to 1991, with papilloma assessment in 9108. Individuals with papillomas (N=480) were classified into 4 groups: single papilloma (SP, N=372), single papilloma with ADH or ALH (SP+A, N=54), multiple (>5) papillomas (MP, N=41), and multiple papillomas with ADH or ALH (MP+A, N=13). Those without papillomas were classified as nonproliferative (NP, N=6053), proliferative without atypia (PDWA, N=2308), and ADH/ALH [atypical hyperplasia (AH), N=267]. The relative risk of cancer development within our cohort was compared to that expected in the general population using standardized incidence ratios. The relative risk of breast cancer development associated with SP [2.04, 95% confidence interval (CI) 1.43-2.81] was greater than NP (1.28, 95% CI 1.16-1.42) but similar to PDWA (1.90, 95% CI 1.66-2.16). The risk associated with SP+A (5.11, 95% CI 2.64-8.92) was highly elevated but not substantively different than atypical hyperplasia (4.17, 95% CI 3.10-5.50). Patients with MP are at increased risk compared with PDWA or SP (3.01, 95% CI 1.10-6.55), particularly those with MP+A (7.01, 95% CI 1.91-17.97). There was a marginal increase in breast cancer risk (16%) among patients with proliferative disease if a papilloma was present, but this did not reach statistical significance (P=0.29). The observed frequency of ipsilateral (vs. contralateral) breast cancer development in papilloma subsets was not significantly different than other patient groups. We conclude that SP imparts a cancer risk similar to conventional proliferative fibrocystic change. The presence of papilloma in, or associated with, atypia does not modify the risk connotation of ADH/ALH overall. MP constitutes a proliferative breast disease subset having unique clinical and biologic behavior.

Original languageEnglish (US)
Pages (from-to)665-672
Number of pages8
JournalAmerican Journal of Surgical Pathology
Volume30
Issue number6
DOIs
StatePublished - Jun 2006

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Papilloma
Breast Neoplasms
Confidence Intervals
Hyperplasia
Breast Diseases
Neoplasms
Breast
Biopsy

Keywords

  • Atypical hyperplasia
  • Breast cancer
  • Intraductal papilloma

ASJC Scopus subject areas

  • Anatomy
  • Pathology and Forensic Medicine

Cite this

An analysis of breast cancer risk in women with single, multiple, and atypical papilloma. / Lewis, Jason T.; Hartmann, Lynn C.; Vierkant, Robert A.; Maloney, Shaun D.; Shane Pankratz, V.; Allers, Teresa M.; Frost, Marlene H.; Visscher, Daniel W.

In: American Journal of Surgical Pathology, Vol. 30, No. 6, 06.2006, p. 665-672.

Research output: Contribution to journalArticle

Lewis, JT, Hartmann, LC, Vierkant, RA, Maloney, SD, Shane Pankratz, V, Allers, TM, Frost, MH & Visscher, DW 2006, 'An analysis of breast cancer risk in women with single, multiple, and atypical papilloma', American Journal of Surgical Pathology, vol. 30, no. 6, pp. 665-672. https://doi.org/10.1097/00000478-200606000-00001
Lewis, Jason T. ; Hartmann, Lynn C. ; Vierkant, Robert A. ; Maloney, Shaun D. ; Shane Pankratz, V. ; Allers, Teresa M. ; Frost, Marlene H. ; Visscher, Daniel W. / An analysis of breast cancer risk in women with single, multiple, and atypical papilloma. In: American Journal of Surgical Pathology. 2006 ; Vol. 30, No. 6. pp. 665-672.
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abstract = "Breast papillomas may be single or multiple and associated with atypical ductal or lobular hyperplasias (ADH/ALH). The risk of breast carcinoma development in patients with papillomas, particularly those with multiple or atypical lesions, is incompletely defined. Fibrocystic lesions were histopathologically classified in a benign breast disease cohort of 9155 who underwent biopsy from 1967 to 1991, with papilloma assessment in 9108. Individuals with papillomas (N=480) were classified into 4 groups: single papilloma (SP, N=372), single papilloma with ADH or ALH (SP+A, N=54), multiple (>5) papillomas (MP, N=41), and multiple papillomas with ADH or ALH (MP+A, N=13). Those without papillomas were classified as nonproliferative (NP, N=6053), proliferative without atypia (PDWA, N=2308), and ADH/ALH [atypical hyperplasia (AH), N=267]. The relative risk of cancer development within our cohort was compared to that expected in the general population using standardized incidence ratios. The relative risk of breast cancer development associated with SP [2.04, 95{\%} confidence interval (CI) 1.43-2.81] was greater than NP (1.28, 95{\%} CI 1.16-1.42) but similar to PDWA (1.90, 95{\%} CI 1.66-2.16). The risk associated with SP+A (5.11, 95{\%} CI 2.64-8.92) was highly elevated but not substantively different than atypical hyperplasia (4.17, 95{\%} CI 3.10-5.50). Patients with MP are at increased risk compared with PDWA or SP (3.01, 95{\%} CI 1.10-6.55), particularly those with MP+A (7.01, 95{\%} CI 1.91-17.97). There was a marginal increase in breast cancer risk (16{\%}) among patients with proliferative disease if a papilloma was present, but this did not reach statistical significance (P=0.29). The observed frequency of ipsilateral (vs. contralateral) breast cancer development in papilloma subsets was not significantly different than other patient groups. We conclude that SP imparts a cancer risk similar to conventional proliferative fibrocystic change. The presence of papilloma in, or associated with, atypia does not modify the risk connotation of ADH/ALH overall. MP constitutes a proliferative breast disease subset having unique clinical and biologic behavior.",
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N2 - Breast papillomas may be single or multiple and associated with atypical ductal or lobular hyperplasias (ADH/ALH). The risk of breast carcinoma development in patients with papillomas, particularly those with multiple or atypical lesions, is incompletely defined. Fibrocystic lesions were histopathologically classified in a benign breast disease cohort of 9155 who underwent biopsy from 1967 to 1991, with papilloma assessment in 9108. Individuals with papillomas (N=480) were classified into 4 groups: single papilloma (SP, N=372), single papilloma with ADH or ALH (SP+A, N=54), multiple (>5) papillomas (MP, N=41), and multiple papillomas with ADH or ALH (MP+A, N=13). Those without papillomas were classified as nonproliferative (NP, N=6053), proliferative without atypia (PDWA, N=2308), and ADH/ALH [atypical hyperplasia (AH), N=267]. The relative risk of cancer development within our cohort was compared to that expected in the general population using standardized incidence ratios. The relative risk of breast cancer development associated with SP [2.04, 95% confidence interval (CI) 1.43-2.81] was greater than NP (1.28, 95% CI 1.16-1.42) but similar to PDWA (1.90, 95% CI 1.66-2.16). The risk associated with SP+A (5.11, 95% CI 2.64-8.92) was highly elevated but not substantively different than atypical hyperplasia (4.17, 95% CI 3.10-5.50). Patients with MP are at increased risk compared with PDWA or SP (3.01, 95% CI 1.10-6.55), particularly those with MP+A (7.01, 95% CI 1.91-17.97). There was a marginal increase in breast cancer risk (16%) among patients with proliferative disease if a papilloma was present, but this did not reach statistical significance (P=0.29). The observed frequency of ipsilateral (vs. contralateral) breast cancer development in papilloma subsets was not significantly different than other patient groups. We conclude that SP imparts a cancer risk similar to conventional proliferative fibrocystic change. The presence of papilloma in, or associated with, atypia does not modify the risk connotation of ADH/ALH overall. MP constitutes a proliferative breast disease subset having unique clinical and biologic behavior.

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