Association between cyclooxygenase-2 expression in atypical hyperplasia and risk of breast cancer

Daniel W Visscher, V. Shane Pankratz, Marta Santisteban, Carol Reynolds, Ari Ristimäki, Robert A. Vierkant, Wilma L. Lingle, Marlene H. Frost, Lynn C. Hartmann

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Abstract

Background: The cyclooxygenase-2 (COX-2) enzyme, which is induced by inflammatory and mitogenic stimuli, plays a protumorigenic role in several human cancers. COX-2 is overexpressed in invasive and in situ breast cancers. Atypical hyperplasia in breast tissue, although benign, is associated with a high risk of breast cancer. We investigated whether COX-2 overexpression in atypical hyperplasia is associated with the risk of subsequent breast cancer. Methods: COX-2 expression was assessed immunohistochemically in archival sections from 235 women with atypia whose biopsy specimens were obtained at the Mayo Clinic from January 1, 1967, through December 31, 1991. COX-2 expression was scored as 0 (negative), 1+ (weak), 2+ (moderate), or 3+ (strong). Risk factor information and follow-up for breast cancer events were obtained via a study questionnaire and the medical records. All statistical tests were two-sided. Results: Forty-one (17%) of the 235 women developed breast cancer during a median follow-up of 15 years. Moderate (category 2+) or strong (category 3+) COX-2 expression was identified in 71 (30%) and 34 (14%) of the 235 samples, respectively. The risk for developing breast cancer, relative to a control population (the Iowa Surveillance, Epidemiology, and End Results registry), increased with increasing COX-2 expression (relative risk [RR] = 2.63, 95% confidence interval [CI] = 1.56 to 4.15, for those with negative or weak COX-2 expression; RR = 3.56, 95% CI = 1.94 to 5.97, for those with moderate expression; and RR = 5.66, 95% CI = 2.59 to 10.75, for those with strong expression; P =. 07). Overexpression of COX-2 was statistically significantly associated with the type of atypia (lobular vs ductal, P <. 001), number of foci of atypia in the biopsy (P =. 02), and older age at time of biopsy (>45 years, P =. 01). Conclusions: COX-2 appears to be a biomarker that further stratifies breast cancer risk among women with atypia and may be a relevant target for chemoprevention strategies.

Original languageEnglish (US)
Pages (from-to)421-427
Number of pages7
JournalJournal of the National Cancer Institute
Volume100
Issue number6
DOIs
StatePublished - Mar 2008

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Cyclooxygenase 2
Hyperplasia
Breast Neoplasms
Confidence Intervals
Population Surveillance
Chemoprevention
Medical Records
Registries
Epidemiology
Breast
Biomarkers
Biopsy
Enzymes

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Visscher, D. W., Pankratz, V. S., Santisteban, M., Reynolds, C., Ristimäki, A., Vierkant, R. A., ... Hartmann, L. C. (2008). Association between cyclooxygenase-2 expression in atypical hyperplasia and risk of breast cancer. Journal of the National Cancer Institute, 100(6), 421-427. https://doi.org/10.1093/jnci/djn036

Association between cyclooxygenase-2 expression in atypical hyperplasia and risk of breast cancer. / Visscher, Daniel W; Pankratz, V. Shane; Santisteban, Marta; Reynolds, Carol; Ristimäki, Ari; Vierkant, Robert A.; Lingle, Wilma L.; Frost, Marlene H.; Hartmann, Lynn C.

In: Journal of the National Cancer Institute, Vol. 100, No. 6, 03.2008, p. 421-427.

Research output: Contribution to journalArticle

Visscher, DW, Pankratz, VS, Santisteban, M, Reynolds, C, Ristimäki, A, Vierkant, RA, Lingle, WL, Frost, MH & Hartmann, LC 2008, 'Association between cyclooxygenase-2 expression in atypical hyperplasia and risk of breast cancer', Journal of the National Cancer Institute, vol. 100, no. 6, pp. 421-427. https://doi.org/10.1093/jnci/djn036
Visscher, Daniel W ; Pankratz, V. Shane ; Santisteban, Marta ; Reynolds, Carol ; Ristimäki, Ari ; Vierkant, Robert A. ; Lingle, Wilma L. ; Frost, Marlene H. ; Hartmann, Lynn C. / Association between cyclooxygenase-2 expression in atypical hyperplasia and risk of breast cancer. In: Journal of the National Cancer Institute. 2008 ; Vol. 100, No. 6. pp. 421-427.
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title = "Association between cyclooxygenase-2 expression in atypical hyperplasia and risk of breast cancer",
abstract = "Background: The cyclooxygenase-2 (COX-2) enzyme, which is induced by inflammatory and mitogenic stimuli, plays a protumorigenic role in several human cancers. COX-2 is overexpressed in invasive and in situ breast cancers. Atypical hyperplasia in breast tissue, although benign, is associated with a high risk of breast cancer. We investigated whether COX-2 overexpression in atypical hyperplasia is associated with the risk of subsequent breast cancer. Methods: COX-2 expression was assessed immunohistochemically in archival sections from 235 women with atypia whose biopsy specimens were obtained at the Mayo Clinic from January 1, 1967, through December 31, 1991. COX-2 expression was scored as 0 (negative), 1+ (weak), 2+ (moderate), or 3+ (strong). Risk factor information and follow-up for breast cancer events were obtained via a study questionnaire and the medical records. All statistical tests were two-sided. Results: Forty-one (17{\%}) of the 235 women developed breast cancer during a median follow-up of 15 years. Moderate (category 2+) or strong (category 3+) COX-2 expression was identified in 71 (30{\%}) and 34 (14{\%}) of the 235 samples, respectively. The risk for developing breast cancer, relative to a control population (the Iowa Surveillance, Epidemiology, and End Results registry), increased with increasing COX-2 expression (relative risk [RR] = 2.63, 95{\%} confidence interval [CI] = 1.56 to 4.15, for those with negative or weak COX-2 expression; RR = 3.56, 95{\%} CI = 1.94 to 5.97, for those with moderate expression; and RR = 5.66, 95{\%} CI = 2.59 to 10.75, for those with strong expression; P =. 07). Overexpression of COX-2 was statistically significantly associated with the type of atypia (lobular vs ductal, P <. 001), number of foci of atypia in the biopsy (P =. 02), and older age at time of biopsy (>45 years, P =. 01). Conclusions: COX-2 appears to be a biomarker that further stratifies breast cancer risk among women with atypia and may be a relevant target for chemoprevention strategies.",
author = "Visscher, {Daniel W} and Pankratz, {V. Shane} and Marta Santisteban and Carol Reynolds and Ari Ristim{\"a}ki and Vierkant, {Robert A.} and Lingle, {Wilma L.} and Frost, {Marlene H.} and Hartmann, {Lynn C.}",
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AU - Visscher, Daniel W

AU - Pankratz, V. Shane

AU - Santisteban, Marta

AU - Reynolds, Carol

AU - Ristimäki, Ari

AU - Vierkant, Robert A.

AU - Lingle, Wilma L.

AU - Frost, Marlene H.

AU - Hartmann, Lynn C.

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N2 - Background: The cyclooxygenase-2 (COX-2) enzyme, which is induced by inflammatory and mitogenic stimuli, plays a protumorigenic role in several human cancers. COX-2 is overexpressed in invasive and in situ breast cancers. Atypical hyperplasia in breast tissue, although benign, is associated with a high risk of breast cancer. We investigated whether COX-2 overexpression in atypical hyperplasia is associated with the risk of subsequent breast cancer. Methods: COX-2 expression was assessed immunohistochemically in archival sections from 235 women with atypia whose biopsy specimens were obtained at the Mayo Clinic from January 1, 1967, through December 31, 1991. COX-2 expression was scored as 0 (negative), 1+ (weak), 2+ (moderate), or 3+ (strong). Risk factor information and follow-up for breast cancer events were obtained via a study questionnaire and the medical records. All statistical tests were two-sided. Results: Forty-one (17%) of the 235 women developed breast cancer during a median follow-up of 15 years. Moderate (category 2+) or strong (category 3+) COX-2 expression was identified in 71 (30%) and 34 (14%) of the 235 samples, respectively. The risk for developing breast cancer, relative to a control population (the Iowa Surveillance, Epidemiology, and End Results registry), increased with increasing COX-2 expression (relative risk [RR] = 2.63, 95% confidence interval [CI] = 1.56 to 4.15, for those with negative or weak COX-2 expression; RR = 3.56, 95% CI = 1.94 to 5.97, for those with moderate expression; and RR = 5.66, 95% CI = 2.59 to 10.75, for those with strong expression; P =. 07). Overexpression of COX-2 was statistically significantly associated with the type of atypia (lobular vs ductal, P <. 001), number of foci of atypia in the biopsy (P =. 02), and older age at time of biopsy (>45 years, P =. 01). Conclusions: COX-2 appears to be a biomarker that further stratifies breast cancer risk among women with atypia and may be a relevant target for chemoprevention strategies.

AB - Background: The cyclooxygenase-2 (COX-2) enzyme, which is induced by inflammatory and mitogenic stimuli, plays a protumorigenic role in several human cancers. COX-2 is overexpressed in invasive and in situ breast cancers. Atypical hyperplasia in breast tissue, although benign, is associated with a high risk of breast cancer. We investigated whether COX-2 overexpression in atypical hyperplasia is associated with the risk of subsequent breast cancer. Methods: COX-2 expression was assessed immunohistochemically in archival sections from 235 women with atypia whose biopsy specimens were obtained at the Mayo Clinic from January 1, 1967, through December 31, 1991. COX-2 expression was scored as 0 (negative), 1+ (weak), 2+ (moderate), or 3+ (strong). Risk factor information and follow-up for breast cancer events were obtained via a study questionnaire and the medical records. All statistical tests were two-sided. Results: Forty-one (17%) of the 235 women developed breast cancer during a median follow-up of 15 years. Moderate (category 2+) or strong (category 3+) COX-2 expression was identified in 71 (30%) and 34 (14%) of the 235 samples, respectively. The risk for developing breast cancer, relative to a control population (the Iowa Surveillance, Epidemiology, and End Results registry), increased with increasing COX-2 expression (relative risk [RR] = 2.63, 95% confidence interval [CI] = 1.56 to 4.15, for those with negative or weak COX-2 expression; RR = 3.56, 95% CI = 1.94 to 5.97, for those with moderate expression; and RR = 5.66, 95% CI = 2.59 to 10.75, for those with strong expression; P =. 07). Overexpression of COX-2 was statistically significantly associated with the type of atypia (lobular vs ductal, P <. 001), number of foci of atypia in the biopsy (P =. 02), and older age at time of biopsy (>45 years, P =. 01). Conclusions: COX-2 appears to be a biomarker that further stratifies breast cancer risk among women with atypia and may be a relevant target for chemoprevention strategies.

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