Breast Cancer Risk and Progressive Histology in Serial Benign Biopsies

Daniel W Visscher, Ryan D. Frank, Jodi Carter, Robert A. Vierkant, Stacey J Winham, Ethan P. Heinzen, Brendan T. Broderick, Lori A. Denison, Teresa M. Allers, Joanne L. Johnson, Marlene H. Frost, Lynn C. Hartmann, Amy C Degnim, Derek C Radisky

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: More than 1 million women per year in the United States with benign breast biopsies are known to be at elevated risk for breast cancer (BC), with risk stratified on histologic categories of epithelial proliferation. Here we assessed women who had serial benign biopsies over time and how changes in the histologic classification affected BC risk. Methods: In the Mayo Clinic Benign Breast Disease Cohort of 13 466 women, 1414 women had multiple metachronous benign biopsies (10.5%). Both initial and subsequent biopsies were assessed histologically. BC risk for clinical and prognostic factors was assessed using subdistribution models to account for competing risks, and logistic regression/Wilcoxon/chi-square tests to assess covariates. All statistical tests were two-sided. Results: Breast cancer risk for women with serial biopsies, stratified by histologic category in the later biopsies, was similar to women with a single biopsy. We found that changes in histological category between initial and subsequent biopsy statistically significantly impacted BC risk. Women with nonproliferative initial findings and subsequent proliferative findings had an increased risk (hazard ratio [HR] = 1.77, 95% confidence interval [CI] = 1.06 to 2.94, P = .03) compared with no change. Among women with proliferative disease without atypia at initial biopsy, risk decreased if later biopsy regressed to nonproliferative (HR=0.49, 95% CI=0.25 to 0.98) and increased if later biopsy showed progression to atypical hyperplasia (HR=1.49, 95% CI=0.73 to 3.05) compared with no change (P = .04). Conclusions: We found that breast cancer risk increases in women with progressive epithelial proliferation over time and decreases in women whose biopsies show less proliferation. This finding has important implications for effective clinical management of the 100 000 women per year who have multiple benign breast biopsies.

Original languageEnglish (US)
Article numberdjx035
JournalJournal of the National Cancer Institute
Volume109
Issue number10
DOIs
StatePublished - 2017

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Histology
Breast Neoplasms
Biopsy
Confidence Intervals
Breast
Breast Diseases
Chi-Square Distribution
Hyperplasia
Logistic Models
Odds Ratio

ASJC Scopus subject areas

  • Medicine(all)
  • Oncology
  • Cancer Research

Cite this

Breast Cancer Risk and Progressive Histology in Serial Benign Biopsies. / Visscher, Daniel W; Frank, Ryan D.; Carter, Jodi; Vierkant, Robert A.; Winham, Stacey J; Heinzen, Ethan P.; Broderick, Brendan T.; Denison, Lori A.; Allers, Teresa M.; Johnson, Joanne L.; Frost, Marlene H.; Hartmann, Lynn C.; Degnim, Amy C; Radisky, Derek C.

In: Journal of the National Cancer Institute, Vol. 109, No. 10, djx035, 2017.

Research output: Contribution to journalArticle

Visscher, DW, Frank, RD, Carter, J, Vierkant, RA, Winham, SJ, Heinzen, EP, Broderick, BT, Denison, LA, Allers, TM, Johnson, JL, Frost, MH, Hartmann, LC, Degnim, AC & Radisky, DC 2017, 'Breast Cancer Risk and Progressive Histology in Serial Benign Biopsies', Journal of the National Cancer Institute, vol. 109, no. 10, djx035. https://doi.org/10.1093/jnci/djx035
Visscher, Daniel W ; Frank, Ryan D. ; Carter, Jodi ; Vierkant, Robert A. ; Winham, Stacey J ; Heinzen, Ethan P. ; Broderick, Brendan T. ; Denison, Lori A. ; Allers, Teresa M. ; Johnson, Joanne L. ; Frost, Marlene H. ; Hartmann, Lynn C. ; Degnim, Amy C ; Radisky, Derek C. / Breast Cancer Risk and Progressive Histology in Serial Benign Biopsies. In: Journal of the National Cancer Institute. 2017 ; Vol. 109, No. 10.
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abstract = "Background: More than 1 million women per year in the United States with benign breast biopsies are known to be at elevated risk for breast cancer (BC), with risk stratified on histologic categories of epithelial proliferation. Here we assessed women who had serial benign biopsies over time and how changes in the histologic classification affected BC risk. Methods: In the Mayo Clinic Benign Breast Disease Cohort of 13 466 women, 1414 women had multiple metachronous benign biopsies (10.5{\%}). Both initial and subsequent biopsies were assessed histologically. BC risk for clinical and prognostic factors was assessed using subdistribution models to account for competing risks, and logistic regression/Wilcoxon/chi-square tests to assess covariates. All statistical tests were two-sided. Results: Breast cancer risk for women with serial biopsies, stratified by histologic category in the later biopsies, was similar to women with a single biopsy. We found that changes in histological category between initial and subsequent biopsy statistically significantly impacted BC risk. Women with nonproliferative initial findings and subsequent proliferative findings had an increased risk (hazard ratio [HR] = 1.77, 95{\%} confidence interval [CI] = 1.06 to 2.94, P = .03) compared with no change. Among women with proliferative disease without atypia at initial biopsy, risk decreased if later biopsy regressed to nonproliferative (HR=0.49, 95{\%} CI=0.25 to 0.98) and increased if later biopsy showed progression to atypical hyperplasia (HR=1.49, 95{\%} CI=0.73 to 3.05) compared with no change (P = .04). Conclusions: We found that breast cancer risk increases in women with progressive epithelial proliferation over time and decreases in women whose biopsies show less proliferation. This finding has important implications for effective clinical management of the 100 000 women per year who have multiple benign breast biopsies.",
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AU - Frank, Ryan D.

AU - Carter, Jodi

AU - Vierkant, Robert A.

AU - Winham, Stacey J

AU - Heinzen, Ethan P.

AU - Broderick, Brendan T.

AU - Denison, Lori A.

AU - Allers, Teresa M.

AU - Johnson, Joanne L.

AU - Frost, Marlene H.

AU - Hartmann, Lynn C.

AU - Degnim, Amy C

AU - Radisky, Derek C

PY - 2017

Y1 - 2017

N2 - Background: More than 1 million women per year in the United States with benign breast biopsies are known to be at elevated risk for breast cancer (BC), with risk stratified on histologic categories of epithelial proliferation. Here we assessed women who had serial benign biopsies over time and how changes in the histologic classification affected BC risk. Methods: In the Mayo Clinic Benign Breast Disease Cohort of 13 466 women, 1414 women had multiple metachronous benign biopsies (10.5%). Both initial and subsequent biopsies were assessed histologically. BC risk for clinical and prognostic factors was assessed using subdistribution models to account for competing risks, and logistic regression/Wilcoxon/chi-square tests to assess covariates. All statistical tests were two-sided. Results: Breast cancer risk for women with serial biopsies, stratified by histologic category in the later biopsies, was similar to women with a single biopsy. We found that changes in histological category between initial and subsequent biopsy statistically significantly impacted BC risk. Women with nonproliferative initial findings and subsequent proliferative findings had an increased risk (hazard ratio [HR] = 1.77, 95% confidence interval [CI] = 1.06 to 2.94, P = .03) compared with no change. Among women with proliferative disease without atypia at initial biopsy, risk decreased if later biopsy regressed to nonproliferative (HR=0.49, 95% CI=0.25 to 0.98) and increased if later biopsy showed progression to atypical hyperplasia (HR=1.49, 95% CI=0.73 to 3.05) compared with no change (P = .04). Conclusions: We found that breast cancer risk increases in women with progressive epithelial proliferation over time and decreases in women whose biopsies show less proliferation. This finding has important implications for effective clinical management of the 100 000 women per year who have multiple benign breast biopsies.

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