title: Stratification of breast cancer risk in women with atypia: a Mayo cohort study.
abstract: OBJECTIVE
  Atypical hyperplasia is a well-recognized risk factor for breast cancer, conveying an approximately four-fold increased risk. Data regarding long-term absolute risk and factors for risk stratification are needed.
  
  
  METHODS
  Women with atypical hyperplasia in the Mayo Benign Breast Disease Cohort were identified through pathology review. Subsequent breast cancers were identified via medical records and a questionnaire. Relative risks (RRs) were estimated using standardized incidence ratios, comparing the observed number of breast cancers with those expected based on Iowa Surveillance, Epidemiology, and End Results (SEER) data. Age, histologic factors, and family history were evaluated as risk modifiers. Plots of cumulative breast cancer incidence provided estimates of risk over time.
  
  
  RESULTS
  With mean follow-up of 13.7 years, 66 breast cancers (19.9%) occurred among 331 women with atypia. RR of breast cancer with atypia was 3.88 (95% CI, 3.00 to 4.94). Marked elevations in risk were seen with multifocal atypia (eg, three or more foci with calcifications [RR, 10.35; 95% CI, 6.13 to 16.4]). RR was higher for younger women (< 45; RR, 6.76; 95% CI, 3.24 to 12.4). Risk was similar for atypical ductal and atypical lobular hyperplasia, and family history added no significant risk. Breast cancer risk remained elevated over 20 years, and the cumulative incidence approached 35% at 30 years.
  
  
  CONCLUSIONS
  Among women with atypical hyperplasia, multiple foci of atypia and the presence of histologic calcifications may indicate "very high risk" status (> 50% risk at 20 years). A positive family history does not further increase risk in women with atypia.
authors.affiliation: Division of General Surgery, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
authors.forename: Amy C
authors.initials: AC
authors.lastname: Degnim
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Visscher
authors.forename: Hal K
authors.initials: HK
authors.lastname: Berman
authors.forename: Marlene H
authors.initials: MH
authors.lastname: Frost
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Sellers
authors.forename: Robert A
authors.initials: RA
authors.lastname: Vierkant
authors.forename: Shaun D
authors.initials: SD
authors.lastname: Maloney
authors.forename: V Shane
authors.initials: VS
authors.lastname: Pankratz
authors.forename: Piet C
authors.initials: PC
authors.lastname: de Groen
authors.forename: Wilma L
authors.initials: WL
authors.lastname: Lingle
authors.forename: Karthik
authors.initials: K
authors.lastname: Ghosh
authors.forename: Lois
authors.initials: L
authors.lastname: Penheiter
authors.forename: Thea
authors.initials: T
authors.lastname: Tlsty
authors.forename: L Joseph
authors.initials: LJ
authors.lastname: Melton
authors.forename: Carol A
authors.initials: CA
authors.lastname: Reynolds
authors.forename: Lynn C
authors.initials: LC
authors.lastname: Hartmann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001941:Breast Diseases / Q000150:complications* / Q000175:diagnosis* / Q000453:epidemiology; D001943:Breast Neoplasms / Q000150:complications* / Q000175:diagnosis* / Q000453:epidemiology; D015331:Cohort Studies; D005192:Family Health; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006965:Hyperplasia / Q000150:complications* / Q000453:epidemiology; D008875:Middle Aged; D012306:Risk; D013997:Time Factors