title: Columnar cell lesions and subsequent breast cancer risk: a nested case-control study.
abstract: BACKGROUND
  Histologic and genetic evidence suggests that at least some columnar cell lesions (CCL) of the breast represent precursor lesions in the low-grade breast neoplasia pathway. However, the risk of subsequent breast cancer associated with the presence of CCL in a benign breast biopsy is poorly understood.
  
  
  METHODS
  The authors examined the association between the presence of CCL and subsequent breast cancer risk in a nested case-control study of benign breast disease (BBD) and breast cancer within the Nurses' Health Studies (394 cases, 1,606 controls). Benign breast biopsy slides were reviewed by pathologists and CCL presence assessed. Logistic regression was used to compute odds ratios (ORs) and 95% confidence intervals (CIs) for the association between CCL and breast cancer risk.
  
  
  RESULTS
  Women with CCL (140 cases, 448 controls) had an increased risk of breast cancer compared with those without CCL (OR = 1.44, 95% CI: 1.14 to 1.83), although this was attenuated and became non-significant after adjustment for the histologic category of BBD (OR = 1.20, 95% CI: 0.94 to 1.54). CCL presence was associated with the greatest risk of breast cancer for those with nonproliferative BBD (OR = 1.36, 95% CI: 0.79 to 2.37) and the lowest risk for those with atypical hyperplasia (AH) (OR = 1.10, 95% CI: 0.65 to 1.87); however, this apparent heterogeneity in risk across BBD categories was not significant (P for interaction between CCL presence and BBD category = 0.77).
  
  
  CONCLUSIONS
  These results provide evidence that CCL may be an important marker of breast cancer risk in women with BBD but suggest that CCL do not increase breast cancer risk independently of concurrent proliferative changes in the breast.
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA. sarah.aroner@channing.harvard.edu
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Aroner
authors.forename: Laura C
authors.initials: LC
authors.lastname: Collins
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Schnitt
authors.forename: James L
authors.initials: JL
authors.lastname: Connolly
authors.forename: Graham A
authors.initials: GA
authors.lastname: Colditz
authors.forename: Rulla M
authors.initials: RM
authors.lastname: Tamimi
mesh_terms: D000328:Adult; D001706:Biopsy; D001940:Breast / Q000473:pathology*; D001941:Breast Diseases / Q000473:pathology*; D001943:Breast Neoplasms / Q000473:pathology*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D016017:Odds Ratio; D011230:Precancerous Conditions / Q000473:pathology; D018570:Risk Assessment; D012307:Risk Factors