title: Clinicopathologic features of breast cancers that develop in women with previous benign breast disease.
abstract: BACKGROUND
  Women with benign breast disease (BBD) have an increased risk of developing breast cancer (BC). Nearly 30% of all BCs develop in women with prior BBD. Information regarding features of the expected number of BCs after BBD would enhance individualized surveillance and prevention strategies for these women. In the current study, the authors sought to characterize BCs developing in a large cohort of women with BBD.
  
  
  METHODS
  The current study cohort included 13,485 women who underwent breast biopsy for mammographic or palpable concerns between 1967 and 2001. Biopsy slides were reviewed and classified as nonproliferative disease, proliferative disease without atypia, or atypical hyperplasia. BCs were identified by follow-up questionnaires, medical records, and Tumor Registry data. BC tissues were obtained and reviewed.
  
  
  RESULTS
  With median follow-up of 15.8 years, 1273 women developed BC. The majority of BCs were invasive (81%), of which 61% were ductal, 13% were mixed ductal/lobular, and 14% were lobular. Approximately two-thirds of the BC cases were intermediate or high grade, and 29% were lymph node positive. Cancer characteristics were similar across the 3 histologic categories of BBD, with a similar frequency of ductal carcinoma in situ, invasive disease, tumor size, time to invasive BC, histologic type of BC, lymph node positivity, and human epidermal growth factor receptor 2 positivity. Women with atypical hyperplasia were found to have a higher frequency of estrogen receptor-positive BC (91%) compared with women with proliferative disease without atypia (80%) or nonproliferative disease (85%) (P = .02).
  
  
  CONCLUSIONS
  A substantial percentage of all BCs develop in women with prior BBD. The majority of BCs after BBD are invasive tumors of ductal type, with a substantial number demonstrating lymph node positivity. Of all the BCs in the current study, 84% were estrogen receptor positive. Prevention therapy should be strongly encouraged in higher-risk women with BBD.
authors.affiliation: Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Visscher
authors.affiliation: Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Marlene H
authors.initials: MH
authors.lastname: Frost
authors.affiliation: Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Lynn C
authors.initials: LC
authors.lastname: Hartmann
authors.affiliation: Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
authors.forename: Ryan D
authors.initials: RD
authors.lastname: Frank
authors.affiliation: Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Vierkant
authors.affiliation: Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Ann E
authors.initials: AE
authors.lastname: McCullough
authors.affiliation: Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
authors.forename: Stacey J
authors.initials: SJ
authors.lastname: Winham
authors.affiliation: Health Science Research, Mayo Clinic, Rochester, Minnesota.
authors.forename: Celine M
authors.initials: CM
authors.lastname: Vachon
authors.affiliation: Department of General Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Karthik
authors.initials: K
authors.lastname: Ghosh
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Kathleen R
authors.initials: KR
authors.lastname: Brandt
authors.affiliation: Library, Mayo Clinic, Rochester, Minnesota.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Farrell
authors.affiliation: Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Yaman
authors.initials: Y
authors.lastname: Tarabishy
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Tina J
authors.initials: TJ
authors.lastname: Hieken
authors.affiliation: Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Tufia C
authors.initials: TC
authors.lastname: Haddad
authors.affiliation: Research Services, Mayo Clinic, Rochester, Minnesota.
authors.forename: Ruth A
authors.initials: RA
authors.lastname: Kraft
authors.affiliation: Division of Cancer Biology, Mayo Clinic Florida, Jacksonville, Florida.
authors.forename: Derek C
authors.initials: DC
authors.lastname: Radisky
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Amy C
authors.initials: AC
authors.lastname: Degnim
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis*; D001706:Biopsy / Q000379:methods*; D062005:Biopsy, Large-Core Needle; D001940:Breast / Q000473:pathology*; D001941:Breast Diseases / Q000473:pathology; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology; D018275:Carcinoma, Lobular / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000175:diagnosis; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000175:diagnosis; D008327:Mammography; D008875:Middle Aged; D060787:Neoplasm Grading; D011230:Precancerous Conditions / Q000473:pathology*; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000032:analysis; D011960:Receptors, Estrogen / Q000032:analysis; D011980:Receptors, Progesterone / Q000032:analysis; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D014408:Biomarkers, Tumor; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; C508053:ERBB2 protein, human
keywords: atypical hyperplasia; benign breast disease; breast cancer features; breast cancer risk; risk; tumor characteristics