title: Extent of atypical hyperplasia stratifies breast cancer risk in 2 independent cohorts of women.
abstract: Women with atypical hyperplasia (AH) on breast biopsy have a substantially increased risk of breast cancer (BC). Here the BC risk for the extent and subtype of AH is reported for 2 separate cohorts.
  
  
  
  All samples containing AH were included from 2 cohorts of women with benign breast disease (Mayo Clinic and Nashville). Histology review quantified the number of foci of atypical ductal hyperplasia (ADH) and atypical lobular hyperplasia (ALH). The BC risk was stratified for the number of AH foci within AH subtypes.
  
  
  
  The study included 708 Mayo AH subjects and 466 Nashville AH subjects. In the Mayo cohort, an increasing number of foci of AH was associated with a significant increase in the risk of BC both for ADH (relative risks of 2.61, 5.21, and 6.36 for 1, 2, and ≥3 foci, respectively; P for linear trend = .006) and for ALH (relative risks of 2.56, 3.50, and 6.79 for 1, 2, and ≥3 foci, respectively; P for linear trend = .001). In the Nashville cohort, the relative risks of BC for ADH were 2.70, 5.17, and 15.06 for 1, 2, and ≥3 foci, respectively (P for linear trend < .001); for ALH, the relative risks also increased but not significantly (2.61, 3.48, and 4.02, respectively; P = .148). When the Mayo and Nashville samples were combined, the risk increased significantly for 1, 2, and ≥3 foci: the relative risks were 2.65, 5.19, and 8.94, respectively, for ADH (P < .001) and 2.58, 3.49, and 4.97, respectively, for ALH (P = .001).
  
  
  
  In 2 independent cohort studies of benign breast disease, the extent of atypia stratified the long-term BC risk for ADH and ALH. Cancer 2016;122:2971-2978. © 2016 American Cancer Society.
authors.affiliation: Division of Subspecialty General Surgery, Mayo Clinic, Rochester, Minnesota. degnim.amy@mayo.edu.
authors.forename: Amy C
authors.initials: AC
authors.lastname: Degnim
authors.affiliation: Department of Biostatistics, Vanderbilt University, Nashville, Tennessee.
authors.forename: William D
authors.initials: WD
authors.lastname: Dupont
authors.affiliation: Cancer Biology, Mayo Clinic, Jacksonville, Florida.
authors.forename: Derek C
authors.initials: DC
authors.lastname: Radisky
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Vierkant
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida.
authors.forename: Ryan D
authors.initials: RD
authors.lastname: Frank
authors.affiliation: Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Marlene H
authors.initials: MH
authors.lastname: Frost
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
authors.forename: Stacey J
authors.initials: SJ
authors.lastname: Winham
authors.affiliation: Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, Tennessee.
authors.forename: Melinda E
authors.initials: ME
authors.lastname: Sanders
authors.affiliation: Division of Genetic Medicine, Vanderbilt University, Nashville, Tennessee.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Smith
authors.affiliation: Breast Pathology Consultants, Nashville, Tennessee.
authors.forename: David L
authors.initials: DL
authors.lastname: Page
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
authors.forename: Tanya L
authors.initials: TL
authors.lastname: Hoskin
authors.affiliation: Division of Epidemiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Celine M
authors.initials: CM
authors.lastname: Vachon
authors.affiliation: Breast Diagnostic Clinic, Mayo Clinic, Rochester, Minnesota.
authors.forename: Karthik
authors.initials: K
authors.lastname: Ghosh
authors.affiliation: Division of Subspecialty General Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Tina J
authors.initials: TJ
authors.lastname: Hieken
authors.affiliation: Information Technology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Lori A
authors.initials: LA
authors.lastname: Denison
authors.affiliation: Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Jodi M
authors.initials: JM
authors.lastname: Carter
authors.affiliation: Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Lynn C
authors.initials: LC
authors.lastname: Hartmann
authors.affiliation: Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Visscher
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000473:pathology*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006965:Hyperplasia / Q000473:pathology*; D008875:Middle Aged; D009367:Neoplasm Staging; D011230:Precancerous Conditions / Q000473:pathology*; D011379:Prognosis; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: atypical ductal hyperplasia; atypical hyperplasia; atypical lobular hyperplasia; breast cancer; risk