Subsequent Breast Cancer Risk Following Diagnosis of Atypical Ductal Hyperplasia on Needle Biopsy.
OBJECTIVE
Atypical ductal hyperplasia (ADH) is a known risk factor for breast cancer. Published risk estimates are based on cohorts that included women whose ADH was diagnosed before widespread use of screening mammograms and did not differentiate between the methods used to diagnose ADH, which may be related to the size of the ADH focus. These risks may overestimate the risk in women with presently diagnosed ADH.


OBJECTIVE
To examine the risk of invasive cancer associated with ADH diagnosed using core needle biopsy vs excisional biopsy.


METHODS
A cohort study was conducted comparing the 10-year cumulative risk of invasive breast cancer in 955 331 women undergoing mammography with and without a diagnosis of ADH. Data were obtained from 5 breast imaging registries that participate in the National Cancer Institute-funded Breast Cancer Surveillance Consortium.


METHODS
Diagnosis of ADH on core needle biopsy or excisional biopsy in women undergoing mammography.


METHODS
Ten-year cumulative risk of invasive breast cancer.


RESULTS
The sample included 955 331 women with 1727 diagnoses of ADH, 1058 (61.3%) of which were diagnosed by core biopsy and 635 (36.8%) by excisional biopsy. The mean (interquartile range) age of the women at diagnosis was 52.6 (46.9-60.4) years. From 1996 to 2012, the proportion of ADH diagnosed by core needle biopsy increased from 21% to 77%. Ten years following a diagnosis of ADH, the cumulative risk of invasive breast cancer was 2.6 (95% CI, 2.0-3.4) times higher than the risk in women with no ADH. Atypical ductal hyperplasia diagnosed via excisional biopsy was associated with an adjusted hazard ratio (HR) of 3.0 (95% CI, 2-4.5) and, via core needle biopsy, with an adjusted HR of 2.2 (95% CI, 1.5-3.4). Ten years after an ADH diagnosis, an estimated 5.7% (95% CI, 4.3%-10.1%) of the women had a diagnosis of invasive cancer. Women with ADH diagnosed on excisional biopsy had a slightly higher risk (6.7%; 95% CI, 3.0%-12.8%) compared with those with ADH diagnosed via core needle biopsy (5%; 95% CI, 2.2%-8.9%).


CONCLUSIONS
Current 10-year risks of invasive breast cancer after a diagnosis of ADH may be lower than those previously reported. The risk associated with ADH is slightly lower for women whose ADH was diagnosed by needle core biopsy compared with excisional biopsy.
Department of Surgery, Tel Aviv-Sourasky Medical Center, Tel Aviv, Israel2Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Tehillah S
TS
Menes
Department of Medicine, University of California, San Francisco4Department of Epidemiology and Biostatistics, University of California, San Francisco.
Karla
K
Kerlikowske
Fred Hutchinson Cancer Research Center, Seattle, Washington.
Jane
J
Lange
Department of Pathology, Mount Sinai Medical Center, New York, New York.
Shabnam
S
Jaffer
Radiology Associates of Albuquerque, Albuquerque, New Mexico8Department of Radiology, University of New Mexico, Albuquerque.
Robert
R
Rosenberg
Group Health Research Institute, Group Health Cooperative, Seattle, Washington10Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Sacramento.
Diana L
DL
Miglioretti
D000328:Adult; D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000175:diagnosis / Q000209:etiology / Q000473:pathology*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000150:complications / Q000175:diagnosis / Q000473:pathology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology*; D012307:Risk Factors