Women with at least three sites of cellular atypia in breast tissue, almost eight times more likely than average women to develop breast cancer, according to findings of the Mayo Clinic Cancer Center led study of women with atypical hyperplasia. The results are published in the July 1 issue of the Journal of Clinical Oncology.
Several previous studies have shown that atypical hyperplasia (also called atypia) in breast tissue, is a major risk factor for breast cancer. Women who have breast biopsy and diagnosis of atypia are considered high risk. Many council to consider preventive medications such as tamoxifen or other risk reduction approaches. However, questions remained from prior research whether a positive family history further increases risk in women with atypia and for how long the increased risk in women with atypia lasts.
"The most commonly used tool for predicting risk in women with atypia is the Gail model, which may incorrectly estimate that our study shows that the family does not change significantly the risk in women with atypia," says Amy Degnim, MD, a Mayo Clinic surgeon and study author . "Our findings show that women with atypia have a higher absolute risk of breast cancer than previously estimated. This risk is 25 percent more than 25 years and is much higher in women with multiple areas of atypia and calcification." The model predicts Gail risk with age at onset of menstruation, age at first birth, number of previous breast biopsies, presence of atypia and number of close relatives with breast cancer.
While the Mayo Clinic study found that the family is further increased risk, age at diagnosis of atypia that affect risk, with younger women (under 45 years), more than twice as likely to develop breast cancer compared with women diagnosed with atypia after 55 . Number of areas of atypical hyperplasia was significant as well. With one area of atypia, breast cancer risk is 2.3 times compared with the general population, this risk more than doubled when two websites and increased to nearly eightfold as sites increased to three or more. A group of women at highest risk had three or more areas of atypical and calcification - with a 10.4 times more risk than the general population.
"With the ability to stratify the risk of breast cancer in women with atypical, we can have more informed discussions with our patients with respect to their own risk," says Dr. Denim. "This will help us, that individual negotiations on how aggressively seek to reduce the risk of treatment."
These findings resulted from a review of the records of 331 women with atypical identified in the Mayo cohort of 9,376 women who have benign breast biopsies surgically obtained between 1967 and 1991. More than half (55.9 percent), women were more than 55 years when diagnosed with atypical, and 42.9 percent had breast cancer in the family. The majority (68.6 percent) of women showed calcification in tissue biopsies, and 40 percent have more seats atypical hyperplane.
The American Cancer Society reports that more than 240,000 women will be diagnosed in the United States this year with breast cancer, and more than 40,000 die from it. Dr. Degnim and her colleagues are working scientists better understand the steps that precede breast cancer and which of them can be recognized in benign breast tissue. The current study contributes to Mayo emerging model that seeks to define more accurately the risk of every woman and adapt screening and risk reduction measures to women depending on their individual risks.
"The most commonly used tool for predicting risk in women with atypia is the Gail model, which may incorrectly estimate that our study shows that the family does not change significantly the risk in women with atypia," says Amy Degnim, MD, a Mayo Clinic surgeon and study author . "Our findings show that women with atypia have a higher absolute risk of breast cancer than previously estimated. This risk is 25 percent more than 25 years and is much higher in women with multiple areas of atypia and calcification." The model predicts Gail risk with age at onset of menstruation, age at first birth, number of previous breast biopsies, presence of atypia and number of close relatives with breast cancer.
"With the ability to stratify the risk of breast cancer in women with atypical, we can have more informed discussions with our patients with respect to their own risk," says Dr. Denim. "This will help us, that individual negotiations on how aggressively seek to reduce the risk of treatment."
The American Cancer Society reports that more than 240,000 women will be diagnosed in the United States this year with breast cancer, and more than 40,000 die from it. Dr. Degnim and her colleagues are working scientists better understand the steps that precede breast cancer and which of them can be recognized in benign breast tissue. The current study contributes to Mayo emerging model that seeks to define more accurately the risk of every woman and adapt screening and risk reduction measures to women depending on their individual risks.
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