An analysis of breast cancer risk in women with single, multiple, and atypical papilloma
An analysis of breast cancer risk in women with single, multiple, and atypical papilloma
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DOI：
10.1097/00000478-200606000-00001
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发表时间：
2006-06-01
影响因子：
5.6
通讯作者：
Visscher, DW
中科院分区：
文献类型：
--
作者：
Lewis, JT;Hartmann, LC;Visscher, DW
乳腺乳头状瘤可以是单发或多发，并伴有非典型导管或小叶增生（ADH/ALH）。乳头状瘤患者发生乳腺癌的风险，特别是多发性或非典型病变的患者，尚未完全确定。在1967年至1991年接受活检的9155例良性乳腺疾病队列中，对纤维囊性病变进行了组织病理学分类，其中9108例进行了乳头状瘤评估。将480例乳头状瘤患者分为4组：单发乳头状瘤组（SP，N 372），单发乳头状瘤伴ADH或ALH组（SP + A，N 54），多发乳头状瘤组（MP，N 41），多发乳头状瘤伴ADH或ALH组（MP + A，N 13）。无乳头状瘤的患者分为非增殖性（NP，N = 6053）、增殖性无乳头状瘤（PDWA，N = 2308）和ADH/ALH [非典型增生（AH），N = 267]。使用标准化发病率比，将我们队列中癌症发展的相对风险与一般人群中的预期风险进行比较。与SP相关的乳腺癌发生的相对风险[2.04，95%置信区间（CI）1.43-2.81]大于NP（1.28，95% CI 1.16-1.42），但与PDWA（1.90，95% CI 1.66-2.16）相似。与SP+A（5.11，95% CI 2.64-8.92）相关的风险高度升高，但与不典型增生（4.17，95% CI 3.10-5.50）无实质性差异。与PDWA或SP相比，MP患者的风险增加（3.01，95% CI 1.10-6.55），尤其是MP+A患者（7.01，95% CI 1.91-17.97）。如果存在乳头状瘤，增生性疾病患者的乳腺癌风险略有增加（16%），但没有达到统计学意义（P = 0.29）。在乳头状瘤亚群中观察到的同侧（与对侧）乳腺癌发展的频率与其他患者组没有显著差异。我们的结论是，SP赋予癌症的风险类似于传统的增生性纤维囊性变化。乳头状瘤的存在，或与，垂体瘤不修改ADH/ALH的风险内涵的整体。MP是一种具有独特临床和生物学行为的增生性乳腺疾病。
Breast papillomas may be single or multiple and associated with atypical ductal or lobular hyperplasias (ADH/ALH). The risk of breast carcinoma development in patients with papillomas, particularly those with multiple or atypical lesions, is incompletely defined. Fibrocystic lesions were histopathologically classified in a benign breast disease cohort of 9155 who underwent biopsy from 1967 to 1991, with papilloma assessment in 9108. Individuals with papillomas (N = 480) were classified into 4 groups: single papilloma (SP, N 372), single papilloma with ADH or ALH (SP + A, N 54), multiple (> 5) papillomas (MP, N = 41), and multiple papillomas with ADH or ALH (MP + A, N = 13). Those without papillomas were classified as nonproliferative (NP, N = 6053), proliferative without atypia (PDWA, N = 2308), and ADH/ALH [atypical hyperplasia (AH), N = 267]. The relative risk of cancer development within our cohort was compared to that expected in the general population using standardized incidence ratios. The relative risk of breast cancer development associated with SP [2.04, 95% confidence interval (CI) 1.43-2.81] was greater than NP (1.28, 95% CI 1.16-1.42) but similar to PDWA (1.90, 95% CI 1.66-2.16). The risk associated with SP+A (5.11, 95% CI 2.64-8.92) was highly elevated but not substantively different than atypical hyperplasia (4.17, 95% CI 3.10-5.50). Patients with MP are at increased risk compared with PDWA or SP (3.01, 95% CI 1.10-6.55), particularly those with MP+A (7.01, 95% CI 1.91-17.97). There was a marginal increase in breast cancer risk (16%) among patients with proliferative disease if a papilloma was present, but this did not reach statistical significance (P = 0.29). The observed frequency of ipsilateral (vs. contralateral) breast cancer development in papilloma subsets was not significantly different than other patient groups. We conclude that SP imparts a cancer risk similar to conventional proliferative fibrocystic change. The presence of papilloma in, or associated with, atypia does not modify the risk connotation of ADH/ALH overall. MP constitutes a proliferative breast disease subset having unique clinical and biologic behavior.