you can't always write off a benign pathology breast lump diagnosis...
Certain Types of Non-cancerous Breast Lumps Are Associated with a Higher Risk of Breast Cancer
L. Hartmann et al., New England Journal of Medicine, July 21, 2005 Other Articles in this Edition August 2005 Research News Inflammatory Breast Cancer, Though Rare, Is Being Diagnosed More Often Certain Types of Non-cancerous Breast Lumps Are Associated with a Higher Risk of Breast Cancer Is this for me? If you've had a benign (not cancerous) breast lump, this article can help you find out whether that affects your risk of developing breast cancer. Background and importance of the study: Eight out of 10 lumps that women (or their health care providers) feel in their breasts turn out to be benign (not cancerous). A benign lump is a group of breast cells that might appear normal or somewhat abnormal, and the cells might be growing at a normal rate or faster than normal (hyperactive). After getting a breast biopsy and waiting for the results, finding out that a lump is benign comes as a HUGE relief. But some benign breast lumps can increase your risk for developing breast cancer later. Studies have shown that women who have benign breast lumps are 50–60% more likely than other women to develop breast cancer. Not all benign breast lumps are the same, though. It's unclear whether all types of benign lumps influence breast cancer risk in the same way. In the study reviewed here, researchers looked at a large number of women who were diagnosed with benign breast lumps. The researchers wanted to see how many of the women later developed breast cancer and whether a certain type of benign breast lump was associated with a higher risk of developing breast cancer. Study design: Researchers from four institutions looked at information on 9,087 women who had surgery to remove a benign breast lump at the Mayo Clinic between 1967 and 1991. The women were between 18 and 85 years old. The study was funded by the U.S. Department of Defense, the National Institutes of Health, the Susan G. Komen Breast Cancer Foundation, the Breast Cancer Research Foundation, and the Andersen Foundation. The researchers sent each woman a questionnaire asking about:
Next, a breast pathologist used a microscope to look at tissue samples from the benign lumps that had been removed from each woman in the study. The pathologist classified each lump into one of three categories:
To judge whether having a benign breast lump increases the risk of getting breast cancer, the researchers needed to know how many women would be estimated to get breast cancer in an AVERAGE population. The researchers used the Surveillance, Epidemiology, and End Results (SEER) registry, a huge collection of information on how many people get cancer each year (incidence) and how long they live (survival). The National Cancer Institute manages this registry. Results: During the follow-up period, 707 of the 9,087 women who were followed in this study were diagnosed with breast cancer. By comparison, based on the SEER registry, the researchers estimated that 453 out of 9,087 women in the general population (without a known history of a benign breast lump) would be diagnosed with breast cancer during that same period. This means that a diagnosis of benign breast disease increased the risk of later getting breast cancer by about 56%. The increase in risk could be seen for up to 25 years after the initial surgery to remove the benign breast lump. The benign breast lumps of the 9,087 women in the study were classified as follows:
The researchers also looked at the average age of women who had a benign breast lump. For all of the women in the study, the average age at surgery was about 51. But women with non-proliferative lumps were slightly younger (about 50) than the whole group. And women with atypical hyperplasia were slightly older (about 58). The researchers then looked for any relationships between the different breast cancer risk factors. They found that for women diagnosed with atypical hyperplasia, the age at diagnosis made a difference. When compared to the average woman in the SEER registry:
Conclusions: The researchers concluded that certain types of benign breast disease can increase the risk of breast cancer. The researchers also concluded that family history and age at diagnosis may further influence this risk.
Women with non-proliferative lumps who had a weak or no family history of breast cancer had NO increase in breast cancer risk. In this study, the benign tumors were classified as follows:
Take-home message: Out of 10 women who find lumps in their breasts, eight of them will receive a diagnosis of a benign lump. If you're one of these eight women, you're totally relieved and thankful. Your conversation with your doctor is probably short and upbeat. But this research suggests that the answer of "no cancer" shouldn't end your discussion with your doctor. This study might be able to help you and your doctor learn as much as you can about how to take care of you in the future. Because the study is big, with careful pathology review and 15 years of follow-up, the results are reliable and give us a better idea of how the changes that produce breast lumps may influence your risk of developing breast cancer. If your pathology report says you have a benign lump, that's terrific! But you need to know more. What TYPE of benign lump do you have? Are the cells proliferative—growing rapidly? Are the cells atypical—do they look abnormal in some way? Not all breast pathologists use the same terms in the same ways to describe the different types of breast cells. There are a lot of steps between normal cells and cancer cells, and some of these changes may be small and subtle. So two pathologists may classify a group of cells in two different ways. And a pathologist may use another term instead of proliferation, such as hyperplasia or increased mitosis. Ask your doctor for a copy of your pathology report. If there are any terms you do not understand, ask your doctor for an explanation. Once you and your doctor both are comfortable with the way your benign lump has been classified, review any history of breast cancer in your family and your age when the lump was found. By looking at all these factors, you'll have a better idea of your risk for developing breast cancer. Most women who get benign results from their biopsies don't have to be concerned. In this study, almost 67% of the women had non-proliferative lumps with no atypia—the cells looked normal and weren't growing rapidly. And for women with non-proliferative lumps AND no or a weak family history of breast cancer, there was NO INCREASE in risk. About 30% had proliferative changes with no atypia—the cells were growing, but appeared normal. Only 4% had atypical hyperplasia, which is associated with the highest risk of developing breast cancer. If your pathology report says that you have atypical hyperplasia and you are younger than 45, or you have a strong family history of breast cancer, you have an increased risk of developing breast cancer in the future. Lifestyle changes, medicines, and surgery are all options that can reduce your risk. Talk to your doctor about these choices and see if any of them make sense for you. And keep visiting breastcancer.org for the latest information on how to reduce your risk for breast cancer. http://www.breastcancer.org/images/become_member.gif http://www.breastcancer.org/images/spacer.gif Your generous support makes it possible for us to continue bringing you the latest breast cancer research findings. Please consider making a secure online donation today. Next Page: Risk Not the Same in Both Breasts with Atypical Lobular Hyperplasia back to top http://www.breastcancer.org/images/send_page.gif Send this page to a friend This page was last modified on July 27, 2006 Site Map | Contact Us | Make a Donation breastcancer.org 111 Forrest Avenue 1R |
Don't write off benign lumps continued...
I know most of you are aware of the above article implications, but thought I would post it for those who aren't.
PS Just thought it was interesting too that if you are 45 or younger with an Atypical ductal hyperplasia benign diagnosis, you are really at a 20 out of 100 risk of developing cancer-WOW. |
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