Hyperplastic and Premalignant Lesions Precursors and Markers of Increased Risk of Breast Cancer

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The various identified breast lesions of interest are listed in Table 1 and 2 along with their major known associations. The precise separation of these lesions in practical histopathology has evolved over time, and as a practical matter in clinical medicine, there remain some differences in application in the clinical arena. Basically, most ofthe studies presented in this review have been accepted by major pathology associations in North America and Britain.

The ductal carcinomas in-situ (DCIS) are well accepted as precursors lesions. They probably have a magnitude of risk in the range of 50% over a ten year period with some variation in both size at time of diagnosis and risk differing between the low and high grade varieties. Presentation of DCIS raises the very important consideration not frequently discussed, the nature of the subsequently developing invasive lesion. The majority ofthe invasive carcinomas developing at least in the short period of several years after initial identification ofan inadequately removed low grade DCIS are low grade invasive cancers, and many ofthese lesions may have prolonged periods without invasion (16, 17).

Whilst, the high grade DCIS are associated with subsequent high grade invasive tumors with metastatic and death dealing capacity (18), the subsequent invasive carcinomas after low grade DCIS are largely local. The invasive tumors developing after identification atypical ductal hyperplasia (ADH) after biopsy may occur anywhere in either breast (19, 20), and their type is probably randomly distributed amongst those ordinarily seen.

Table 1. Histologically Defined Lesions of Female Breast with Proven Predictiveness for Later Carcinoma.


Enlarged Lobular Units with Columnar Alteration

(Columnar Alteration with Secretion or Hyperplastic Unfolded Lobules)

Quite common, usually co-exist with hyperplastic lesions

Proliferative Disease Without Atypia most are usual pattern hyperplasia of EHLA (Epithelial Hyperplasia Lacking Atypia)

Defined by their association with a RR of 1.5-2.0 x

Changes present in about 25% of biopsies

Atypical Ductal Hyperplasia

Similar histology to low grade DCIS, but of limited extent

General distribution of cancer risk, in each breast,

Magnitude = 4.0-5.0 x

Atypical Lobular Hyperplasia

Major lesion of lobular neoplasia series

Regional distribution of risk.

Cancer in same breast as ALH 70% of the time, and possibly favoring same region in same breast. RR ~ 4.0 x, decreasing with menopause.

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