In 1998 the Cancer Committee of the College of American Pathologists updated the consensus statement originally published in 1986 on the relative risk for breast cancer associated with premalignant breast lesions. The relative risk associated with each finding is not an absolute risk, but rather affects the risk as compared to women of similar age without histologic abnormalities.
Terminology:
(1) fibrocystic "change" is preferred to fibrocystic "disease"
(2) mild hyperplasia: epithelial proliferation 3-4 cell layers thick, which does not bridge or distend the lumen
(2) moderate and florid epithelial hyperplasia without atypia: shows a swirling or streaming pattern of cells, with bridging of the lumen. The cells vary in slightly in size and shape. Some cells may have a syncytial appearance due to indistinct cell borders.
(3) atypical ductal hyperplasia (ADH): partial involvement of ductal spaces by the same uniform, evenly spaced cells as low-grade noncomedo DCIS, together with a second population of non-atypical, often polarized cells, usually seen along the basement membrane. In addition, lesions are classified as ADH if there are the cytologic and architectural features of low grade, noncomedo DCIS that involve only a single space or which measure less than 2 mm in diameter.
|
Relative Risk Associated with a Biopsy Change |
Term for Increased Risk |
|
1 time |
no increased risk |
|
1.5 to 2 times |
slightly increased risk |
|
4 to 5 times |
moderately increased risk |
|
8 to 10 times |
markedly increased risk |
The risk associated with a specific histologic change decreases over time. The risks decrease up to 67% over a 10-year period.
|
Diagnosis on Breast Biopsy |
Risk |
|
adenosis, non-sclerosing |
1.0 (no increase) |
|
adenosis, sclerosing |
1.5 to 2.0 |
|
adenosis, sclerosing, with atypical ductal or lobular hyperplasia |
6.7 |
|
carcinoma in situ, ductal |
8.0 to 10.0 |
|
carcinoma in situ, lobular |
8.0 to 10.0 |
|
cysts, simple |
1.0 (no increase) |
|
duct ectasia |
1.0 (no increase) |
|
fibroadenoma with complex features and/or proliferative epithelial changes in the surrounding tissue |
1.5 to 2.0 |
|
fibroadenoma without complex features |
1.0 (no increase) |
|
fibrosis |
1.0 (no increase) |
|
hyperplasia, atypical ductal |
4.0 to 5.0 |
|
hyperplasia, atypical lobular |
4.0 to 5.0 |
|
hyperplasia, mild, without atypia |
1.0 (no increase) |
|
hyperplasia, moderate or florid, without atypia |
1.5 to 2.0 |
|
mastitis |
1.0 (no increase) |
|
metaplasia, apocrine, without associated hyperplasia or adenosis |
1.0 (no increase) |
|
metaplasia, squamous |
1.0 (no increase) |
|
papilloma, solitary without coexistent atypical hyperplasia |
1.5 to 2.0 |
after Table 1, page 1054
In the implementation, the maximum relative risk factor is used, rather than trying to attempt combining risks if multiple abnormalities are seen.
|
Current Age |
Risk of Developing Invasive Breast Carcinoma in the Next 10 Years if No Significant Lesions Present |
|
20 |
1 in 2,000 |
|
30 |
1 in 256 |
|
40 |
1 in 67 |
|
50 |
1 in 39 |
|
60 |
1 in 29 |
If the age-specific probability is 1 in X, and the increased risk is Y, then the risk for the patient is 1 in (X) / (Y).
Specialty: Hematology Oncology, Surgery, general, Obstetrics & Gynecology
