Abstract
BackgroundFibroadenomas are common benign breast lesions, and studies of European American women indicate a persistent, increased risk of breast cancer after diagnosing a fibroadenoma on biopsy. This association has not been independently assessed in African American women, despite reports that these women are more likely to present with fibroadenomas.MethodsThe study cohort included 3853 African American women with a breast biopsy completed between 1997 and 2010 in metropolitan Detroit. Biopsies were microscopically reviewed for benign breast lesions, including fibroadenoma, proliferative disease, and atypia. Risk of breast cancer within the cohort was estimated using relative risk ratios and 95% CIs calculated using multivariable log-binomial regression. Relative risk of breast cancer in this cohort compared with African American women in the broader metropolitan Detroit population was estimated using standardized incidence ratios (SIRs).ResultsFibroadenomas occurred more frequently in biopsies of younger women, and other types of benign breast lesions were less likely to occur when a fibroadenoma was present (p = 0.008 for lobular hyperplasia; all other p values < 0.01). Unlike women with other benign lesions (SIR, 1.41; 95% CI, 1.20, 1.66), women with fibroadenomas did not have an increased risk of developing breast cancer compared with the general population (SIR, 0.94; 95% CI, 0.75, 1.18). Biopsies that indicated a fibroadenoma were associated with a reduced risk of breast cancer after adjusting for age at biopsy, proliferation, and atypia (relative risk, 0.67; 95% CI, 0.48, 0.93) compared with biopsies without a fibroadenoma.ConclusionsThese findings have important implications for breast cancer risk models and clinical assessment, particularly among African American women, in whom fibroadenomas are common.
Highlights
Fibroadenomas are common benign breast lesions, and studies of European American women indicate a persistent, increased risk of breast cancer after diagnosing a fibroadenoma on biopsy
Distribution of benign breast disease (BBD) features and characteristics by fibroadenoma status A total of 3845 benign breast biopsies were assessed in this African American cohort, 1798 (47%) of which were diagnosed with fibroadenoma
Breast cancer risk compared with population level risk Overall, this cohort of women exhibited an increased incidence of approximately 20% (SIR, 1.19; 95% CI, 1.05–1.36) of breast cancer compared with the general African American population in metropolitan Detroit (Table 2)
Summary
Fibroadenomas are common benign breast lesions, and studies of European American women indicate a persistent, increased risk of breast cancer after diagnosing a fibroadenoma on biopsy. This association has not been independently assessed in African American women, despite reports that these women are more likely to present with fibroadenomas. Biopsies that exhibit proliferative disease or cellular atypia, as defined by Dupont and Page criteria, are consistently associated with increases in breast cancer risk [2,3,4] These pathologic criteria have been included in risk assessment models to identify women at high risk of developing breast cancer. Reliable estimates of breast cancer risk associated with individual lesions can improve risk models, allowing physicians to better identify women at high risk of developing breast cancer who may benefit from additional screening or chemoprevention
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