Abstract
Benign breast diseases (BBDs) are common and associated with breast cancer risk, yet the etiology and risk of BBDs have not been extensively studied. To investigate the risk of BBDs by age, hormonal factors, and family history of breast cancer. This retrospective cohort study assessed 70 877 women from the population-based Karolinska Mammography Project for Risk Prediction of Breast Cancer (KARMA) who attended mammographic screening or underwent clinical mammography from January 1, 2011, to March 31, 2013, at 4 Swedish hospitals. Participants took part in a comprehensive questionnaire on recruitment. All participants had complete follow-up through high-quality Swedish national registers until December 31, 2015. Pathology medical records on breast biopsies were obtained for the participants, and BBD subtypes were classified according to the latest European guidelines. Analyses were conducted from January 1 to July 31, 2020. Hormonal risk factors and family history of breast cancer. For each BBD subtype, incidence rates (events per 100 000 person-years) and multivariable Cox proportional hazards ratios (HRs) with time-varying covariates were estimated between the ages of 25 and 69 years. A total of 61 617 women within the mammographic screening age of 40 to 69 years (median age, 53 years) at recruitment with available questionnaire data were included in the study. Incidence rates and risk estimates varied by age and BBD subtype. At premenopausal ages, nulliparity (compared with parity ≥3) was associated with reduced risk of epithelial proliferation without atypia (EP; HR, 0.62; 95% CI, 0.46-0.85) but increased risk of cysts (HR, 1.38; 95% CI, 1.03-1.85). Current and long (≥8 years) oral contraceptive use was associated with reduced premenopausal risk of fibroadenoma (HR, 0.65; 95% CI, 0.47-0.90), whereas hormone replacement therapy was associated with increased postmenopausal risks of epithelial proliferation with atypia (EPA; HR, 1.81; 95% CI, 1.07-3.07), fibrocystic changes (HR, 1.60; 95% CI, 1.03-2.48), and cysts (HR, 1.98; 95% CI, 1.40-2.81). Furthermore, predominantly at premenopausal ages, obesity was associated with reduced risk of several BBDs (eg, EPA: HR, 0.31; 95% CI, 0.17-0.56), whereas family history of breast cancer was associated with increased risk (eg, EPA: HR, 2.11; 95% CI, 1.48-3.00). These results suggest that the risk of BBDs varies by subtype, hormonal factors, and family history of breast cancer and is influenced by age. Better understanding of BBDs is important to improve the understanding of benign and malignant breast diseases.
Highlights
Benign breast diseases (BBDs) are common throughout a woman’s lifetime, from early reproductive life to the postmenopausal part of life, making it a potential health concern to a large number of women.[1,2,3,4,5,6] The etiology and risk of BBDs have not been extensively studied, despite an increasing incidence of BBDs detected by population-based mammographic screening.[7,8] the exact incidence rates are unexplored
Current and long (Ն8 years) oral contraceptive use was associated with reduced premenopausal risk of fibroadenoma (HR, 0.65; 95% CI, 0.47-0.90), whereas hormone replacement therapy was associated with increased postmenopausal risks of epithelial proliferation with atypia (EPA; hazard ratio (HR), 1.81; 95% CI, 1.07-3.07), fibrocystic changes (HR, 1.60; 95% CI, 1.03-2.48), and cysts (HR, 1.98; 95% CI, 1.40-2.81)
Predominantly at premenopausal ages, obesity was associated with reduced risk of several BBDs, whereas family history of breast cancer was associated with increased risk
Summary
Benign breast diseases (BBDs) are common throughout a woman’s lifetime, from early reproductive life to the postmenopausal part of life, making it a potential health concern to a large number of women.[1,2,3,4,5,6] The etiology and risk of BBDs have not been extensively studied, despite an increasing incidence of BBDs detected by population-based mammographic screening.[7,8] the exact incidence rates are unexplored. Previous studies[1,2,9] on BBDs have often been small, inconsistent in their pathological disease classification, and conducted before mammographic screening programs were introduced. To our knowledge, there are no up-to-date studies of the incidences of distinct BBD subtypes, and risk factors have not been well established. Given that the risk of BBD diagnosis extends throughout several decades in a woman’s life, it is important to understand how age influences the risk
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
