Declines in ductal hyperplasia may be linked to hormone therapy reduction

Abstract

Researchers are beginning to observe a possible link between the decline of atypical ductal hyperplasia—a known risk for breast cancer—and the reduced use of postmenopausal hormone therapy. Hormone therapy use is associated with more benign breast biopsies, as well as the development of early and late-stage breast cancer. As hormone therapy use has declined over the years, so has the incidence of atypical ductal hyperplasia, according to Tehillah Menes, MD, chief of the breast service in the department of surgery at Elmhurst Hospital Center in NewYork. Previous research has indicated that women with atypical ductal hyperplasia have a 3-fold to 5-fold increased risk of breast cancer. Using data from the Breast Cancer Surveillance Consortium, Dr. Menes and colleagues examined the rates and risks of atypical ductal hyperplasia in more than 2.4 million mammograms. They found that between 1996 and 2005, post- menopausal hormone therapy use decreased from 35% to 11%, while the incidence of atypical ductal hyperplasia decreased from 5.5 per 10,000 mammograms in 1999 to 2.4 per 10,000 mammograms in 2005. The researchers note that they did not expect to observe this decline because of the increased use of mammography to discover abnormal lesions. They also found that atypical ductal hyperplasia is usually associated with low-grade cancers or early stage cancers, which may support the idea of separate pathways for the development of low-grade and high-grade breast cancers, Dr. Menes says. She and her colleagues conclude that future research should focus on the influence of exogenous hormone therapy on benign proliferative lesions of the breast. Decreased use of hormone replacement therapy may be linked to fewer cases of a typical ductal hyperplasia.