P4-11-18: Mammographic Surveillance in Atypical Hyperplasia of the Breast and Subsequent Development of Cancer. A Need for Long Term Follow Up.

Abstract

Abstract Introduction Atypical hyperplasia of the breast is a known risk factor for breast cancer. Despite this risk there are no published guidelines on a recommended follow up regime for these patients. Methods A retrospective study was carried out on 1920 core biopsy results within a major screening breast unit from 2001 to 2005. Patients who had a final diagnosis of Atypical Ductal Hyperplasia (ADH), Atypical Lobular Hyperplasia (ALH) and Lobular Carcinoma in Situ (LCIS) were included. Information was extracted from multidisciplinary team meeting records, departmental data bases, pathology and radiology reports. Details of follow up and subsequent cancer diagnosis were noted. Results 83 patients were diagnosed with ALH, ADH or LCIS from a core biopsy. The mean age was 54 years (range 40–85 years). Seventy six (91.6%) of these patients went on to have an excision biopsy. Sixty four (77.1%) women have received long term mammographic follow up ranging from 5 to 9 years to date. Nineteen patients did not receive mammographic surveillance. Of this group 2 patients with LCIS had bilateral risk reducing mastectomies and 2 patients died shortly after diagnosis with no evidence of breast cancer. Eight patients developed breast cancer 3 to 8 years after their initial diagnosis. Of these, four patients developed cancer in the same breast that atypia had been diagnosed in previously, and four in the contra lateral breast. Conclusion 12.5 % of patients in the follow up group developed breast cancer within 8 years of diagnosis of atypical hyperplasia. A review of the literature suggests that in view of the increased risk of subsequent breast cancer in this group of women long term follow up is required. On the basis of these findings we recommend that all patients diagnosed with ALH, ADH or LCIS should be entered into an 18 monthly mammogram surveillance programme for 15 years. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-11-18.