Abstract
Data on the risk of breast cancer following a benign breast disease (BBD) diagnosis were derived predominantly from populations of women biopsied before the widespread use of mammographic screening and in whom these lesions were mostly incidental findings. Whether or not similar risk associations are seen when these lesions are detected in mammographically screened populations is unknown. To address this, we examined the variation in BBD and breast cancer risk associations by the calendar time of BBD diagnosis (pre- vs. post-mammography era [before vs. 1985 and after]) in a nested case–control study within the Nurses’ Health Study (NHS) and NHSII BBD subcohort (488 cases; 1908 controls). We performed logistic regression analysis, adjusting for matching factors and potential confounders, to estimate odds ratio (ORs) and 95% confidence interval (CI) for the association between BBD subtype (non-proliferative, proliferative without atypia, proliferative with atypical hyperplasia (AH)) and subsequent breast cancer risk. When compared with non-proliferative lesions, both proliferative lesions without atypia (PWA) and AHs were associated with similar levels of risk in the pre-mammographic (pre) and post-mammographic (post) time periods (PWA: OR [95% CI] = 1.73 [1.27, 2.36] pre vs. 1.12 [0.73, 1.74] post; AH: 4.41 [2.90, 6.70] pre vs. 3.69 [2.21, 6.15] post). The interaction by mammography era was not statistically significant (p-interaction = 0.47). These results suggest that the risk associations reported for BBD subtypes in the pre-mammography era remain valid for BBD detected after the widespread implementation of mammographic screening.
Highlights
Benign breast disease (BBD) is a term that encompasses a heterogeneous group of lesions with different levels of subsequent breast cancer risk
We examined whether the associations of BBD subtype with breast cancer risk were similar between the pre- and post-mammography era
Compared to women with BBDs detected during premammography era, those with BBDs detected during postmammography era were more likely to have atypical hyperplasia, higher adult body mass index (BMI), and higher levels of physical activity
Summary
Benign breast disease (BBD) is a term that encompasses a heterogeneous group of lesions with different levels of subsequent breast cancer risk. Most epidemiologic studies, including studies from our group, have shown that proliferative lesions without atypia are associated with a 1.5- to 2-fold increase in breast cancer risk, whereas atypical hyperplasias are associated with a 4–5-fold increase in risk[1,2,3,4] These data were derived from populations of women who, for the most part, were biopsied before the widespread use of screening mammography and in whom these lesions were incidental findings in the context of a clinically symptomatic lesion, most often a palpable mass, that was surgically excised[5]. We examined whether the associations vary by BBD detection method (mammogram vs. self-exam/physician’s exam)
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