The Evolving Era of Breast Cancer Risk Assessment in Benign Breast Disease
Menée à partir des données des registres américains des cancers et à partir d'échantillons biopsiques prélevés entre 2002 et 2013 sur 4 819 femmes atteintes d'une lésion mammaire bénigne (âge médian : 51 ans ; durée médiane de suivi : 10,9 ans), cette étude évalue l'association entre ce type de lésion et le risque de développer un cancer du sein
Breast cancer remains a formidable public health concern, and considerable efforts have been made to improve risk stratification and prevention. Benign breast disease (BBD), a comprehensive term used to describe many types of nonmalignant breast lesions, has been demonstrated to be an important risk factor for subsequent breast cancer development, particularly when certain histologic characteristics have been identified. Consequently, BBD diagnoses can significantly impact management decisions, and therefore, accurate diagnosis is critical.Sherman et al conducted a retrospective analysis of 4819 women diagnosed with BBD via percutaneous biopsy and found that women with BBD had a 2-fold increased risk of developing breast cancer compared with women in the general population. More specifically, women with nonproliferative BBD had a standardized incidence ratio (SIR), compared with the general population, of 1.42 (95% CI, 1.19-1.71), those with proliferative BBD without atypia had an SIR of 2.19 (95% CI, 1.88-2.54), and those with atypical hyperplasia had an SIR of 3.91 (95% CI, 2.97-5.14). These data further support the well-documented risk of a subsequent breast cancer diagnosis associated with an initial diagnosis of BBD. However, the generalizability of the data should be considered. The study cohort included almost exclusively non-Hispanic White patients, thus not significantly contributing to our understanding of how race and ethnicity may be associated with BBD and subsequent breast cancer development. Furthermore, the study lacks data regarding the interobserver reproducibility of certain benign diagnoses. The discrepancy among pathologists’ interpretation of atypia has been well documented, with discordance rates over 50% in select studies. These variations in the histologic assessment of atypia may lead to undertreatment of a missed cancer, inadequate risk counseling, and/or unnecessary interventions.
JAMA Surgery , éditorial, 2022