Benign breast disease heterogeneity: association with histopathology, age, and ethnicity

• Published in: Breast cancer research and treatment 2008-09, Vol.111 (2), p.289-296
• Main Authors: Cheng, Jingfang, Qiu, Shijing, Raju, Usha, Wolman, Sandra R., Worsham, Maria J.
• Format: Article
• Language: English
• Subjects: Adult; Age; Age Factors; Aged; Biological and medical sciences; Black or African American; Black People; Breast cancer; Breast Diseases - ethnology; Breast Diseases - pathology; Breasts; Cancer research; Cell Proliferation; Epidemiology; Ethnicity; Female; Gynecology. Andrology. Obstetrics; Humans; Mammary gland diseases; Medical disorders; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Oncology; Risk factors; Tumors; White People
• ISSN: 0167-6806; 1573-7217
• DOI: 10.1007/s10549-007-9775-5

Background Benign breast biopsies with concurrent multiple benign lesions with different histopathologic diagnoses were termed heterogeneous benign breast disease (HBBD). Multiplicity of benign breast disease (BBD) lesions in a biopsy is a risk factor for progression to breast cancer (BC). Elucidation of the biological characteristics and clinical implications of HBBD may also be relevant to the refinement of risks for BC in women with a BBD diagnosis. Design In this study, we investigated the association of HBBD with histopathology, age, and ethnicity. A cohort of 4,341 women, 1,208 African Americans and 3,133 Caucasians, diagnosed with BBD, was identified after examination of an excisional breast biopsy. BBD biopsies were categorized as nonproliferative (NP, low risk or risk 1 lesions), proliferative without atypia (P, intermediate risk or risk 2 lesions), and proliferative with atypia (AH, high risk or risk 3 lesions). A BBD biopsy with only a single BBD lesion was termed simple BBD (SBBD). BBD biopsies with multiple lesions were further classified as single level HBBD (SL-HBBD) if the concurrent lesions were within the same risk level, or as multiple level HBBD (ML-HBBD) if lesions fell into more than one risk group. Results In this cohort, 69% of women with a BBD diagnosis fit the HBBD criteria. Among women with HBBD, ML-HBBD was almost three times more prevalent than SL-HBBD and was significantly more likely to be composed of risk 2 and risk 3 lesions. The likelihood of HBBD was 57% higher in Caucasian American women than in African American women with BBD (OR 1.57; 95% CI: 1.37, 1.81). The average lesion number in HBBD was directly proportional to increasing lesion risk ( P  55 years had a 3.12 (95% CI: 2.59, 3.75) and a 2.28 (95% CI: 1.94, 2.68) fold higher likelihood of HBBD compared to those ≤45 years. Significant interaction was found between concurrent lesion levels and age ( P