Women with hyperplastic breast disease are supposed to be primary prevention candidates for breast cancer, yet few risk models have included benign lesions in assessing the risk of developing breast cancer. A recent study published in JCO included benign breast lesions (BBD) in the US Breast Cancer Surveillance Consortium (BCSC) risk model, which is the only model that uses breast density to predict breast cancer incidence. The study developed and validated a competing risk model using SEER data on breast cancer incidence from 2000-2010 and competing risk demographics corrected for death in 2010. Cox proportional risk regression was used to estimate relative risk for age, race/ethnicity, family history of breast cancer, history of breast biopsy, BBD diagnosis, and breast density measured by BCSC. The study included 1135977 women aged 35-74 years who underwent mammography with no history of breast cancer and 17% of whom had undergone breast biopsy. During the follow-up period (mean 6.9 years), 17,908 women were diagnosed with invasive breast cancer.
The BBD model predicted a slightly higher risk of incidence than actual (expected: actual = 1.04; 95% CI, 1.03-1.06) with moderate accuracy (area under the ROC curve of 0.665). The inclusion of BBD in the model increased the proportion of women with a 5-year risk of cancer of 3% or greater from 9.3% to 27.8% (P<0.001) in women with breast hyperplastic disease. In conclusion, by using breast density and BBD diagnosis, the BCSC BBD model can accurately estimate a woman's risk of developing breast cancer. An increasing number of women with BBD are using the BCSC
BBD model predicts and then confirms that they are at high risk for breast cancer. (Above from MedSci) Sounds scary, doesn’t it? How likely is it that a benign breast lesion, such as what is commonly referred to as “breast hyperplasia”, will develop into breast cancer? What should be the clinical management of patients with “breast enlargement”? Medical Pulse has interviewed Professor Wang Jiandong from the General Hospital of the Chinese People’s Liberation Army on this issue. I believe the answer from Professor Wang can help you to clear your doubts. Professor Wang said: “It is important to note that the so-called ‘breast enlargement’ and the pathological ‘hyperplasia’ are two concepts. ‘ should refer to breast pain. ”The main statement of breast pain patients is often to ask the doctor to exclude whether they have grown a tumor, which is a misunderstanding of ‘breast enlargement’ by patients, most of Most of the tumors are not painful. Breast pain is commonly referred to as breast pain, and has many causes, mainly related to the cyclical changes of female hormones. According to Chinese medicine, the breast is an organ affected by emotions, so when women are stressed and depressed, breast pain is also more likely to occur. ”Because ‘breast enlargement’ and ‘breast pain’ in fact cross over, so it is easy to be misunderstood by ordinary patients, in recent years, especially in Europe and the United States in the dilution of ‘breast enlargement This is to distinguish it from the pathological ‘hyperplasia’ that doctors talk about. In the face of a patient with breast pain, the doctor may recommend an ultrasound examination and then, depending on her age, the condition of the breast to decide whether to do another mammogram test to rule out early tumors as much as possible through the above methods. ”In the examination of breast disease, clinicians should also pay attention to the characteristics of Chinese people. The Chinese breast is mostly dense and relatively smaller than in Europe and the United States, and the detection rate of mammography for tumors is affected by the degree of denseness of the gland. Therefore, breast ultrasound is equally important for Chinese patients. The imaging department will perform BIRADS score according to the presentation of the masses found by imaging. Generally BIRADS
2 and 3 are considered benign diseases, such as cysts or fibroadenomas, and regular annual review is recommended; if BIRADS
grade 4 and 5 are considered as malignant lesions, and should be combined with other imaging examinations and puncture biopsy, and then the next treatment plan will be made according to the pathological results.