Hall, Emma; (1999) Benign breast disease as a risk factor for breast cancer. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

This thesis focuses on the role that benign breast disease (BBD) plays in the subsequent development of breast cancer. The epidemiology of both diseases is described and important risk factor differences are highlighted. Results are presented from a cohort of 22,500 women first seen for BBD at Guy's Hospital between 1946 and 1982. This is one of the largest studies of its kind with a median follow-up of 19 years. Comparison to population breast cancer incidence rates gave a standardised incidence ratio (SIR) of 154.8 (95% Cl: 142.6-168.1). The risk was greater for women with BBD requiring immediate treatment or further investigation such as biopsy or aspiration (SIR=170, 95% Cl: 152-190), but was also elevated in those with 'untreated' BBD (SIR=140, 95% Cl: 123-158). Women with a family history of breast cancer were at greater risk as were nulliparous women and women older at first childbirth. The risk of cancer decreased over time but remained elevated up to 20 years after the initial episode of BBD. The longevity of risk was more pronounced in women with 'treated' BBD and those remaining at risk 20 years after initial diagnosis had an SIR of 155 (95% Cl: 105-227) for subsequent breast cancer. A case-control pathological review of the benign tissue of women who underwent BBD biopsy and who subsequently did or did not develop cancer was performed. This allowed more accurate assessment of the risks associated with specific histologic types of BBD. Proliferative disease with atypia conferred a risk of breast cancer over four times that of non-proliferative biopsied disease (OR=4.25, 95% Cl: 2.07-8.72). Intraduct papilloma was found to carry a greater risk of subsequent cancer than other forms of biopsied BBD (OR=3.47, 95% Cl: 1.79-6.74). Such identification of high-risk benign lesions will facilitate further work on biomolecular markers for breast cancer and will ultimately support cancer prevention strategy.

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