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Long-Term Safety of Observation in Selected Women Following Core Biopsy Diagnosis of Atypical Ductal Hyperplasia

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Atypical ductal hyperplasia (ADH) found on core biopsy is associated with an upgrade to carcinoma in 10–30 % of women, thus surgical excision remains the standard of care. This study compares the incidence of breast cancer in women with ADH who were observed with those who underwent surgical excision of the ADH site.

Methods

Our departmental, prospectively maintained registry was reviewed to identify patients with ADH diagnosed by core biopsy. Surgically treated patients were excluded if upstaged to carcinoma following excision for ADH diagnosis. Breast cancer events were classified as index site (site of ADH biopsy), ipsilateral breast unrelated to index site, or contralateral breast.

Results

Overall, 175 women met the study criteria; 125 were observed and 50 underwent excision. With a median follow-up of 3 years, 14 breast cancer events were noted in 13 patients. In the surgery group, six women developed breast cancer (12 %), including one bilateral, compared with seven cancers (5.6 %) in the observed group (p = 0.14). Index site events and ipsilateral cancers were the same in both groups [2 vs. 0.8 % (p = 0.49) and 4 versus 4.8 % (p = 1.00), respectively]. All contralateral cancers occurred in the surgical group (8 vs. 0 %; p < 0.01). A prior history of breast cancer was the only variable associated with subsequent breast cancer events (hazard ratio 12.53, 95 % confidence interval 3.30–47.57).

Conclusion

Observation is appropriate in selected women with ADH on core biopsy. Index site failures are rare and are superseded by cancer risk elsewhere in the breast.

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Funding

This work was supported by a University of Texas MD Anderson Cancer Center support Grant (5 P30 CA016672 36).

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Authors and Affiliations

  1. Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Rhiana S. Menen MD, Nivetha Ganesan BS & Isabelle Bedrosian MD

  2. Department of Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Therese Bevers MD & Robin Coyne RN, MSN

  3. Department of Biostatics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Jun Ying MS

  4. Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Deanna Lane MD

  5. Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Constance Albarracin MD

Authors
  1. Rhiana S. Menen MD
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  2. Nivetha Ganesan BS
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  3. Therese Bevers MD
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  4. Jun Ying MS
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  5. Robin Coyne RN, MSN
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  6. Deanna Lane MD
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  7. Constance Albarracin MD
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  8. Isabelle Bedrosian MD
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Corresponding author

Correspondence to Isabelle Bedrosian MD.

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Menen, R.S., Ganesan, N., Bevers, T. et al. Long-Term Safety of Observation in Selected Women Following Core Biopsy Diagnosis of Atypical Ductal Hyperplasia. Ann Surg Oncol 24, 70–76 (2017). https://doi.org/10.1245/s10434-016-5512-9

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  • DOI: https://doi.org/10.1245/s10434-016-5512-9

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