The Influence of Age on the Histopathology and Prognosis of Atypical Breast Lesions.

Abstract

BACKGROUND:Although several prognostic variables and risk factors for breast cancer are age-related, the association between age and risk of cancer with breast atypia is controversial. This study aimed to compare the type of breast atypia and risk of underlying or subsequent breast cancer by age. METHODS:Adult women with breast atypia (atypical ductal hyperplasia, atypical lobular hyperplasia, and lobular carcinoma in situ) at a single institution from 2008 to 2017 were stratified by age at initial diagnosis: <50 y, 50-70 y, and >70 y. Regression modeling was used to estimate the association of age with risk of underlying carcinoma or subsequent cancer diagnosis. RESULTS:A total of 530 patients with atypia were identified: 31.1% < 50 y (n = 165), 58.1% 50-70 y (n = 308), and 10.8% > 70 y (n = 57). The proportion of women with atypical ductal hyperplasia steadily increased with age, compared with atypical lobular proliferations (P = 0.04). Of those with atypia on needle biopsy, the overall rate of underlying carcinoma was 17.5%. After adjustment, older age was associated with a greater risk of underlying carcinoma (odds ratio: 1.028, 95% confidence interval: 1.003-1.053; P = 0.03). Of those confirmed to have atypia on surgical excision, the overall rate of a subsequent cancer diagnosis was 15.7%. Age was not associated with a long-term risk for breast cancer (P = 0.48) or the time to a subsequent diagnosis of carcinoma (log-rank P = 0.41). CONCLUSIONS:Although atypia diagnosed on needle biopsy may be sufficient to warrant surgical excision, older women may be at a greater risk for an underlying carcinoma, albeit the long-term risk for malignancy associated with atypia does not appear to be affected by age.

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Citation

Published Version (Please cite this version)

10.1016/j.jss.2019.03.047

Publication Info

Sergesketter, Amanda R, Samantha M Thomas, Oluwadamilola M Fayanju, Carolyn S Menendez, Laura H Rosenberger, Rachel A Greenup, Terry Hyslop, Edgardo R Parrilla Castellar, et al. (2019). The Influence of Age on the Histopathology and Prognosis of Atypical Breast Lesions. The Journal of surgical research, 241. pp. 188–198. 10.1016/j.jss.2019.03.047 Retrieved from https://hdl.handle.net/10161/19537.

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Scholars@Duke

Thomas

Samantha Thomas

Biostatistician, Principal

Samantha is the manager of the Duke Cancer Institute (DCI) Biostatistics Shared Resource. Collaboratively, she primarily works with physicians in DCI, specifically in research of Endocrine Neoplasia and Breast Cancer. She is also the director of the Biostatistics, Epidemiology, Research, and Design Methods (BERD) Core Training and Internship Program (BCTIP). Her professional experience involves study design, analysis, and reporting of clinical trials and observational studies. Her specific areas of interest include training of collaborative biostatisticians, modeling of non-linear associations, and application of partitioning analyses to identify homogeneous patient groups.

Menendez

Carolyn Sue Menendez

Assistant Professor of Surgery
Rosenberger

Laura Horst Rosenberger

Associate Professor of Surgery

Dr. Laura Rosenberger is an Associate Professor of Surgery, where she has a high-volume breast surgical oncology practice and enjoys all aspects of an academic career. She has clinical expertise and research interest in rare breast cancers, including sarcomas and a specific focus on phyllodes tumors. Dr. Rosenberger is the founding and coordinating Principal Investigator of multiple, multi-institutional studies, including a funded prospective germline testing study, and an actively accruing rare breast tumor registry with tissue biorepository. She has authored, or co-authored, over 75 peer-reviewed publications, and serves on multiple national committees including a member of the National Comprehensive Cancer Network, or NCCN, Breast Cancer Panel.  

Hyslop

Terry Hyslop

Adjunct Professor in the Department of Biostatistics & Bioinformatics
Hwang

Eun-Sil Shelley Hwang

Mary and Deryl Hart Distinguished Professor of Surgery, in the School of Medicine
Plichta

Jennifer K Plichta

Associate Professor of Surgery

Dr. Jennifer Plichta is an Associate Professor of Surgery & Population Health Sciences at Duke University. She serves as the Director of the Breast Risk Assessment Clinic in the Duke Cancer Institute, where she cares for patients with breast cancer, benign breast problems, and those with an increased risk of breast cancer. Her clinical interests include establishing routine breast cancer risk assessment for women and creating personalized management strategies for those found to be “high risk”.

 

Dr. Plichta’s research focuses of identifying and managing women with risk factors for breast cancer, including those with genetic mutations, such as BRCA, those with abnormal breast biopsies, and those with a family history of breast cancer. She is also studying metastatic breast cancer and how breast cancer staging can be used to improve patient care and education. 

 

However, her dedication to breast cancer extends beyond her clinical and research interests. She also enjoys educating the community about breast cancer and helping to raise money for breast cancer research and education. She is the creator and primary coordinator of Duke’s free, annual breast education day for the community, “What’s best for breasts?”.


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