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World Journal of Surgery

, Volume 18, Issue 1, pp 32–38 | Cite as

Evaluation and management of high risk and premalignant lesions of the breast

  • David L. Page
  • Roy A. Jensen
Article

Abstract

Specific, combined histologic and cytologic patterns of atypical epithelial hyperplasia (AH) in the breast indicate a medically relevant risk of breast cancer development in 5% to 10% of women with otherwise benign biopsies. This risk is four to five times that of similar women without such lesions, that is, women of the same age and at risk for the same period of time. These relative risks are not stable and fall 10 to 15 years after detection, more closely approximating the risks of women of comparable age. Proliferative disease without atypia, no matter how extensive or complex, predicts only a slight elevation of risk, which approaches double that of the reference population. There is a strong interaction of AH with family history of breast cancer in at least a first degree relative. This risk doubles the risk of AH alone and is approximately 20% at 10 to 15 years after biopsy, particularly for women in their forties and early fifties. These considerations are of less clinical importance in women over age 60. Low replacement doses of conjugated estrogen after the menopause do not further elevate risk beyond that identified by histologic patterns. Noncomedo ductal carcinoma in situ may be considered a true precursor lesions; however, it differs significantly in many ways from the more advanced lesion recognized as the comedo type of ductal carcinoma in situ. Small examples of noncomedo ductal carcinoma in situ can eventuate in invasive carcinoma after 6 to 10 years. They may be treated by wide local excision without radiation, with no recurrence up to 8 to 10 years in all likelihood. Ductal carcinoma in situ lesions can be extensive within the breast, and this conservative posture should be reserved for smaller lesions.

Keywords

Breast Cancer Ductal Carcinoma Cual Wide Local Excision Aspect Histologiques 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Il existe chez 5 à 10 % des femmes qui ont apparemment des résultats normaux de biopsies mammaires, des aspects histologiques et cytologiques d'hyperplasie épithéliale atypique (HEA) du sein qui semblent prédire un certain risque de développer un cancer du sein. Ce risque a été estimé à 4–5 fois celui que présentent les femmes du même âge avec les mêmes autres facteurs de risque, mais qui n'ont pas de telles anomalies histo-cytologiques. Ce risque n'est cependant pas constant et semble diminuer avec le temps, rejoignant le même risques qu'ont d'autres femmes aux mêmes âges 10 à 15 ans après la première détection de ces anomalies. Le risque de voir se développer une prolifération sans atypie cellulaire, même extensive ou complexe, n'est que deux fois celui de la population en générale. L'HEA se voit souvent dans la fratrie des familles a cancer du sein, du moins chez les cousines au premier degré. Ce risque, deux fois celui de l'HEA, se situe à 20% environ 10–15 ans après la biopsie, en particulier chez les femmes de la cinquième (40–49) ou au début de la sixième (50) décennie. Ces considérations ont moins d'importance après l'âge de 60 ans. Un traitement par des oestrogènes à de faibles doses après la ménopause ne semble pas augmenter ce risque. Seuls les cancers intracanalaires in situ non comédocarcinomateux peuvent être considérés comme des lésions précancéreuses et ne nécessitent pas de traitement étendu, que nécessitent, par contre, les lésions du type comédocarcinome, même in situ. Des lésions non comédocarcinomateuses peuvent parfois devenir des cancers invasifs en 6 à 10 ans. Il faut les

Resumen

Patrones histológicos y citológicos combinados de hiperplasia epitelial atípica (HA) en la glándula mamaria son indicativos de un riesgo de desarrollar cáncer del orden de 5 a 10% en las mujeres con lesiones por lo demás benignas. El riesgo es 4–5 veces mayor que el de mujeres de poblaciones similares que no poseen tales lesiones. Tales riesgos relativos no son estables, y disminuyen 10–15 años luego de la detección, para aproximarse a los riesgos de mujeres de edades comparables. La enfermedad proliferativa sin atipia, no importa qué tan extensa o compleja sea, predice un ligero riesgo mayor, el cual se acerca al doble del de la población de referencia.

Hay una fuerte interacción de la HA con la historia familiar de cáncer mamario en por lo menos los familiaries de primer grado. Tal riesgo dobla al riesgo de HA sola, la dobla y se aproxima al 20% a los 10–15 años después de la biopsia, en particular en mujeres en las edades de los 40 y los primero 50 años, pero tales consideraciones son de menor importancia clínica en mujeres de 60 años. Los estrógenos conjugados en dosis bajas, administrados después de la menopausia, no parecieron incrementar el riesgo por encima del que fue identificado mediante patrones histológicos.

Sólo el carcinoma in situ de tipo no comedo puede ser considerado como lesión precursora pero que no da lugar al tratamiento más extenso que se recomienda para el tipo más avanzado de comedo carcinoma ductal in situ. Pequeños carcinomas ductales in situ de tipo no comedo pueden resultar en carcinoma invasivo en un periodo de 6 a 10 años. Estos pueden ser tratados con resección local amplia sìn ìrradiación, pudiendose esperar que probablemente no se presentara recurrencia hasta en 8–10 años de seguimiento. Los carcinomas ductales in situ pueden ser lesiones muy extensas, y esta conducta conservadora debe ser reservada para las lesiones menores.

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Copyright information

© Société Internationale de Chirurgie 1994

Authors and Affiliations

  • David L. Page
    • 1
  • Roy A. Jensen
    • 1
  1. 1.Department of PathologyVanderbilt University Medical CenterNashvilleUSA

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