Atypical ductal or lobular hyperplasia, lobular carcinoma in-situ, flat epithelial atypia, and future risk of developing breast cancer: Systematic review and meta-analysis

• Published in: Breast (Edinburgh) Vol. 78; p. 103807
• Main Authors: Baker, Jannah, Noguchi, Naomi, Marinovich, M Luke, Sprague, Brian L., Salisbury, Elizabeth, Houssami, Nehmat
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.12.2024; Elsevier
• Subjects: Atypical proliferations; Biopsy; Breast - pathology; Breast cancer; Breast cancer risk; Breast Carcinoma In Situ - epidemiology; Breast Carcinoma In Situ - pathology; Breast Neoplasms - epidemiology; Breast Neoplasms - pathology; Carcinoma, Intraductal, Noninfiltrating - epidemiology; Carcinoma, Intraductal, Noninfiltrating - pathology; Carcinoma, Lobular - epidemiology; Carcinoma, Lobular - pathology; Female; Humans; Hyperplasia - pathology; Incidence; Lobular carcinoma in-situ; Mammography; Precancerous Conditions - epidemiology; Precancerous Conditions - pathology; Review; Risk Assessment; Risk Factors; Atypical proliferations; Lobular carcinoma in-situ; Breast cancer risk; Breast cancer; Mammography; Biopsy
• ISSN: 0960-9776; 1532-3080; 1532-3080
• DOI: 10.1016/j.breast.2024.103807

Biopsy-proven breast lesions such as atypical ductal hyperplasia (ADH) or atypical lobular hyperplasia (ALH), lobular carcinoma in situ (LCIS) and flat epithelial atypia (FEA) increase subsequent risk of breast cancer (BC), but long-term risk has not been synthesized. A systematic review was conducted to quantify future risk of breast cancer accounting for time since diagnosis of these high-risk lesions. A systematic search of literature from 2000 was performed to identify studies reporting BC as an outcome following core-needle or excision biopsy histology diagnosis of ADH, ALH, LCIS, lobular neoplasia (LN) or FEA. Meta-analyses were conducted to estimate cumulative BC incidence at five-yearly intervals following initial diagnosis for each histology type. Seventy studies reporting on 47,671 subjects met eligibility criteria. BC incidence at five years post-diagnosis with a high-risk lesion was estimated to be 9.3 % (95 % CI 6.9–12.5 %) for LCIS, 6.6 % (95 % CI 4.4–9.7 %) for ADH, 9.7 % (95 % CI 5.3–17.2 %) for ALH, 8.6 % (95 % CI 6.5–11.4 %) for LN, and 3.8 % (95 % CI 1.2–11.7 %) for FEA. At ten years post-diagnosis, BC incidence was estimated to be 11.8 % (95 % CI 9.0–15.3 %) for LCIS, 13.9 % (95 % CI 7.8–23.6 %) for ADH, 15.4 % (95 % CI 7.2–29.3 %) for ALH, 17.0 % (95 % CI 7.2–35.3 %) for LN and 7.2 % (95 % CI 2.2–21.2 %) for FEA. Our findings demonstrate increased BC risk sustained over time since initial diagnosis of high-risk breast lesions, varying by lesion type, with relatively less evidence for FEA. •Cumulative breast cancer risk varies by time from initial lesion and by lesion type.•Moderate/high breast cancer risk shown within 10 years from initial high-risk lesion.•There is relatively less evidence of breast cancer risk after flat epithelial atypia.