How does benign breast disease (BBD) affect a women's risk for breast cancer?

Updated: Dec 26, 2019
  • Author: Graham A Colditz, MD, DrPH; Chief Editor: Chandandeep Nagi, MD  more...
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Benign breast disease (BBD) includes a number of breast abnormalities. These benign conditions vary in their cellular and pathologic features and, most importantly, in their impact on subsequent breast cancer risk. The 3 most clinically relevant groups are defined by changes in breast cells and include (1) nonproliferative, (2) proliferative without atypia, and (3) proliferative with atypia.

Nonproliferative lesions include cysts, apocrine metaplasia, and mild hyperplasia of usual type. Women with these lesions are at the same risk of breast cancer as women without a breast biopsy.

Proliferative lesions without atypia (eg, intraductal papilloma, sclerosing adenosis, moderate hyperplasia of usual type) are associated with a 1.5- to 2-fold increased risk of breast cancer compared to nonproliferative lesions.

Atypical ductal (ADH) and lobular (ALH) hyperplasias make up the group of proliferative lesions with atypia. Atypical hyperplasias are similar to in situ carcinomas in that they are both characterized by proliferation of epithelial cells, but they do not share all of the morphologic and pathologic features. These lesions are associated with a 3.5- to 6-fold increased risk of subsequent breast cancer. A large follow-up of 9087 women for a median of 15 years by investigators at Mayo Clinic showed that risk was greater among women diagnosed prior to menopause and that there was no interaction between histologic findings and family history of breast cancer. [77]

Other risk factors such as alcohol and hormone use do not appear to act differently according to types of benign breast disease, indicating that prevention strategies apply across women with and without a history of benign lesions.

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