Breast cancer risk is not equal in both breasts after diagnosis of a specific type of atypia

Please note that if you are outside North America, the embargo for LANCET press material is 0001 hours UK Time Friday, 11 January, 2003

Dr David Page and colleagues from the Vanderbilt Medical Center, Nashville, Tennessee, USA, studied 7600 women who had undergone breast biopsy, usually because they could feel a lump. Microscopic examination revealed 264 women with a type of abnormality called atypical lobular hyperplasia. Fifty of these women developed invasive breast cancer.

Women with atypical lobular hyperplasia were three times more likely to develop invasive breast cancer than women who do not have this type of tissue abnormality. In addition, the breast cancer was found to develop on the same side (ipsilateral) as the atypia in two-thirds (34) of these 50 women, rather than in the opposite (contralateral) breast. These findings challenge the current belief that risk is equal in both breasts after a diagnosis of atypical lobular hyperplasia.

Dr Page comments: "Most predictors of cancer are either local precursors or markers of general risk in both breasts. Atypical lobular hyperplasia, however, carries a risk that is intermediate and regional, favoring the breast with atypia."

In a Commentary (page 96) published in the same issue of The Lancet, Sunil Lakhani says now is the time for an awakening about atypical lobular hyperplasia, and states that there is no doubt that lesions such as atypical lobular hyperplasia are precursors for and risk indicators of breast cancer. However, Lakhani cautions that this statement should not be taken to mean that correct management is therefore mastectomy, or that surgeons should look for positive margins with atypical lobular hyperplasia.