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Dion L, Racin A, Brousse S, Beltjens F, Cauchois A, Levêque J, Coutant C, Lavoué V. Atypical epithelial hyperplasia of the breast: state of the art. Expert Rev Anticancer Ther 2016; 16:943-53. [PMID: 27367571 DOI: 10.1080/14737140.2016.1204916] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Atypical epithelial hyperplasia (AEH) of the breast is considered benign histological lesions with breast cancer risk. This review focuses on clinical signification and management of AEH that remains controversial. AREAS COVERED A review of published studies was performed using medline database. In this review, we fully describe the current evidence available. In particular, we describe 1) data from immunohistochemistry and molecular studies that suggest AEH is a precursor of breast cancer; 2) epidemiological studies demonstrate low rate of breast cancer in women with AEH; 3) surgical excision is necessary after diagnosis of AEH, such as lobular carcinoma in situ or atypical ductal hyperplasia, on core needle biopsy; 4) although current recommendations are evolving to fewer (if not no) excisions for flat epithelial with atypia and classic lobular neoplasia found on percutaneous biopsy (without radiologic indications for excision). Expert commentary: HEA management steel need prospective evidences, but recent retrospective data give some clue for less invasive management for some of HEA.
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Affiliation(s)
- Ludivine Dion
- a Department of Gynaecology , Rennes University Hospital , Rennes , Cedex 2 , France
| | - Adelaïde Racin
- a Department of Gynaecology , Rennes University Hospital , Rennes , Cedex 2 , France
| | - Susie Brousse
- a Department of Gynaecology , Rennes University Hospital , Rennes , Cedex 2 , France
| | - Françoise Beltjens
- b Department of Tumour Pathology , Georges-François Leclerc Cancer Centre - Unicancer , Dijon , France.,c University of Burgundy-Franche Comté , Dijon , France.,d Department of Surgical Oncology , Georges-François Leclerc Cancer Centre - Unicancer , Dijon , France
| | - Aurélie Cauchois
- e Department of Tumour Pathology , Rennes University Hospital, University of Rennes 1 , Rennes , France
| | - Jean Levêque
- a Department of Gynaecology , Rennes University Hospital , Rennes , Cedex 2 , France.,f Regional University Centre of Mastology, CRLCC Eugène Marquis , Rennes , Cedex , France.,g ER440, Oncogenesis, Stress and Signaling , INSERM , Rennes , France
| | - Charles Coutant
- b Department of Tumour Pathology , Georges-François Leclerc Cancer Centre - Unicancer , Dijon , France.,c University of Burgundy-Franche Comté , Dijon , France.,d Department of Surgical Oncology , Georges-François Leclerc Cancer Centre - Unicancer , Dijon , France
| | - Vincent Lavoué
- a Department of Gynaecology , Rennes University Hospital , Rennes , Cedex 2 , France.,f Regional University Centre of Mastology, CRLCC Eugène Marquis , Rennes , Cedex , France.,g ER440, Oncogenesis, Stress and Signaling , INSERM , Rennes , France
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Cox B, Ballard-Barbash R, Broeders M, Dowling E, Malila N, Shumak R, Taplin S, Buist D, Miglioretti D. Recording of hormone therapy and breast density in breast screening programs: summary and recommendations of the International Cancer Screening Network. Breast Cancer Res Treat 2010; 124:793-800. [PMID: 20414718 DOI: 10.1007/s10549-010-0893-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 04/07/2010] [Indexed: 11/30/2022]
Abstract
Breast density and the use of hormone therapy (HT) for menopausal symptoms alter the risk of breast cancer and both factors influence screening mammography performance. The International Cancer Screening Network (ICSN) surveyed its 29 member countries and found that few programs record breast density or the use of HT among screening participants. This may affect the ability of programs to assess their effectiveness in reducing breast cancer mortality. Seven countries recorded the use of HT at screening, and some were able to link screening records to individual prescribing records of HT. Eight countries reported recording breast density at screening mammography for some or all women screened. The recommendations of the ICSN for recording information about breast density and HT are presented.
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Affiliation(s)
- Brian Cox
- Hugh Adam Cancer Epidemiology Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
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Lavoué V, Bertel C, Tas P, Bendavid C, Rouquette S, Foucher F, Audrain O, Bouriel C, Levêque J. Hyperplasie épithéliale atypique du sein : bilan des connaissances et pratique clinique. ACTA ACUST UNITED AC 2010; 39:11-24. [DOI: 10.1016/j.jgyn.2009.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Revised: 08/22/2009] [Accepted: 09/09/2009] [Indexed: 10/20/2022]
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Duport N, Ancelle-Park R. Do socio-demographic factors influence mammography use of French women? Analysis of a French cross-sectional survey. Eur J Cancer Prev 2006; 15:219-24. [PMID: 16679864 DOI: 10.1097/01.cej.0000198902.78420.de] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to analyse the independent role of socio-demographic factors on the use of mammography according to whether or not an organized breast cancer screening programme exists. The study sample of 2825 women aged 40-74 years was drawn from a cross-sectional population-based survey of French households. Among these women 46% lived in districts that offered a screening programme and 63% reported undergoing mammography in the previous 2 years. Living in a district that offered a screening programme was associated with increased use of mammography. According to both univariate and multivariate analysis, several socio-demographic characteristics, such as high monthly household income or high education level, increased the probability of using mammography. However, three factors had a major positive impact on its use: (1) having had a gynaecological examination in the previous 2 years, (2) living in a district where a screening programme was available, and (3) age. There was a significant interaction between the factors 2 and 3. Between 40 and 60 years, age had the same impact on the use of mammography whether or not women lived in a district with a screening programme. After the age of 60 years, the use of mammography collapsed among women living in a district without a screening programme and remained frequent among women living in the district that offered such a programme. Even if the overall level of mammography screening was high and the existence of a screening programme maintained a high level of mammography use among older women, the programme should target better the women of underprivileged spheres and reinforce the role of the general practitioner; in particular for women not followed by a gynaecologist.
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Affiliation(s)
- Nicolas Duport
- Institut de Veille Sanitaire, Département des Maladies Chroniques et des Traumatismes, Saint-Maurice, France.
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Abstract
In the climacteric, about 40% of the women have occult breast tumors the growth of which may be stimulated by hormones. Many genetic, reproductive and lifestyle factors may influence the incidence of breast cancer. Epidemiological data suggest that the increase in the relative risk (RR) of breast cancer induced by hormone replacement therapy (HRT) is comparable with that associated with early menarche, late menopause, late first birth, alcohol consumption, etc. One of the most important risk factors is obesity which exceeds the effect of HRT by far, and in overweight postmenopausal women the elevated risk of breast cancer is not further increased by HRT. As in the WHI study the majority of women was overweight or obese, this trial was unsuitable for the investigation of breast cancer risk. In the women treated with an estrogen/progestin combination, the RR of breast cancer rose only in those women who have been treated with hormones prior to the study, suggesting a selection bias. In the women not pretreated with hormones, it was not elevated. In the estrogen-only arm of the WHI study, there was no increase but a steady decrease in the RR of breast cancer during 6.8 years of estrogen therapy. This result was unexpected, as estrogens are known to facilitate the development and growth of breast tumors, and the effect is enhanced by the addition of progestins. Obese women are at high risk to develop a metabolic syndrome including insulin resistance and hyperinsulinemia. In postmenopausal women, elevated insulin levels are not only associated with an increased risk for cardiovascular disease, but also for breast cancer. This might explain the effects observed in both arms of the WHI study: HRT with relative low doses of estrogens may improve insulin resistance and, hence, reduce the elevated breast cancer risk in obese patients, whereas this beneficial estrogen effect may be antagonized by progestins. The principal options for the reduction of breast cancer risk in postmenopausal women are the prevention of overweight and obesity to avoid the development of hyperinsulinemia, the medical treatment of insulin resistance, the use of low doses of estrogens and the reduction of exposure to progestins. The latter might include long-cycles with the sequential use of appropriate progestins every 3 months for 14 days. There are large inter-individual variations in the proliferative response to estrogens of the endometrium. Control by vaginalsonography and progestin challenge tests may help to identify those women who may be candidates for low-dose estrogen-only therapy.
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Affiliation(s)
- Herbert Kuhl
- Department of Gynecology and Obstetrics, J. W. Goethe University of Frankfurt, Theodor-Stern-Kai 7, D-60590 Frankfurt am Main, Germany.
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Quelle est la valeur d’une mammographie normale pour écarter un cancer ? IMAGERIE DE LA FEMME 2004. [DOI: 10.1016/s1776-9817(04)94815-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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