Columnar Cell Lesions and Subsequent Breast Cancer Risk: Results from the Nurses' Health Studies
LC Collins, SA Aroner, JC Connolly, GA Colditz, SJ Schnitt, RM Tamimi. Beth Israel Deaconess Medical Center, Boston; Harvard School of Public Health, Boston; Washington University School of Medicine, St. Louis; Harvard Medical School, Boston
Background: Emerging evidence suggests that columnar cell lesions (CCL) represent an early stage in the low grade breast neoplasia pathway. However, the level of subsequent breast cancer risk conferred by these lesions when present in a benign breast biopsy is unclear.
Design: We examined the association between the presence of CCL and subsequent breast cancer risk in a case-control study of benign breast disease (BBD) and breast cancer nested within the Nurses' Health Studies (394 cases, 1606 controls). Benign breast biopsy slides were reviewed blinded to case-control status and categorized as showing non-proliferative lesions, proliferative lesions without atypia or atypical hyperplasia; the presence or absence of CCL was also noted. Logistic regression was used to compute odds ratios (ORs) and 95% confidence intervals (CIs) for the association between CCL and breast cancer risk. There were too few examples of CCL with atypia (i.e., flat epithelial atypia) to further stratify the analysis according to the presence or absence of atypia in the CCL.
Results: CCL were seen in 588 of the benign breast biopsies (140 cases, 448 controls). The presence of CCL was significantly associated with the presence of proliferative lesions without atypia and with atypical hyperplasia (p<0.001, for both). Women with CCL had an increased risk of breast cancer compared with those without CCL (OR=1.44, 95%CI 1.14–1.83). However, this increase in risk was attenuated after adjustment for histologic category of BBD (OR=1.20, 95%CI 0.94–1.54). The table shows the relative risk for development of breast cancer jointly classified by BBD category and the presence or absence of CCL.
|BBD/CCL histologic category||Cases||Controls||OR (95% CI)|
|Nonproliferative, no CCL||80||518||1.0 (Reference)|
|Nonproliferative, CCL||19||93||1.33 (0.77-2.29)|
|Proliferative, no CCL||125||558||1.46 (1.08-1.99)|
|Proliferative, CCL||74||277||1.81 (1.27-2.58)|
|Atypical hyperplasia, no CCL||49||82||4.26 (2.75-6.59)|
|Atypical hyperplasia, CCL||47||78||4.37 (2.81-6.81)|