ArticlesRisk of breast cancer in women with palpable breast cysts: a prospective study
Introduction
Astley Cooper, in 1829, distinguished cysts from breast cancer.1 The first comprehensive clinical description of cystic disease was made more than 50 years later by Reclus2 and Brissaud.3 Reclus showed that microscopic cysts were commonly bilateral and could involve the whole gland.3 Microcysts are no longer thought to be pathological but are viewed as part of the normal involution process.4 Gross or palpable breast cysts are larger cysts that are thought to be aberrations of the normal process of involution and not a disease.4 Haagensen's estimate,5 based on the observation that gross cysts and breast cancer are seen with equal frequency, is that 7% of women in the western world develop palpable breast cysts.
The published evidence on the relation of palpable breast cysts (so-called cystic disease of the breast) and subsequent breast cancer is conflicting, mainly because definitions of cystic disease have differed. However, those studies that have included only or mainly patients with clinically palpable cysts have shown that these women are more likely than the general population to develop breast cancer.6, 7, 8, 9, 10, 11, 12, 13, 14
There are two clearly defined types of breast cysts.15, 16, 17, 18 Type I cysts are lined by apocrine epithelium and contain fluid with an electrolyte composition similar to that of intracellular fluid (high concentrations of potassium [K+], low concentrations of sodium (Na+), Na+/K+ ratio <3, and high concentrations of steroid hormones, including androsterone, epiandrosterone, and dehydroepiandrosterone, and their conjugates.16, 17, 19 Type II cysts are lined by flattened attenuated epithelium and contain fluid with an electrolyte composition similar to that of plasma (Na+/K+ ratio ≥3) and have lower concentrations of steroid hormones and their conjugates than type I cysts. The natural history of these two cyst types seems to differ; patients with type I cysts are more likely to develop further cysts than women with type II cysts, and patients who develop large numbers of cysts almost always have type I cysts.20 Histological risk factors for breast cancer have been reported to be more common with type I cysts21 and the few data available relating cyst type to breast-cancer risk have suggested that cancer might be more common in patients with such cysts.13, 14, 21
We aimed to assess prospectively in a large series of women with palpable breast cysts whether the risk of development of breast cancer was higher than in the normal population, and whether particular groups of women with cysts were at a higher risk of breast cancer than others.
Section snippets
Patients
1374 women with palpable breast cysts attending the Edinburgh Breast Unit in 1981–87 were studied. The Edinburgh Breast Unit is the only breast referral centre in Edinburgh and covers the population of Edinburgh, East and West Lothian, West Fife, and the Borders. This clinic is the first that patients attend and these 1374 women represented all new referrals with palpable cysts to the Unit during the study period. All patients had a full clinical assessment done by two doctors at the first
Results
74 invasive breast cancers developed in the study population. Seven of these developed before first cyst aspiration. From case notes and pathology records, two further patients were identified as having intracystic cancers. These nine patients were excluded from subsequent analyses and 65 cancers were analysed. Median follow-up was 5·0 years (range 0·04–12·4) in patients who developed cancer and 9·6 years (6·0–14·1) in those who did not.
The overall incidence of breast cancer in patients with
Discussion
Several studies have assessed the relation between palpable breast cysts and breast cancer. Early studies investigated the frequency with which breast cysts were found in breasts removed because of carcinoma.25 Since cystic disease affects a younger age-group than breast cancer, any cysts that precede breast cancer are likely to have disappeared by the time a cancer develops, and, therefore, any conclusions based on these studies are unreliable. Several authors have reported on series of
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2013, Journal of ProteomicsCitation Excerpt :One of the most relevant problems in breast cancer prevention is how to identify the women who might be at higher risk of developing this disease and, therefore, who might gain the greatest benefit from periodic surveillance with new imaging technologies or from chemoprevention measures. Gross cystic disease of the breast (GCDB) is a common benign disease of the mammary gland, affecting some 7% of women in Western countries [1]. It is associated with a 2–4 fold increased risk of developing breast cancer, probably as a consequence of the evolution of the proliferative epithelial changes which are commonly associated with this benign condition [2].