THE PRESENCE OF PROLIFERATIVE BREAST DISEASE WITH ATYPIA DOES NOT SIGNIFICANTLY INFLUENCE OUTCOME IN EARLY-STAGE INVASIVE BREAST-CANCER TREATED WITH CONSERVATIVE SURGERY AND RADIATION

Purpose: To evaluate the influence of the benign background breast-tis sue change of atypical hyperplasia (AH) on outcome in patients with ea rly-stage invasive breast cancer treated with conservative surgery and radiation. Materials and Methods: Four hundred and sixty women with S tage I-II breast cancer treated with conservative surgery and radiatio n from 1982-1994 had pathologic assessment of their background adjacen t benign breast tissue. The median follow-up was 5.6 years (range 0.1- 15). The median age was 55 years (range 24-88). Of these, 23% had posi tive axillary nodes; 25% received adjuvant chemotherapy (CMF or CAF) w ith (9%) or without (17%) tamoxifen. Of the total, 24% received adjuva nt tamoxifen alone. The patients were divided into 2 groups: 131 patie nts with atypical hyperplasia (ductal, 99 patients; lobular, 20 pts; a nd type not specified, 12 pts), and 329 patients with no proliferative changes or proliferative changes without atypia. Result: A statistica lly significant difference was observed between the 2 groups for metho d of detection, primary tumor size, presence of lobular carcinoma in s itu (LCIS), pathologic nodal status, region(s) treated with radiation, and type of adjuvant therapy. Patients with atypical hyperplasia (AH) had smaller primary tumors (T1 80% vs. 70%) more often detected solel y by mammography (51% vs. 36%) with negative axillary nodes (87% vs. 7 3%) and radiation treatment to the breast only (93 % vs. 78%). LCIS wa s observed in 9% of the patients with AH and 3% of those without AH. P atients with AH more often received tamoxifen alone (32% vs. 21%), rat her than chemotherapy (15% vs. 29%). There were no statistically signi ficant differences between the 2 groups for race, age, menopausal stat us, family history, histology, histologic subtype DCIS when present, t he presence or absence of an extensive intraductal component, final ma rgin status, estrogen or progesterone receptor status, use of re-excis ion, or total radiation dose to the primary. The 5- and 10-year actuar ial ipsilateral breast tumor recurrence rates were 2% and 12% for pati ents with AH and 4% and 8% for those without AH (p = 0.44). Younger wo men or those with a positive family history of breast cancer with AH d id not have an increased rate of breast failure when compared to simil ar patients without AH. There were no significant differences in the 5 - and 10-year actuarial rates of distant metastases (AH 5- and 10-year 7% and 7%, no AH 5- and 10-year 8% and 16%, p = 0.31), regional node recurrence (AH 1% and 1%, no AH 1% and 1%,p = 0.71), contralateral bre ast cancer (AH 3% and 3%, no AH 3% and 8%,p = 0.71), overall survival (AH 95% and 86%, no AH 95% and 89%, p = 0.79), or cause-specific survi val (AH 98% and 95%, no AH 96% and 91%, p = 0.27). Subset analysis for ipsilateral breast tumor recurrence, distant metastases, overall, and cause-specific survival for T1 vs. T2 tumors and path node negative v s. path node-positive patients revealed no significant differences bet ween the 2 groups. Conclusion: AH was not associated with an increased risk of ipsilateral breast tumor recurrence or contralateral breast c ancer in this study of patients with invasive breast cancer treated wi th conservative surgery and radiation. Therefore, the presence of prol iferative changes with atypia in background benign breast tissue shoul d not be a contraindication to breast-conservation therapy. (C) 1998 E lsevier Science Inc.