Expanding role of breast cytopathology as a risk predictor - Commentary

There are two approaches to the detection and treatment of breast cancer. A lmost all current efforts are focused on improving the detection of small c ancers and their treatment. Breast cancers, even when detected at their sma llest visible size, still carry a substantial risk of claiming the life of a patient. The alternative is to focus on the identification of cancer prec ursor lesions. Effective identification and treatment of precursor lesions would prevent all breast cancer deaths. This requires scientific assessment of the effectiveness of prevention strategies in high-risk women. Certain groups of women are known to be at high risk for development of breast canc er. These include women with a personal and/or family history of previous b reast cancer, women carrying certain genes, and women with atypical hyperpl asia. Detection of atypical hyperplasia by surgical biopsy in a symptomatic population for risk assessment is not practical. The alternative is the us e of noninvasive procedures such as fine-needle aspiration biopsy in order to sample and monitor the earliest changes associated with breast cancer. T his requires adequate recognition of the cytomorphology of breast cancer pr ecursor lesions and the ability to distinguish between prognostically relev ant morphologic alterations and atypias associated with various benign brea st diseases.