Abstract

PIP: This review of the epidemiologic and endocrinologic literature aims to improve understanding of the etiology of premalignant breast disease. Although there are inconsistencies regarding the clinical symptoms defined as benign breast disease, there are 2 major clinical categories: cysts treated by aspiration and solid lesions treated by excision or incision biopsy. A necessary research approach is to determine which patients with benign breast disease have an increased risk of breast cancer and study them to determine whether they carry any endocrine or biologic stigmata. Epithelial hyperplasia is the lesion with greatest premalignant potential. Both population and case-control studies have examined the association between benign breast disease and the risk factors of age, reproductive history, family history of breast cancer, obesity, socioeconomic status, race, oral contraceptive use, and methylxanthines. No clear or consistent endocrine or hormonal abnormalities have been detected in women with benign breast disease. On the other hand, cyst fluid studies have revealed high amounts of androsterone sulfate and DHA-sulfate compared with serum levels. Carcinoembryonic antigen levels are highest in women with fibrocystic disease. At this point, it is unclear whther the progression from normal epithelium through atypia and hyperplasia and then in in situ carcinoma or invasive carcinoma is under hormonal control. Inconsistencies within the research literature may reflect the heterogeneity of conditions encompassed within the benign breast disease category. Since epithelial hyperplasia is likely a forerunner of breast cancer, such patients should be monitored to determine whether they exhibit a consistently abnormal pattern of hormonal production, e.g., subnormal androgen levels or elevation of free estradiol.