Benign breast disease and breast cancer.

to the editor: The article on the risk of cancer in patients with benign breast disease by Hartmann et al. (July 21 issue) 1 contains some questionable assumptions. “Atypical ductal hyperplasia” and “lobular hyperplasia,” shown in Figure 1E and Figure 1F of the article, do not belong in the category of benign breast disease. Experienced pathologists know that the differentiation of the so-called atypical ductal hyperplasia from an intraductal carcinoma of the breast is extremely difficult in most cases and impossible in some. 2 Lobular hyperplasia, shown in Figure 1F, is closely related to lobular carcinoma in situ, recognized for generations as a precursor lesion of breast cancer. 3 Thus, these two types of lesions should be classified as precursors of mammary carcinoma, as demonstrated by a much higher rate of subsequent breast cancer in patients with these lesions than in patients with truly benign disorders. One would have expected an even higher rate of cancer in patients who were apparently not treated, except for excision of the lesion. The issue of lesion classification and risk is even more important if this information is shared with patients, as suggested by Elmore and Gigerenzer, in the accompanying editorial. 4