A 35-year-old woman undergoes excisional biopsy of a breast mass showing sclerosing adenosis, apocrine metaplasia, and ductal hyperplasia without atypia. What is her relative risk for subsequent invasive breast carcinoma compared to the general population?

• A Moderately increased risk (~1.5–2x) — proliferative disease without atypia ✓
• B No increased risk (relative risk = 1)
• C Slightly increased risk (~1.5–2x) — non-proliferative disease with sclerosing adenosis
• D Markedly increased risk (~4–5x) — atypical ductal hyperplasia

Explanation

The Dupont and Page classification stratifies benign breast lesions by cancer risk. Sclerosing adenosis and ductal hyperplasia without atypia fall under 'proliferative disease without atypia,' carrying a slightly increased relative risk of approximately 1.5–2x compared to the general population. Non-proliferative lesions (cysts, mild hyperplasia, apocrine metaplasia alone) confer no increased risk. Atypical ductal hyperplasia (ADH) elevates risk to 4–5x, and LCIS/DCIS in situ lesions carry substantially higher risks.

Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.