Upgrade of high-risk breast lesions detected on mammography in the Breast Cancer Surveillance Consortium

Tehillah S. Menes, Robert Rosenberg, Steven Balch, Shabnam Jaffer, Karla Kerlikowske, Diana L Miglioretti

Research output: Contribution to journalArticle

42 Scopus citations


Background Upgrade rates of high-risk breast lesions after screening mammography were examined. Methods The Breast Cancer Surveillance Consortium registry was used to identify all Breast Imaging Reporting and Data System category 4 assessments followed by needle biopsies with high-risk lesions. Follow-up was performed for all women. Results High-risk lesions were found in 957 needle biopsies, with excision documented in 53%. Most (n = 685) were atypical ductal hyperplasia (ADH), 173 were lobular neoplasia, and 99 were papillary lesions. Upgrade to cancer varied with type of lesion (18% in ADH, 10% in lobular neoplasia, and 2% in papillary lesions). In premenopausal women with ADH, upgrade was associated with family history. Cancers associated with ADH were mostly (82%) ductal carcinoma in situ, and those associated with lobular neoplasia were mostly (56%) invasive. During a further 2 years of follow-up, cancer was documented in 1% of women with follow-up surgery and in 3% with no surgery. Conclusions Despite low rates of surgery, low rates of cancer were documented during follow-up. Benign papillary lesions diagnosed on Breast Imaging Reporting and Data System category 4 mammograms among asymptomatic women do not justify surgical excision.

Original languageEnglish (US)
Pages (from-to)24-31
Number of pages8
JournalAmerican Journal of Surgery
Issue number1
StatePublished - Jan 2014



  • Atypical ductal hyperplasia
  • Atypical lobular hyperplasia
  • High-risk breast lesions
  • Lobular neoplasia
  • Papillary lesions
  • Upgrade

ASJC Scopus subject areas

  • Surgery

Cite this