Research table: Hyperplasia and breast cancer risk

This summary table contains detailed information about research studies. Summary tables are a useful way to look at the science behind many breast cancer guidelines and recommendations. However, to get the most out of the tables, it’s important to understand some key concepts. Learn how to read a research table.

Introduction: Hyperplasia is a benign breast condition where some breast cells divide more quickly than normal.

There are 2 types of hyperplasia: usual and atypical.

• With usual hyperplasia, the dividing cells look normal under a microscope.
• With atypical hyperplasia, the dividing cells look abnormal under a microscope.

Studies show both types of hyperplasia are linked to an increased risk of breast cancer. However, women with atypical hyperplasia have a greater increased risk of breast cancer than women with usual hyperplasia.

There are special breast cancer screening guidelines for women with atypical hyperplasia.

Learn more about hyperplasia and breast cancer risk.

Learn more about benign breast conditions.

Learn about the strengths and weaknesses of different types of studies. 

See how this risk factor compares with other risk factors for breast cancer.  

Study selection criteria: Prospective cohort studies and nested case-control studies with at least 300 cases and meta-analyses.

Table note: Relative risk above 1 indicates increased risk. Relative risk below 1 indicates decreased risk.

Study	Study Population (number of participants)	Follow-up (years)		Relative Risk of Breast Cancer in Women with Hyperplasia Compared to Women without Hyperplasia, RR (95% CI)
				Usual Hyperplasia	Atypical Hyperplasia
Prospective cohort studies
Lilleborge et al. [1]	762,643 (21,015 cases)		7-11		2.9 (2.5-3.3)*
Breast Cancer Surveillance Consortium [2-3]	1,279,443 (18,586 cases)		8		Estrogen receptor-positive tumors: 4.47 (2.88-6.96) Estrogen receptor-negative tumors: 0.20 (0.02-2.51)
	955,331 (1,727 cases)		10		2.7 (1.7-4.3)
Visscher et al. [4]	13,485 (1,273 cases)		16	1.94 (1.78-2.12)*	4.18 (3.53-4.90)*
Hartmann et al. [5]	9,087 (707 cases)		15	1.88 (1.66-2.12)	4.24 (3.26-5.41)
Breast Cancer Prevention Trial-NSABP [6]	11,307 (338 cases)		7	1.60 (1.17-2.19)
Study	Study Population (number of participants)			Relative Risk of Breast Cancer in Women with Hyperplasia Compared to Women without Hyperplasia, RR (95% CI)
	Cases		Controls†	Usual Hyperplasia	Atypical Hyperplasia
Nested case-control studies
Dupont et al. [7]	1,925		1,378	1.9 (1.2-2.9)	5.3 (3.1-8.8)
Kabat et al. [8]	615		624	1.45 (1.10-1.90)	5.27 (2.29-12.15)
Nurses’ Health Study and Nurses’ Health Study II [9]	488		1,907	1.6 (1.3-2.1)	4.5 (3.2-6.2)
Sherman et al. [10]	338		4,481		2.99 (2.15-4.18)
Study	Study Population			Relative Risk of Breast Cancer in Women with Hyperplasia Compared to Women without Hyperplasia, RR (95% CI)
				Usual Hyperplasia	Atypical Hyperplasia
Meta-analyses
Dyrstad et al. [11]	15 studies			1.76 (1.58-1.95)
	13 studies				3.93 (3.24-4.76)

* Relative risks estimated from standardized incidence ratios.

† Controls were women who had non-proliferative (without fast-growing cells) benign breast disease.

References

1. Lilleborge M, Falk RS, Russnes H, Sauer T, Ursin G, Hofvind S. Risk of breast cancer by prior screening results among women participating in BreastScreen Norway. Cancer. 125(19):3330-3337, 2019.
2. Kerlikowske K, Gard CC, Tice JA, et al. for the Breast Cancer Surveillance Consortium. Risk factors that increase risk of estrogen receptor-positive and -negative breast cancer. J Natl Cancer Inst. 109(5): djw276, 2016.
3. Menes TS, Kerlikowske K, Lange J, Jaffer S, Rosenberg R, Miglioretti DL. Subsequent breast cancer risk following diagnosis of atypical ductal hyperplasia on needle biopsy. JAMA Oncol. 3(1):36-41, 2017. 
4. Visscher DW, Frost MH, Hartmann LC, et al. Clinicopathologic features of breast cancers that develop in women with previous benign breast disease. Cancer. 122(3):378-85, 2016.
5. Hartmann LC, Sellers TA, Frost MH, et al. Benign breast disease and the risk of breast cancer. N Engl J Med. 353(3):229-37, 2005.
6. Wang J, Costantino JP, Tan-Chiu E, et al. Lower-category benign breast disease and the risk of invasive breast cancer. J Natl Cancer Inst. 96(8):616-20, 2004.
7. Dupont WD and Page DL. Risk factors of breast cancer in women with proliferative breast disease. N Engl J Med. 312(3):146-151, 1985.
8. Kabat GC, Jones JG, Olson N, et al. A multi-center prospective cohort study of benign breast disease and risk of subsequent breast cancer. Cancer Causes Control. 21(6):821-8, 2010.
9. Collins LC, Aroner SA, Connolly JL, Colditz GA, Schnitt SJ, Tamimi RM. Breast cancer risk by extent and type of atypical hyperplasia: An update from the Nurses’ Health Studies. Cancer. 122(4):515-20, 2016.
10. Sherman ME, Vierkant RA, Winham SJ, et al. Benign breast disease and breast cancer risk in the percutaneous biopsy era. JAMA Surg. 159(2):193-201, 2024.
11. Dyrstad SW, Yan Y, Fowler AM, Colditz GA. Breast cancer risk associated with benign breast disease: systematic review and meta-analysis. Breast Cancer Res Treat. 149(3):569-75, 2015.

Updated 06/05/24