Obesity in high-risk peri- and post-menopausal women is associated with increased cytological abnormalities in random periareolar frine needle aspiration.

A40

Background: Excessive body weight (body mass index [BMI (kg/m²) > 25) is consistently associated with post-menopausal breast cancer, and increases the risk of death from this disease. While previous studies have explored associations between body weight and indirect biomarkers associated with disease risk, few have explored associations between body weight status and direct measures on target tissue. Methods: The correlation between epithelial cytology and BMI was assessed in 62 high-risk peri- and post-menopausal women from the Duke University high-risk cohort using Random Periareolar Fine Needle Aspiration (RPFNA). RPFNA is a research technique developed to repeatedly sample mammary epithelial cells in high risk women; the presence of atypia in RPFNA has been prospectively validated to confer a 5.6-fold increase in short-term risk for breast cancer [Fabian, et al. JNCI, 2000]. Women were required to have either a: 1) 5-year Gail risk calculation > 1.7; 2) prior biopsy exhibiting atypical hyperplasia, lobular carcinoma in situ (LCIS), or ductal carcinoma in situ (DCIS); or 3) known or suspected BRCA1/2 mutation carrier. RPFNA cytology specimens were stratified using the Masood Cytology Index score: ≤10, non-proliferative (normal); 11-13, hyperplasia, 14-16 atypia; >17 suspicious cytology. The number of epithelial cells was quantitated and classified as <10 cells (insufficient quantity for cytological analysis), 10-100 cells, 100-500 cells, 500-1,000 cells, 1,000-5,000 cells, and >5,000 cells. Masood Cytology Index scores and cell count were assigned by a single dedicated pathologist who was blinded with regard to body weight status. The correlation between increased body mass index (BMI) and epithelial cytology was tested in these 62 high-risk peri- and post-menopausal women. Results: Masood Cytology Index scores were significantly higher (p=0.017) in women with BMIs > 25 (13.9 + 0.4) than in women with BMIs < 25 (12.7 + 0.3). In addition, women with BMIs> 25 also had significantly higher RPFNA cell counts than women whose BMIs were less than 25. Conclusions: These findings suggest that overweight and obesity in high-risk peri- and post-menopausal women is associated with increased cytological abnormalities in RPFNA as assessed by the Masood Cytology Index.