Micropapillary patterns of apocrine change in human female breasts are common histological findings. They have been identified as cancer associated and implicated as an indicator of cancer risk in a predictive manner. This study has stratified papillary apocrine change (PAC) into categories of increasing complexity using a combination of cytological and histological pattern rules. Cases (2,876) were identified in a review of 10,357 benign breast biopsies. Of 5966 women, 1613 and PAC and were followed for a median of 20 years after biopsy for the development of invasive carcinoma of the breast. There was a slight association with cancer risk elevation, but most of this disappeared when women with concurrent, specifically identified patterns of atypical hyperplasia (AH) were excluded from the groups with PAC. The resultant relative risk was only 1.2 after women with AH were excluded. Only 1% of the reviewed biopsies demonstrated highly complex patterns of PAC, and 20% of these had coexistent lesions of AH. Women with highly complex patterns of PAC without AH did experience a relative risk of 2.4 (95% confidence interval = 0.77-7.04) but without statistical significance. More than one-half of all PAC patterns occurred without concurrent foci of lesions of proliferative disease that are associated with a slight elevation of breast cancer risk (at least 1.5 times); when present without proliferative disease, there was no suggestion of later breast cancer risk for PAC.