What is Atypical Breast Hyperplasia?
The Atypical breast hyperplasia is a benign (non-cancerous) lesion characterized by an increased number of cells in an area of the breast. Some of these cells show atypical features, that is, they deviate from their normal morphology.
Depending on the lesion’s location, there are two types:
- Atypical Ductal Hyperplasia - ADH: Occurs inside the milk ducts, the small tubes that carry milk to the nipple.
- Atypical Lobular Hyperplasia - ALH: It comes from the lobules of the breast, where milk is produced.
In atypical porogenic hyperplasia, the cells resemble those of carcinoma in situ, but without being cancer. In atypical lobular hyperplasia, a corresponding increase in atypical cells is observed in the lobules.
Is Atypical Hyperplasia Linked to Breast Cancer?
Yes, the Atypical Hyperplasia is considered increased risk factor for development breast cancer in the future. Specifically:
- The risk of cancer increases by about 4 times compared to women who do not have atypical lesions.
- Over a 30-year period, the risk of developing malignancy is approximately 35%.
- In positive women family history of breast cancer, the risk is even greater, with a slightly higher relative risk for premenopausal women with ALH.
How is Atypical Hyperplasia Diagnosed?
Atypical hyperplasia usually does not cause symptoms and is detected in preventive control via:
- Mammography, with a typical finding being the presence calcifications.
- Core needle biopsy of the calcification area.
Histological analysis of the tissue confirms the diagnosis.
How is Atypical Breast Hyperplasia Managed?
Management varies by type:
- Atypical ductal hyperplasia (ADH): Recommended surgery Biopsy for complete removal and examination of a larger section of tissue, as in approximately 20% of cases, the initial diagnosis of atypical ductal hyperplasia (ADH) underestimates the presence of concomitant carcinoma in situ or invasive cancer, especially when the biopsy has been done with a cutting needle.
- Atypical lobular hyperplasia (ALH): When no other lesions coexist, the probability of underestimation is low (5%), and close monitoring may be recommended instead of surgery.
Surveillance and Prevention
Women with atypical hyperplasia are included in a program close monitoring with regular imaging tests. In selected cases, prophylactic hormone therapy (such as tamoxifen or aromatase inhibitors) may be recommended to reduce the risk of cancer. The decision is made on an individual basis, based on history, type of lesion, and tolerance to treatment.
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- Marshall LM, Hunter DJ, Connolly JL, Schnitt SJ, Byrne C, Colditz GA. Risk of breast cancer associated with atypical hyperplasia of lobular and ductal types. Cancer Epidemiol Biomarkers Prev. 1997 May;6(5):297-301.
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