Does Atypical Hyperplasia Increase Breast Cancer Risk?

Does Atypical Hyperplasia Increase Breast Cancer Risk?


Dr. Jay K. Harness: Does atypical lobular hyperplasia
increase the risk of a future breast cancer? Let me share with you some important information
on this subject. Atypical hyperplasia, what is that? Well,
the cells that line the inside of the ducts of the breast and also the cells that line
the inside of the lobules of the breast can begin to change and those changes are often
called atypical meaning they don’t look like the normal cells. Now, there are around 1
million breast biopsies performed in the United States each year and around 10% of the time,
a diagnosis of atypical lobular hyperplasia or atypical ductal hyperplasia was made. Usually,
this is from a needle core biopsy and also usually a recommendation is made or an excisional
biopsy to make sure that we are not missing an underlying cancer. The incidence of called
underlying cancer is usually quite low. Now, in the early January issue from New England
Journal of Medicine was a very special article published in 2015 on this very subject of
atypical hyperplasia. It comes from Dr. Lynn Hartman and colleagues at the Mayo Clinic
in Rochester Minnesota. This is really an important overview article. They get into
the subject of atypical hyperplasia of the breast in greater depth that I have seen in
the long time. The bottom line of the paper is that indeed there is an increased risk
of a future breast cancer with either atypical ductal hyperplasia or atypical lobular hyperplasia
that increase risk is around 30% at 25 years. Now, what should we do about that? Well, if
you have that diagnosis in particularly if you have that diagnosis associated with a
positive family history for breast cancer, then there is no doubt in my mind that you
need to be seen and evaluated at a multidisciplinary center and likely your annual screening should
include breast MRI. The national standards for using breast MRI now are at lifetime risk
of 20 to 25% or greater and clearly that’s the case with atypical ductal or atypical
lobular hyperplasia of the breast. Now, if you had an extremely strong family history,
but you are gene negative, then perhaps even a recommendation for preventative mastectomies
might be made. Now, there have been prevention trials around for several years conducted
both here in the United States and in Europe that we have looked at the effectiveness of
using drugs like tamoxifen, raloxifene, and exemestane as a way of lowering the subsequent
risk of future breast cancer if in fact you have atypical changes that lowering of the
risk is probably around 33% plus or minus a little bit. The difficulty with these regimens
is that the side effects of tamoxifen, raloxifene, or the exemestane may turn women off from
wanting to be on the preventative programs, but clearly the preventative programs work,
so the bottom line is if you have a diagnosis of either atypical ductal hyperplasia or atypical
lobular hyperplasia, please be seen and evaluated by a multidisciplinary breast center. Also,
consider adding or having them considering adding breast MRI to your routine screening.
Also, potentially consider being on a preventative medication to do what’s called chemoprevention.
The bottom line is in view your risk of future breast cancer is increased be proactive and
take the appropriate steps to deal with that issue. Dr. Michael Alvarado: Did you know that not
every breast cancer patient needs chemotherapy? In fact today, there is a way to identify
whether or not you would benefit from that chemotherapy based on the biology of your
tumor. To learn more about the Oncotype DX assay and how to discuss the results with
your physician, just press this button.

3 comments

  1. Does Atypical Hyperplasia Increase Breast Cancer Risk?

    1 million breast biopsies are performed in the United States every year. Around 10% are diagnosed with atypical hyperplasia. But what is atypical hyperplasia?

    Atypical hyperplasia are cells that line the inside of the ducts of the breast. The cells that line the inside of the lobules of the breast can begin to change. Those changes are often called atypical, meaning they don’t look like the normal cells.

    But does atypical hyperplasia affect you cancer risk? Our Medical Director Dr. Jay Harness explains if an atypical hyperplasia can increase your breast cancer risk in the future.

    #BreastCancer   #Cancer  #Hyperplasia

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