Atypical hyperplasia of the breast

Introduction

Sometimes, when doctors perform a biopsy to check for breast cancer, they don't find it. But they may find a condition that may be a sign that you're at increased risk of developing breast cancer in the future. One such breast finding is a condition called atypical hyperplasia, in which too many cells line the wall of a milk duct or lobule and no longer look like normal cells.

Atypical hyperplasia is generally regarded as a precancerous condition. It isn't cancer, but it can be a forerunner to the development of cancer. Over the course of your lifetime, if the cells keep dividing and become more abnormal, the condition is reclassified as carcinoma in situ or noninvasive cancer.

If you have atypical hyperplasia, your risk of eventually developing breast cancer is about four to six times greater than is the risk for a woman who doesn't have the condition.

Signs and symptoms

Atypical hyperplasia can only be diagnosed with a biopsy — a test where a tissue sample is removed and sent for laboratory analysis — to evaluate an abnormal area seen on a mammogram, a new lump or area of thickening, or a nipple change. Atypical hyperplasia is usually an incidental finding of the biopsy results. Because of this, there are no signs or symptoms specific to atypical hyperplasia.

Causes

Atypical hyperplasia is a condition where breast cells are abnormal in number, size, shape, appearance and growth pattern. Location of the abnormal cells within the breast tissue — the lobules or the milk ducts — determines whether the cells are atypical lobular hyperplasia or atypical ductal hyperplasia.

Breast cancer is characterized by the overgrowth of abnormal cells, a multistep process called carcinogenesis. The process begins when normal cell development and growth become disrupted, causing an overproduction of normal-looking cells (hyperplasia). Atypical hyperplasia occurs when the excess cells stack upon one another and begin to take on an abnormal appearance. The abnormal cells can continue to change in appearance and multiply, evolving into noninvasive (in situ) cancer, in which cancer cells remain confined to the area where they start growing. Left untreated, the cancer cells may eventually become invasive cancer, invading surrounding tissue, blood vessels or lymph channels.

Researchers aren't sure exactly what causes the progression from normal cells to hyperplasia to atypical hyperplasia to in situ and invasive cancer.

With atypical hyperplasia, excess normal cells stack upon one another and begin to take on an abnormal appearance. The abnormal cells can continue to change in appearance and multiply, evolving into noninvasive (in situ) cancer or, eventually, invasive breast cancer.

When to seek medical advice

Since you won't notice any signs or symptoms that could indicate the presence of atypical hyperplasia, it's important to have regular checkups, including mammograms and clinical breast exams, to monitor your breast health.

Any time you do notice a change in your breasts, such as a lump, an area of puckered or otherwise unusual skin, a thickened region under the skin, or a nipple discharge, contact your doctor promptly to have it evaluated. Such breast changes could be indicators of more-serious problems, including breast cancer.

Screening and diagnosis

Atypical hyperplasia is usually discovered after a biopsy to evaluate a suspicious area in your breast. During the biopsy, tissue samples are removed and sent for analysis by a specially-trained doctor (pathologist). When the pathologist examines the tissue samples under a microscope, he or she identifies atypical hyperplasia, if it's present.

A diagnosis of atypical hyperplasia often leads to a surgical biopsy (wide local excision or lumpectomy) to remove all of the affected tissue. The pathologist looks at the larger specimen for evidence of in situ or invasive cancer.

Treatment

Atypical hyperplasia is generally treated with surgery to remove the abnormal cells and to make sure no in situ or invasive cancer is also present in the area. However, because atypical hyperplasia increases your risk of developing breast cancer, long term monitoring and employing breast cancer prevention strategies may be in order.

Observation
Careful monitoring increases your chances of early detection and successful treatment, should you develop breast cancer. This may include:

• Monthly breast self-exams to develop breast familiarity and to detect any unusual breast changes
• Clinical breast exams by your health care provider at least twice a year
• Screening mammograms every year
• Screening breast magnetic resonance imaging (MRI), depending on other risk factors, such as a strong family history or a genetic predisposition to breast cancer

Breast cancer risk reduction
To reduce your risk of developing breast cancer, your doctor may recommend that you:

• Take preventive medications. Treatment with a selective estrogen receptor modulator (SERM), such as tamoxifen (Nolvadex) or raloxifene (Evista) for five years inhibits the action of estrogen in your breast tissue. These drugs block estrogen from binding to estrogen receptors in breast tissue. Estrogen fuels breast cancer growth.

• Avoid menopausal hormone therapy and herbal treatments. Researchers have concluded that combination hormone therapy to treat symptoms of menopause — estrogen plus progestin — increases breast cancer risk in postmenopausal women. Many breast cancers depend on hormones for growth. This same relationship between estrogen and increased cancer risk may exist for atypical hyperplasia.

  Little is known about the safety of herbal supplements, which many women use to relieve menopausal symptoms. However, some herbal supplements work like estrogen in your body and could increase the risk of breast cancer.

• Participate in a clinical trial. Clinical trials test new treatments, not yet available to the public at large, that may prove helpful in reducing breast cancer risk associated with atypical hyperplasia. Ask your doctor if you're a candidate for any clinical trials, based on your particular situation.

• Consider preventive (prophylactic) mastectomy. For women at very high risk of breast cancer, preventive mastectomy — surgery to remove one or both breasts — reduces the risk of developing breast cancer in the future. You might be considered at very high risk of breast cancer if you have a genetic mutation in one of the breast cancer genes or you have a strong family history of breast cancer that suggests a likelihood of having such a genetic mutation.

  But this surgery isn't right for everyone. Discuss with your doctor the risks, benefits and limitations of this risk-reducing surgery in light of your personal circumstances. If you have a strong family history of breast cancer, you might benefit from also meeting with a genetic counselor to evaluate your risk of carrying a genetic mutation and the role of genetic testing in your situation.