Atypical hyperplasia of the breast
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Atypical hyperplasia is a precancerous condition affecting breast cells, characterized by the presence of abnormal cells in the milk ducts and lobules. While not cancer itself, atypical hyperplasia heightens the risk of developing breast cancer. If these abnormal cells continue to accumulate and become more irregular over time, there is a potential progression to noninvasive breast cancer (carcinoma in situ) or invasive breast cancer.
Individuals diagnosed with atypical hyperplasia face an elevated risk of future breast cancer development. As a preventive measure, healthcare professionals often recommend rigorous breast cancer screening and may prescribe medications aimed at reducing the risk of breast cancer.
Symptoms
Typically, atypical hyperplasia does not manifest specific symptoms, making it challenging to identify without medical examination. If any concerns or signs trouble you, it is advisable to schedule an appointment with your doctor promptly. This condition is often detected during a breast biopsy conducted to investigate anomalies found on mammograms or ultrasounds. Occasionally, atypical hyperplasia is uncovered during a biopsy performed to explore various breast concerns, such as lumps or nipple discharge.
Causes
The development of atypical hyperplasia in the breast is not fully understood. This condition arises when there are abnormalities in the number, size, shape, growth pattern, and appearance of breast cells. The specific type of atypical hyperplasia is determined by the appearance of the abnormal cells, which can manifest as either atypical ductal hyperplasia within the breast ducts or atypical lobular hyperplasia within the breast lobules.
Atypical hyperplasia is viewed as a component of the complex cellular transitions that could potentially lead to the onset of breast cancer. The progression to breast cancer typically involves the following stages:
- Hyperplasia: The disruption of normal cell development and growth results in an overproduction of normal-looking cells, a condition known as hyperplasia.
- Atypical hyperplasia: Excess cells accumulate and start to exhibit abnormal characteristics.
- Noninvasive (in situ) cancer: The abnormal cells continue to progress in appearance and multiply, evolving into in situ cancer. In this stage, cancer cells remain confined to the milk ducts.
- Invasive cancer: The abnormal cells further accumulate within the duct, continue to multiply, and transform into cancer cells. Invasive cancer is characterized by the invasion of surrounding tissues, blood vessels, or lymph channels.
Diagnosis
Atypical hyperplasia is typically identified following a biopsy conducted to assess a suspicious area detected during a clinical breast examination or through imaging tests like mammograms or ultrasounds. In the case of atypical hyperplasia diagnosis, your physician may advise surgery to extract a more extensive tissue sample for the detection of potential breast cancer. This could involve a surgical biopsy such as wide local excision or lumpectomy, aiming to remove all affected tissue. Subsequently, a pathologist examines the larger specimen to determine the presence of in situ or invasive cancer.
Treatment
- Surgical intervention: Treatment for atypical hyperplasia typically involves surgical removal of abnormal cells, ensuring the absence of in situ or invasive cancer in the area. Physicians commonly advise heightened breast cancer screening and may prescribe medications to mitigate the risk of breast cancer.
- Follow-up tests: Your doctor may suggest various screening options for early breast cancer detection:
- Regular self-exams for breast awareness
- Annual clinical breast exams by healthcare providers
- Yearly screening mammograms
- Additional screening tests like breast magnetic resonance imaging (MRI) or molecular breast imaging based on individual risk factors.
- Risk reduction measures: To minimize the risk of breast cancer, consider the following recommendations from your doctor:
- Use of preventive medications: Selective estrogen receptor modulators (e.g., tamoxifen or raloxifene) may be prescribed for five years to block estrogen’s influence on breast tissue.
- Avoidance of menopausal hormone therapy, especially estrogen plus progestin.
- Participation in clinical trials testing new treatments for reducing breast cancer risk associated with atypical hyperplasia.
- Consideration of prophylactic mastectomy: For individuals with a very high risk of breast cancer, a risk-reducing mastectomy (removal of one or both breasts) may be discussed as an option. Genetic mutations or a strong family history may contribute to this decision. However, it is crucial to thoroughly discuss the risks, benefits, and personal circumstances with your doctor.
- Genetic counseling: If there’s a strong family history of breast cancer, meeting with a genetic counselor may help assess the risk of carrying genetic mutations and the role of genetic testing.
- Healthy lifestyle choices: Implementing healthy lifestyle habits can contribute to overall breast health:
- Regular exercise most days of the week
- Maintaining a healthy weight
- Avoiding smoking
- Limiting alcohol intake, if choosing to consume.
