Materiały źródłowe

• #1 Atypical Breast Hyperplasia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470258/

  Atypical hyperplasia of the breast is defined as abnormal epithelial proliferative breast lesions that are not qualitatively or quantitatively abnormal enough to be classified as carcinoma in situ. Atypical hyperplasia is a premalignant condition and may occur in either ductal or lobular epithelium. […] This activity describes the evaluation, surveillance, and management of atypical breast hyperplasia and highlights the role of the interprofessional team in the care of affected patients. […] Approximately 10% of female breast biopsies will contain an atypical proliferative lesion, with most of these lesions found in women in their 40s. […] Atypical hyperplasia can also be found in males undergoing reduction mammoplasty for gynecomastia, although it is exceedingly rare. The reported incidence in one cohort of over 5000 specimens is reported to be less than 1%.

• #2 Atypia and lobular carcinoma in situ: High-risk lesions of the breast – UpToDate

  https://www.uptodate.com/contents/atypia-and-lobular-carcinoma-in-situ-high-risk-lesions-of-the-breast

  Atypical hyperplasia (AH) includes both atypical ductal hyperplasia (ADH) and atypical lobular hyperplasia (ALH). […] These lesions are considered high risk because they are associated with an increase in the patient’s future risk of developing breast cancer. […] Therefore, when these high-risk lesions are discovered, the focus should be on careful surveillance and consideration of risk reduction strategies. […] The diagnosis, pathology, and management of patients with ADH, ALH, LCIS, and FEA will be reviewed here.

• #2 Atypical Breast Hyperplasia – MD Searchlight

  https://mdsearchlight.com/womens-health/atypical-breast-hyperplasia/

  Atypical hyperplasia of the breast refers to unusual growth of breast cells that are not quite abnormal enough to be classified as carcinoma in situ, a type of early stage cancer. […] Atypical ductal hyperplasia (ADH), abnormal growth in the milk ducts, is fairly common and is reported to be found in about 5% to 20% of breast biopsies. […] Finding either ADH or ALH in a biopsy can increase the risk of developing DCIS or invasive breast cancer by four to five times. […] About 10% of breast biopsies in females reveal an unusual growth of cells, with the majority of these cases occurring in women in their 40s. […] Atypical hyperplasia, an uncommon type of cell growth, cannot be spotted on imaging scans. However, it can be detected when a breast biopsy or surgical removal of tissue is examined under a microscope.

• #3 Atypia and lobular carcinoma in situ: High-risk lesions of the breast – UpToDate

  https://www.uptodate.com/contents/atypia-and-lobular-carcinoma-in-situ-high-risk-lesions-of-the-breast/print

  Atypia and lobular carcinoma in situ: High-risk lesions of the breast […] Proliferative lesions with atypia include atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), and lobular carcinoma in situ (LCIS). These lesions are considered high risk because they are associated with an increase in the patient’s future risk of developing breast cancer. […] Therefore, when these high-risk lesions are discovered, the focus should be on careful surveillance and consideration of risk reduction strategies. […] Atypical hyperplasia (AH) includes both atypical ductal hyperplasia (ADH) and atypical lobular hyperplasia (ALH).

• #3 Atypical Ductal Hyperplasia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK562244/

  Atypical ductal hyperplasia, due to its lack of imaging findings, is, by definition, an incidental pathology finding. Most frequently, this is found on core needle biopsy; however, it can also be discovered on excisional biopsies, breast oncologic surgeries, cosmetic breast reductions, or any other breast surgery resulting in submitting breast tissue to pathology. The prevalence of atypical ductal hyperplasia in biopsies has been in the 3.5 to 5% range and most frequently found on core needle biopsy.[4] […] Rates of ADH in a large study from 2009 reviewing nearly 31,000 biopsies demonstrated initially increasing rate of diagnosis with the increase in breast cancer awareness, screening mammographies, prophylactic mastectomies, and use of post-menopausal hormonal therapy – resulting in peak diagnosis of ADH in 1999 (5.5 cases per 10,000 mamograms). Since the loss of favor of post-menopausal hormonal therapy, however, there has been a slight decrease in the diagnosis of ADH over time.[3]

• #4 Atypical Ductal Hyperplasia: Breast, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/16242-atypical-ductal-hyperplasia

  Atypical ductal hyperplasia occurs when you have abnormal cells in the milk ducts of your breast. These cells have a higher-than-normal chance of becoming cancerous. A breast biopsy diagnoses it. Your provider may recommend additional mammograms if you have atypical ductal hyperplasia. […] A healthcare provider may find atypical ductal hyperplasia (ADH) in between 5% to 20% of breast biopsies. Its not cancer but increases your risk of breast cancer up to 20% or 30% depending on the types of irregular cells your provider sees, as well as other risk factors like genetics or having a personal or family history of cancer. […] The main complication of ADH is that it increases your risk for breast cancer. Its important to follow your providers treatment plan, which typically involves annual mammograms or other breast cancer screenings.

• #5 Decline in atypical ductal hyperplasia linked to decreased use of post menopausal hormone therapy – ecancer

  https://ecancer.org/en/news/792-decline-in-atypical-ductal-hyperplasia-linked-to-decreased-use-of-post-menopausal-hormone-therapy

  The use of postmenopausal hormone therapy has decreased over time in the United States, which researchers suggest may play a key role in the declining rate of atypical ductal hyperplasia, a known risk factor for breast cancer. […] Atypical ductal hyperplasia is associated with the use of postmenopausal hormone treatment and its rates have decreased with the decline in use of this treatment, said researcher Tehillah Menes, M.D., who was the chief of breast service in the Department of Surgery at Elmhurst Hospital Center, New York, when this study was conducted. […] Previous research has shown that women who are diagnosed with atypical ductal hyperplasia are at a three- to five-fold increased risk of developing breast cancer. […] Between 1996 and 2005, the researchers found that postmenopausal hormone therapy use decreased from 35 percent to 11 percent; atypical ductal hyperplasia decreased from 5.5 per 10,000 mammograms in 1999 to 2.4 in 2005.

• #6 Decline in atypical ductal hyperplasia linked to decreased use of post menopausal hormone therapy – ecancer

  https://ecancer.org/en/news/792-decline-in-atypical-ductal-hyperplasia-linked-to-decreased-use-of-post-menopausal-hormone-therapy

  The rate of atypical hyperplasia declined, which we didn’t expect to see with the increased use of mammography to identify abnormal lesions, said researcher Karla Kerlikowske, M.D., professor of medicine and epidemiology and biostatistics at the University of California, San Francisco. […] Findings also showed that when atypical ductal hyperplasia is diagnosed with an associated breast cancer, it is usually not an aggressive type of cancer. […] These findings help clarify the different pathways to the development of breast cancer and the role of postmenopausal hormone treatment in increasing the rates of breast cancer, Menes concluded.

• #7 Atypical Ductal Hyperplasia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK562244/

  Typical patients are females in their fifth to sixth decade of life, as this is the population most likely to be undergoing breast biopsies. Males are also susceptible to atypical ductal hyperplasia, although diagnosis is less common. One Dutch study analyzing over 5,000 cases of excised breast tissue for gynecomastia in males found a prevalence of 0.4% of atypical ductal hyperplasia.[5]

• #8 Atypical cells in a breast lump | Other Conditions | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/breast-cancer/types/atypical-hyperplasia-breast-lump

  Atypical hyperplasia can increase your risk of developing breast cancer in the future. […] Atypical hyperplasia can sometimes develop as the breast changes with age. It can affect women of any age, but is more common in women over 35. […] Atypical hyperplasia is usually found by chance after a routine mammogram or when tissue from a biopsy or breast surgery is looked at under a microscope in the laboratory. […] Your specialist might want you to have follow up appointments. These may include clinic visits and a mammogram every one to two years. How often, and for how long, you go for follow-up appointments will depend on your situation.

• #9 Pathology Outlines – Atypical ductal hyperplasia

  https://www.pathologyoutlines.com/topic/breastadh.html

  Epidemiology […] – F > M (rare incidental finding in gynecomastia) […] – Commonly presents in fourth decade […] – 5 – 20% of breast biopsies (StatPearls: Atypical Breast Hyperplasia [Accessed 19 November 2019]) […] – Reduction of postmenopausal hormonal therapy linked to decreased rates (Cancer Epidemiol Biomarkers Prev 2009;18:2822) […] – 4 – 5x risk of developing ductal carcinoma in situ within 5 years (Cancer Prev Res (Phila) 2014;7:211) […] – Absolute risk of breast cancer is approximately 1% per year for at least 25 years, with a mean latency period of 8 – 12 years after initial diagnosis […] – Recent radiological pathological concordance series have shown that biopsy diagnosed atypical ductal hyperplasia (ADH) has an upgrade rate of 10 – 20% to DCIS or invasive carcinoma

• #10 Case: Atypical Ductal Hyperplasia – Radiology | UCLA Health

  https://www.uclahealth.org/departments/radiology/education/breast-imaging-teaching-resources/cases/atypical-ductal-hyperplasia

  Atypical ductal hyperplasia (ADH) is a non-malignant but high-risk lesion associated with progression to more advanced neoplasms including ductal carcinoma in situ (DCIS) and invasive carcinoma, and as a marker for the development of additional breast cancer. Approximately 3-5% of female breast biopsies will contain ADH, with most lesions found in women in their 40s due to the onset of screening mammograms. […] Although quite rare, ADH can also be seen in the male breast, with prevalence of ADH in males with gynecomastia cited to be less than 1%. […] Studies suggest surgical upgrade rates to DCIS or invasive carcinoma of up to 22-65% for biopsy-proven ADH. Thus, surgical excision is recommended for cases of ADH found on core needle biopsy. Ongoing research is being performed to identify which subtypes of lesions are associated with surgical upgrades. Thus, in the future, we might be able to stratify patients with biopsy-proven ADH into those who require surgical excision, or those who can be monitored over time without the need for excisional biopsy. However, such research is limited in scope at this time, and surgical excision for all cases of ADH on core needle biopsy is currently recommended. The prognosis usually depends on the final excisional biopsy results.

• #11 Atypical Hyperplasia of the Breast: The Black Hole of Routine Breast Cancer Screening | Anticancer Research

  https://ar.iiarjournals.org/content/32/12/5441

  Aim: Determination of the prevalence, of the radiological and clinical characteristics, and outcome of atypical hyperplasia (AH) of the breast within a population subjected to routine screening (double-view mammography with double reading, performed every two years between 50 and 75 years of age). […] AH incidence in the population was 0.19 with the following distribution of lesions: atypical epithelial hyperplasia (AEH, 53%), columnar cell metaplasia with atypia (CCMA, 32%), and lobular intraepithelial neoplasia (LIN, 8%). […] The main radiological finding was the presence of microcalcifications for AEH and CCMA lesions in particular, and the mammograms were valid (correlation between American College of Radiology score and risk of lesion, only 3% of lesions were recognized on the second reading).

• #12 Stratification of Breast Cancer Risk in Women With Atypia: A Mayo Cohort Study

  https://escholarship.org/uc/item/1x09g8kj

  Atypical hyperplasia is a well-recognized risk factor for breast cancer, conveying an approximately four-fold increased risk. […] With mean follow-up of 13.7 years, 66 breast cancers (19.9%) occurred among 331 women with atypia. […] RR of breast cancer with atypia was 3.88 (95% CI, 3.00 to 4.94). […] Marked elevations in risk were seen with multifocal atypia (eg, three or more foci with calcifications [RR, 10.35; 95% CI, 6.13 to 16.4]). […] Risk was similar for atypical ductal and atypical lobular hyperplasia, and family history added no significant risk. […] Breast cancer risk remained elevated over 20 years, and the cumulative incidence approached 35% at 30 years. […] Among women with atypical hyperplasia, multiple foci of atypia and the presence of histologic calcifications may indicate „very high risk” status ( 50% risk at 20 years). A positive family history does not further increase risk in women with atypia.

• #13 Atypical hyperplasia of the breast: Clinical cases and management strategies | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/90/7/423

  Atypical hyperplasia of the breast is a histopathologic lesion identified incidentally on image-guided breast biopsy. It is associated with a substantial increase in lifetime risk for breast cancer. Clinicians should counsel women with atypical hyperplasia regarding risk-reducing strategies, which include preventive endocrine therapy options, enhanced surveillance imaging, and lifestyle modifications. […] Atypical hyperplasia of the breast is a high-risk benign breast lesion that carries an increased lifetime risk for invasive breast cancer. For women with atypical hyperplasia, the cumulative breast cancer risk is approximately 1% per year. […] The American Cancer Society recommends magnetic resonance imaging (MRI) breast screening for patients with a calculated lifetime breast cancer risk of at least 20% based on IBIS.

• #14 Atypia detected during breast screening and subsequent development of cancer: observational analysis of the Sloane atypia prospective cohort in England | The BMJ

  https://www.bmj.com/content/384/bmj-2023-077039

  Atypia refers to the histopathological diagnosis of cytological atypia with or without architectural aberration and is diagnosed in 5-10% of needle biopsies performed as part of the English breast screening programme. […] The presence of atypia has been found to confer a fourfold increased long term risk of subsequent breast cancer over a median follow-up of 15.7 years in a meta-analysis of 13 studies, including a total of 1759 women. […] English guidelines recommend vacuum assisted excision for all atypias (except when associated with a papillary lesion, which requires assessment of the extent in continuity of the atypia) followed by annual mammographic surveillance. […] Annual surveillance imaging is a safety net to ensure no cancers are missed at excision and provide an opportunity for early detection in women at high risk, but this approach is not evidence based.

• #15 Breast Hyperplasia (Ductal or Lobular) | Benign Conditions | American Cancer Society

  https://www.cancer.org/cancer/types/breast-cancer/non-cancerous-breast-conditions/hyperplasia-of-the-breast-ductal-or-lobular.html

  Hyperplasia can affect your risk for breast cancer, but how much depends on what type it is: […] Atypical hyperplasia (either ADH or ALH): The risk of breast cancer is about 4 to 5 times higher than that of a woman with no breast abnormalities. More details about pathology reports showing atypical hyperplasia can be found in Understanding Your Pathology Report: Atypical Hyperplasia. […] Both ADH and ALH are linked to a higher risk of breast cancer. Even though most women with ADH or ALH will not develop breast cancer, it’s still important to talk with a health care provider about your risk and what you can do about it.

• #16 Usual and Atypical Hyperplasia – Breast Cancer Risk

  https://www.komen.org/breast-cancer/facts-statistics/research-studies/topics/hyperplasia-and-breast-cancer-risk/

  Studies show both types of hyperplasia are linked to an increased risk of breast cancer. However, women with atypical hyperplasia have a greater increased risk of breast cancer than women with usual hyperplasia. […] There are special breast cancer screening guidelines for women with atypical hyperplasia. […] 5.3 (3.1-8.8) […] 4.5 (3.2-6.2) […] 3.93 (3.24-4.76)

• #17

  https://link.springer.com/article/10.1007/BF00052748

  The purpose of this paper is to examine critically the evidence that atypical hyperplasia (AH) is a risk factor for breast cancer. […] A total of 18 studies (11 cohort studies, two case-control studies, and five cross-sectional studies) were found that were published in the English language from January 1960 to March 1992 that examined the association of AH as a distinct entity and breast cancer risk. […] A meta-analysis was carried out, based on a total sample size of 182,980 women. Of 16 studies that gave point estimates of risk, 14 exceeded unity and 12 were significantly different from unity. […] The conclusions from the application of the Bradford Hill criteria indicated strongly that AH is a risk factor for breast cancer.

• #18 Long term follow-up of women treated for screen detected atypical ductal hyperplasia or lobular neoplasia in a large UK screening centre | BJC Reports

  https://www.nature.com/articles/s44276-024-00113-2

  Atypical ductal hyperplasia (ADH) and lobular neoplasia (LN) increase subsequent breast cancer (BC) risk. […] However, optimal surveillance and risk reduction regimes remain uncertain. […] In women with ADH/LN most BCs occur beyond 5 years. […] ES regimens should therefore extend to at least 10 years and be at least biennial. […] Preventative therapy should be considered given the high BC SIR and ER positivity of subsequent tumours. […] Women with ADH and LN have 4.7 times the risk of subsequent breast cancer development compared with the general population. […] Most breast cancers occur beyond five years and improved screening strategies, over those reported here, are required. […] Our data suggest optimal screening regimens for women with ADH or LN should extend to at least 10 years and be at a minimum of 2 yearly intervals. […] Women with ADH and LN should also be given the opportunity to take preventive therapy with tamoxifen or anastrozole.

• #19 Navigating breast health: a comprehensive approach to atypical ductal hyperplasia of the breast management and surveillance

  https://www.explorationpub.com/Journals/em/Article/1001205

  Atypical ductal hyperplasia (ADH) is a benign lesion of the breast that is associated with an increased risk of invasive breast cancer. […] Atypical ductal hyperplasia (ADH) is one of the most common high-risk lesions of the breast and confers an increased lifetime risk of developing invasive breast cancer (IBC). […] The management plan for patients diagnosed with ADH includes regular clinical surveillance, diagnostic mammography, along with risk-reduction strategies such as lifestyle modifications or the use of adjuvant endocrine therapies. […] The current recommendation is an excisional biopsy for ADH identified on CNB. […] ADH is associated with a 3 to 5-fold increased relative risk for breast cancer, approximately 1% absolute risk per year for at least 25 years, and a 10-20% absolute lifetime risk of invasive carcinoma development.

• #20 Breast Pre-Cancer Conditions | Atypical Hyperplasia Treatment

  https://www.drnicoleyap.com.au/breast-pre-cancer-conditions/

  Atypical hyperplasia is thought to be part of the complex transition of cells that may accumulate and evolve into breast cancer. […] Once diagnosed with atypical hyperplasia, you have a risk factor that increases your risk of developing breast cancer in the future. The risk of breast cancer in those with atypical hyperplasia is about four times higher than in those who do not have hyperplasia. […] The breast cancer risk with women with atypical hyperplasia increases over time: At 5 years after diagnosis, about 7% of women with atypical hyperplasia may develop breast cancer. Put another way, for every 100 women diagnosed with atypical hyperplasia, 7 can be expected to develop breast cancer five years after diagnosis. And 93 will not be diagnosed with breast cancer. […] At 10 years after diagnosis, about 13% of women with atypical hyperplasia may develop breast cancer. That means for every 100 women diagnosed with atypical hyperplasia, 13 can be expected to develop breast cancer 10 years after diagnosis. And 87 will not develop breast cancer. […] At 25 years after diagnosis, about 30% of women with atypical hyperplasia may develop breast cancer. Put another way, for every 100 women diagnosed with atypical hyperplasia, 30 can be expected to develop breast cancer 25 years after diagnosis. And 70 will not develop breast cancer.

• #21 Menopausal symptom management considerations in patients at high risk for breast cancer – Women’s Healthcare

  https://www.npwomenshealthcare.com/menopausal-symptom-management-considerations-in-patients-at-high-risk-for-breast-cancer/

  Atypical hyperplasia of the breast is a benign (noncancerous) condition in which there is an overgrowth of cells lining the breast ducts or breast lobules. Atypical hyperplasia carries with it a fourfold increase in breast cancer risk and a projected cumulative breast cancer incidence of 30% at 25 years. […] Risk factors such as breast biopsy findings of atypical hyperplasia (ductal/lobular) or lobular carcinoma in situ (LCIS), genetic mutation carriers of high- or moderate-penetrance breast cancer susceptibility genes (ie, BRCA1/2), or those with prior thoracic radiation exposure are so significant that they warrant intervention based on any one of those discoveries alone. […] Collectively, the breast cancer risk factors of atypical hyperplasia, LCIS, having a calculated modified Gail model 5-year risk of 3% or greater, or having a calculated Tyrer-Cuzick model 10-year risk of 5% or greater, are all associated with a recommendation for risk-reducing medications. Risk-reducing medications also are a consideration for risk reduction in BRCA mutation carriers.

• #22 February 25, 2015 – Expect Questions About Atypical Hyperplasia as an Important Risk Factor for Breast Cancer – The ASCO Post

  https://ascopost.com/issues/february-25-2015/expect-questions-about-atypical-hyperplasia-as-an-important-risk-factor-for-breast-cancer/

  The younger a woman is when diagnosed with atypical hyperplasia, the more likely it is that breast cancer will eventually develop over the course of her lifetime. […] A special report in The New England Journal of Medicine concluded that atypical hyperplasia of the breast confers an absolute risk of later breast cancer of 30% at 25 years of follow-up. […] The data are strong enough that we can say that for any woman who has atypical hyperplasia, whether she is younger or older, a general estimate for her risk of developing breast cancer is about 1% per year, Dr. Degnim stated. […] Women with three or more foci of atypical hyperplasia have had a risk of 47% at 25 years, Dr. Degnim said, or about 2% per year. […] Surveillance approaches include looking closer to find a cancer if it is there (ie, MRI in addition to yearly mammography) or looking more frequently (alternating mammography and MRI every 6 months).

• #23 Atypical hyperplasia of the breast | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/breast/what-is-breast-cancer/non-cancerous-conditions/atypical-hyperplasia

  Having atypical hyperplasia increases the risk for breast cancer. This risk is even higher in women who have a family history of breast cancer or who are diagnosed with atypical hyperplasia before they reach menopause. […] The risk of developing breast cancer is greatest 10-15 years after atypical hyperplasia is diagnosed. The risk begins to go down after 15 years. […] Women with atypical hyperplasia should talk to their doctor about a personal plan of testing for breast cancer, including regular mammography. […] Women with atypical hyperplasia should talk to their healthcare team about the benefits and possible risks of taking SERMs to reduce their risk of breast cancer.

• #24 Pathology Outlines – Usual ductal hyperplasia

  https://www.pathologyoutlines.com/topic/breastepithelialductalhyperplasia.html

  Mean age is 54 (N Engl J Med 2005;353:229) […] Most significant finding in 20% of benign breast biopsies (Cancer 2006;106:732) […] Associated with slight increase in subsequent breast cancer risk (1.5 – 2 times) […] Risk may be slightly higher for patients with a positive family history of breast cancer (Cancer 2006;107:1240) […] Indicator of general breast cancer risk rather than direct precursor lesion.

• #25 Atypical Breast Hyperplasia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470258/

  Women should be encouraged to undergo mammogram screening evaluation and breast exams at the currently recommended intervals according to their risk stratification. […] Proper management of patients with this complex disease requires collaboration between radiology, surgery, pathology, and the patient and their primary care team. The current standard of care is to excise high-risk breast lesions due to high upgrade rates on the excision of these breast lesions after a biopsy.

• #26 Atypia and lobular carcinoma in situ: High-risk lesions of the breast – UpToDate

  https://www.uptodate.com/contents/atypia-and-lobular-carcinoma-in-situ-high-risk-lesions-of-the-breast/print

  Atypia and lobular carcinoma in situ: High-risk lesions of the breast […] Proliferative lesions with atypia include atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), and lobular carcinoma in situ (LCIS). These lesions are considered high risk because they are associated with an increase in the patient’s future risk of developing breast cancer. […] Therefore, when these high-risk lesions are discovered, the focus should be on careful surveillance and consideration of risk reduction strategies. […] Atypical hyperplasia (AH) includes both atypical ductal hyperplasia (ADH) and atypical lobular hyperplasia (ALH).

• #27 Atypical hyperplasia of the breast: Clinical cases and management strategies | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/90/7/423

  Because studies show that the lifetime risk of breast cancer is greater than 20% for women with atypical hyperplasia, the role of annual MRI plus mammography surveillance is appropriate. […] The National Comprehensive Cancer Network guidelines for high-risk women include breast awareness, clinical breast examination every 6 to 12 months (minimum 12-month follow-up), annual screening mammography with possible tomosynthesis (not before age 30), and possible annual breast MRI beginning at diagnosis of ALH (not before age 25).

• #28 Navigating breast health: a comprehensive approach to atypical ductal hyperplasia of the breast management and surveillance

  https://www.explorationpub.com/Journals/em/Article/1001205

  According to National Comprehensive Cancer Network (NCCN) recommendations, patients diagnosed with ADH should be offered lifetime surveillance. This includes a clinical breast examination every 6-12 months and an annual digital diagnostic MMO with tomosynthesis beginning at the age of diagnosis of ADH but not prior to the age of 30. […] Due to the high lifetime risk of breast cancer, all patients diagnosed with ADH should be offered lifelong clinical surveillance with clinical breast examination every 6-12 months, annual diagnostic MMO with tomography, and enhanced surveillance with annual MRI.

• #29 February 25, 2015 – Expect Questions About Atypical Hyperplasia as an Important Risk Factor for Breast Cancer – The ASCO Post

  https://ascopost.com/issues/february-25-2015/expect-questions-about-atypical-hyperplasia-as-an-important-risk-factor-for-breast-cancer/

  Dr. Degnim explained that although current screening guidelines do not specifically recommend magnetic resonance imaging (MRI) for women with atypical hyperplasia of the breast, they do recommend MRI as an adjunct to mammography for women who have a lifetime risk of breast cancer of 20% to 25%. […] The risk for women with atypical hyperplasia meets or exceeds that level. […] Because it is not cancer, and even though the data show that 30% of women with atypical hyperplasia developed breast cancer in 25 years, you can look at it the other way around70% of them did not. […] Even among those in whom breast cancer does develop, the report concluded, it can usually be treated successfully, and the diagnosis may occur at an age at which their risk of death from other causes is higher than their risk of death from breast cancer.

• #30 Atypia detected during breast screening and subsequent development of cancer: observational analysis of the Sloane atypia prospective cohort in England | The BMJ

  https://www.bmj.com/content/384/bmj-2023-077039

  This study presents an analysis of the English Sloane Project prospective atypia cohort and reports the proportion of women with atypia who develop breast cancer by type of atypia and time frame. […] The results suggest that additional annual mammography for the first three years after a diagnosis of epithelial atypia might not be necessary over and above UK standard screening practice offered to all women (ie, once every three years). […] Overall, data from the Sloane Atypia Project show that invasive breast cancer incidence at three years after a diagnosis of epithelial atypia was low, and even lower in recent years. […] These data, including the similar ipsilateral and contralateral risks, support the suggestion that many epithelial atypia diagnoses might represent risk factors rather than precursor lesions for invasive cancer within 15 years of follow-up. […] Annual mammography in the short term after atypia diagnosis might not be beneficial and should be reviewed.

• #31

  https://www.cancervic.org.au/cancer-information/screening/breasts-health/atypical-ductal-hyperplasia

  If you’ve been diagnosed with ADH, you’ll need expert advice on the treatment and follow-up that’s best for you. […] In most women ADH is harmless and won’t cause any problems in the future. However, in a few women with ADH, breast cancer can occur at a later date in the same breast or in the other one. Learning about this risk can raise anxiety in women newly diagnosed with ADH, but the risk is small. With regular follow-up, any breast cancer that does develop is likely to be found early. […] The follow-up usually advised for women with ADH is an annual mammogram and a physical breast examination by a doctor. Your doctor may also want to check that you’re aware of the best way to examine your own breasts for signs of unusual change. […] Some women are diagnosed with ADH after having a screening mammogram through the BreastScreen program, and wish to remain in the program. This is usually possible, but yearly screening mammograms will be recommended rather than every 2 years as usually recommended.

• #32 Active surveillance of women diagnosed with atypical ductal hyperplasia on core needle biopsy may spare many women potentially unnecessary surgery, but at the risk of undertreatment for a minority: 10-year surgical outcomes of 114 consecutive cases from a

  https://www.nature.com/articles/modpathol2017114

  A needle core biopsy diagnosis of atypical ductal hyperplasia is an indication for open biopsy. […] If the malignancies diagnosed after surgery for atypical ductal hyperplasia are dominated by low-risk ductal carcinoma in situ, women with atypical ductal hyperplasia may also be considered for surveillance. […] A multivariable model for predicting the likelihood of any malignancy showed a statistically significant association only with the post review subtype of atypical ductal hyperplasia, adjusting for lesion size. […] If active surveillance is adopted for screen-detected atypical ductal hyperplasia diagnosed on core biopsy, 60% of women will avoid unnecessary surgery and a further 24% would meet eligibility criteria for ductal carcinoma in situ surveillance trials. […] These women with high-risk lesions are not reliably identified pre-operatively.

• #33 Atypical ductal hyperplasia: update on diagnosis, management, and molecular landscape | Breast Cancer Research | Full Text

  https://breast-cancer-research.biomedcentral.com/articles/10.1186/s13058-018-0967-1

  One very recent review stated that 22-65% of ADH diagnosed by CNB were upgraded to carcinoma. […] Given the high upgrade rate, it is not surprising that the majority of clinicians suggest a surgical excision after ADH diagnosis on CNB to rule out concomitant malignancy. […] Unfortunately, risk prediction following ADH diagnosis is controversial, and counseling and further screening for these women diagnosed with ADH are therefore probably not adequate. […] Thus far, despite the high risk of developing cancer associated with ADH, attempts to identify clinicopathological or molecular biomarkers to predict individual risk have been unsuccessful. […] The increasing diagnoses of ADH as a consequence of population-based mammographic screening have created clinical dilemmas for treating physicians.

• #34

  https://link.springer.com/article/10.1245/s10434-024-15041-1

  Excision is routinely recommended for atypical ductal hyperplasia (ADH) found on core biopsy given cancer upstage rates of near 20%. […] The upstage rate among 221 ADH lesions was 16.7%, highest in lesions 10 mm, with pathologic suspicion of DCIS, and linear/regional calcifications on mammography. […] Identifying a subgroup of patients with ADH diagnosed on core biopsy who are at low risk for cancer upstage is advantageous to avoid unnecessary and costly surgical procedures and overtreatment of individuals who will derive little benefit from excision. […] Absence of all three high-risk factors was seen in 30% of the cohort, and the upstage rate among this group was under 2%, suggesting that active surveillance as an alternative to surgery may be permissible.

• #35 Atypical hyperplasia of the breast // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/atypical-hyperplasia-of-the-breast

  Medicines that block the hormone estrogen in the body can lower the risk of breast cancer. Most breast cancers use estrogen and other hormones to help the cancer grow. Blocking estrogen helps stop cancer from forming. […] Atypical hyperplasia of the breast is one of several conditions that cause a growth of cells in the breast that isn’t cancerous. These conditions are sometimes called benign breast diseases. […] If you have a very high risk of breast cancer, your healthcare team might recommend surgery to lower your risk. Your risk might be high if you have a strong family history of breast cancer.

• #36 Atypical Hyperplasia Underestimated Marker for Breast Cancer

  https://www.medscape.org/viewarticle/838990

  Women with atypical hyperplasia are at high risk for the development of breast cancer, emphasize Dr Hartmann and colleagues. […] To address this problem of underrecognized risk, the authors call for more intensive surveillance of these women and more widespread use of breast cancer chemopreventive agents such as selective estrogen-receptor modulators and aromatase inhibitors, which have been shown to benefit women with atypical hyperplasia. […] Clinicians should consider having patients with atypical hyperplasia undergo an annual breast magnetic resonance imaging (MRI) screening, in addition to an annual mammogram, the authors suggest. […] Guidelines need to be updated to include annual MRI screening for this atypical hyperplasia population, they add. […] The other broad recommendation from the authors is that patients with atypical hyperplasia be offered chemopreventive agents. […] Current guidelines recommend consideration of pharmacologic therapy to prevent breast cancer among women whose 5-year risk exceeds 1.7%. Women with atypical hyperplasia have a risk of approximately 1% per year for incident breast cancer, meaning that they easily fulfill these criteria.

• #37 Atypical hyperplasia of the breast – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/atypical-hyperplasia/diagnosis-treatment/drc-20369778

  Atypical hyperplasia of the breast increases the risk of breast cancer. So your healthcare team creates a breast cancer screening plan. You might have more-frequent screening or different screening tests than would someone with an average risk of breast cancer. […] Treatment for atypical hyperplasia of the breast may involve surgery to remove the atypical cells. Not everyone needs surgery. Your healthcare team might recommend more-frequent breast cancer screening to watch for signs of breast cancer. […] Atypical hyperplasia of the breast is most often diagnosed during a breast biopsy. […] Your healthcare team carefully considers your biopsy results and your other health conditions when choosing the treatment plan that’s best for you. […] Hormone-blocking medicines that are used to lower breast cancer risk include: Tamoxifen, Raloxifene (Evista), Anastrozole (Arimidex), Exemestane (Aromasin). […] If you have atypical hyperplasia of the breast, a breast health specialist can help you understand your breast cancer risk and create a plan to help you manage the risk.

• #38 Menopausal symptom management considerations in patients at high risk for breast cancer – Women’s Healthcare

  https://www.npwomenshealthcare.com/menopausal-symptom-management-considerations-in-patients-at-high-risk-for-breast-cancer/

  Risk-reducing medications, also referred to as endocrine therapy (previously known as chemoprevention), are extremely effective in reducing breast cancer risk, especially for those with atypical hyperplasia and LCIS. Endocrine therapy has been shown to reduce breast cancer risk in patients with atypical hyperplasia by 86% and in those with LCIS by 50%. […] For patients taking risk-reducing medications, guidelines such as the NCCN recommend against the use of HT for menopausal symptom management. Having atypical hyperplasia or LCIS are strong indications to begin a risk-reducing agent, so patients with a history of biopsy results revealing those findings may also want to consider alternatives to hormone therapy for the management of menopausal symptoms.

• #39 Atypical Ductal Hyperplasia: Breast, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/16242-atypical-ductal-hyperplasia

  Your risk for breast cancer increases up to four times compared to someone without atypical hyperplasia. Other factors are involved in determining your overall risk. Be sure to discuss your risk with your healthcare provider. […] Follow your healthcare providers instructions for follow-up care. This involves attending all breast cancer screenings and making healthy lifestyle choices to reduce your risk. Lifestyle choices could include maintaining a healthy weight, exercising regularly and avoiding beverages containing alcohol.

• #40 Atypical Lobular Hyperplasia and Risk of Breast Cancer

  https://www.verywellhealth.com/atypical-lobular-hyperplasia-of-the-breast-430684

  Atypical lobular hyperplasia (ALH) is a precancerous condition that could lead to the earliest stage of breast cancer, known as ductal carcinoma in situ (DCIS). […] Because the risk of cancer is increased if you have ALH, you would need to undergo routine breast cancer screening. […] Research suggests that the risk of developing breast cancer is as high as 20% if you have been diagnosed with ALH. […] ALH often does not require treatment but will instead be regularly monitored with a screening mammogram and/or a breast MRI. Some people at high risk of breast cancer may have the ALH lesions removed just to be safe.

• #41 Atypical ductal hyperplasia: update on diagnosis, management, and molecular landscape | Breast Cancer Research | Full Text

  https://breast-cancer-research.biomedcentral.com/articles/10.1186/s13058-018-0967-1

  ADH is not only a risk factor for IDC, it is also considered to be a direct but non-obligate precursor to carcinoma. […] Diagnosis of ADH carries a four- to fivefold increased risk of developing breast cancer within 5 years that is not limited to the ipsilateral breast. […] However, Hartmann et al. pointed out that risk estimation has not been calculated as cumulative incidence by the current breast cancer risk prediction tools. […] The occurrence of ADH in the general population varies widely from 3% of benign biopsies to 8-10% to 23%. […] In this review, we focus on the definition, diagnosis, and current management of ADH as well as its molecular alterations. […] The management of patients diagnosed with ADH on CNB varies not only because of the initial biopsy type/size but also because of the variable reported upgrade rate.

• #42 Atypical Ductal Hyperplasia and Lobular In Situ Neoplasm: High-Risk Lesions Challenging Breast Cancer Prevention

  https://www.mdpi.com/2072-6694/16/4/837

  Atypical ductal hyperplasia (ADH-DIN1b) and lobular in situ neoplasms (LINs), including Atypical Lobular Hyperplasia (ALH-LIN1) and Low-Grade Lobular in situ Carcinoma (LIN 2), are among the most commonly diagnosed high-risk lesions diagnosed after a breast biopsy. […] The estimated cumulative incidence of upgrade to BC of these lesions is around 30% at 25 years of follow-up, with a maximum in the first 5 years after the diagnosis. […] Indeed, the histopathological distinction between ADH and Ductal in situ Carcinoma (DCIS) is based on size/extent criteria, and it may be difficult to clearly outline a diagnosis, especially after examining limited samples obtained by a core biopsy (CB). […] The ultimate goal of this study is to present our center’s experience, hoping to provide additional information to manage patients diagnosed with this tricky class of lesions appropriately and indicate the best possible plan specifically tailored to every patient’s disease and risk profile.

• #43 Atypical Hyperplasia on Breast Biopsy may be Misinterpreted by Experienced Pathologists | EBM Focus

  https://www.ebsco.com/clinical-decisions/dynamed-solutions/about/ebm-focus/atypical-hyperplasia-breast-biopsy-may-be

  Breast cancer is the most common form of cancer and second leading cause of cancer deaths in women in the United States (J Natl Cancer Inst 2011 May 4;103(9):714). […] A recent study evaluated the rate of diagnostic inaccuracies of 240 breast biopsy samples evaluated by 126 pathologists from across the United States. […] Excisional or core needle biopsy samples were randomly selected from a registry of 19,498 cases based on the original diagnosis, patient age, breast density, and biopsy type. […] The consensus diagnosis from a panel of 3 expert pathologists served as the reference standard, with a consensus diagnosis of invasive breast cancer in 10%, ductal carcinoma in situ (DCIS) in 30%, atypical hyperplasia in 30%, and benign without atypia in 30%. […] Overall concordance between the expert panel diagnosis and the individual pathologist interpretation was 75.3%.

• #44 Atypical Hyperplasia on Breast Biopsy may be Misinterpreted by Experienced Pathologists | EBM Focus

  https://www.ebsco.com/clinical-decisions/dynamed-solutions/about/ebm-focus/atypical-hyperplasia-breast-biopsy-may-be

  The rate of concordance as well as the rate of overinterpretation and underinterpretation can be found in the table below. […] While the rate of concordance was very high for invasive carcinoma, with only 4% of cases misinterpreted as DCIS, the concordance rate drops considerably for atypical hyperplasia, with most misinterpretations resulting in an underinterpretation of the disease as a benign biopsy. […] Higher rates of disagreement were significantly associated with increased breast density and pathologist characteristics including lower weekly case volume, smaller practices, and nonacademic settings. […] The results of this study suggest that while pathologists generally agree upon interpretation of invasive carcinoma samples, their interpretations of precancerous lesions may be more variable. […] Decreasing variability in biopsy diagnosis is important as overinterpretation may lead to unnecessary treatment and underinterpretation may withhold necessary treatments or decrease surveillance in patients with precancerous lesions.

• #45 Atypical Hyperplasia of the Breast: The Black Hole of Routine Breast Cancer Screening | Anticancer Research

  https://ar.iiarjournals.org/content/32/12/5441

  These lesions raise issues that are left unresolved: their clinical significance remains controversial. […] The aim of this study was to assess the prevalence of borderline lesions in unselected populations taking part in screening programs, together with their characteristics and outcome, and to ascertain the diagnostic accuracy of percutaneous biopsy techniques in a population-based study. […] The percentage of borderline lesions diagnosed with routine breast cancer screening rose over time. […] The incidence of AH breast lesions in an unexposed population benefiting from routine screening is not precisely known. […] We noticed a rise in incidence over time, in our region, which is most plausibly explained by the adoption of new screening practices starting in the year 2000. […] Follow-up of patients with AH is still required, including those who have undergone a surgical biopsy. […] A national observatory could be set up to record and follow-up a cohort of patients and help address clinical issues related to these borderline breast lesions.

• #46 Preneoplastic Low-Risk Mammary Ductal Lesions (Atypical Ductal Hyperplasia and Ductal Carcinoma In Situ Spectrum): Current Status and Future Directions

  https://www.mdpi.com/2072-6694/14/3/507

  Atypical ductal hyperplasia (ADH) belongs to the low-grade pathway of estrogen receptor (ER)-positive/luminal type invasive breast carcinoma (iBC) […] The incidence of ADH/DCIS dramatically increased after the introduction of population-based screening mammography but remains steady in more recent years. […] There are at least four ongoing international clinical trials aimed at studying the natural history of low-risk DCIS and defining specific clinical/pathological biomarkers for a subset of patients who may benefit from adjuvant therapies. […] There are at least four AS trials worldwide, including Comparison of Operative to Monitoring and Endocrine Therapy (COMET) in the United States, the low risk DCIS trial (LORIS) in United Kingdom, the “LOw Risk Dcis” (LORD) in the Netherlands, and LORETTA in Japan.

• #47 Active surveillance of women diagnosed with atypical ductal hyperplasia on core needle biopsy may spare many women potentially unnecessary surgery, but at the risk of undertreatment for a minority: 10-year surgical outcomes of 114 consecutive cases from a

  https://www.nature.com/articles/modpathol2017114

  The launch of surveillance trials for ductal carcinoma in situ leads to the paradoxical situation whereby women with atypical ductal hyperplasia would be advised to proceed promptly to surgery while those with established ductal carcinoma in situ are being observed. […] We can confirm that the preponderance of surgical biopsies performed for a pre-operative diagnosis of atypical ductal hyperplasia, result in non-malignant pathology findings. […] In this series, having evaluated the surgical outcomes for a large cohort of women with screen-detected atypical ductal hyperplasia, we have found that adoption of such a strategy would spare four of five women from immediate surgery. […] Although independent predictors of upgrade to malignancy are identified, no features predict high-risk malignancies reliably to assist patient selection for surveillance. […] In the future, the outcomes from ductal carcinoma in situ surveillance trials are likely to impact the approach to atypical ductal hyperplasia diagnosed by core biopsy.

• #48 Preneoplastic Low-Risk Mammary Ductal Lesions (Atypical Ductal Hyperplasia and Ductal Carcinoma In Situ Spectrum): Current Status and Future Directions

  https://www.mdpi.com/2072-6694/14/3/507

  The prognosis of these lesions together with the early-stage ER-positive/HER2-negative low-grade iBC is excellent. […] The active surveillance (AS) trials are initiated to separate lesions that require active treatment from those that can be safely monitored and only be treated when they develop a change in the clinical/radiologic characteristics. […] The COMET trial amended the inclusion criteria to add patients whose surgical resection margin was positive for DCIS, and patients with a diagnosis of ADH bordering on DCIS. […] The differences between these trials make the comparisons challenging. […] The rate of upgrading to iBC is another concern regarding this disease, with an overall rate estimated at approximately 20%. […] The standard of treatment of DCIS is surgical removal of the lesion with or without RT, with or without HT. […] The inclusion criteria for COMET trial includes LG- and IG-DCIS with any degree of necrosis. […] The author concludes that, in addition to the clinical use, this risk modeling approach could be useful in assessing the results of the AS trials.

• #49 Atypical Ductal Hyperplasia and Lobular In Situ Neoplasm: High-Risk Lesions Challenging Breast Cancer Prevention

  https://www.mdpi.com/2072-6694/16/4/837

  The current study highlights the varying degree of diagnostic detection between ADH and LIN following the stereotactic VABB procedure. […] The BC that does develop subsequently may occur in either breast and not necessarily at the site of the atypia. […] The estimated 5-year DFS was 80% for ADH, 84% for LIN1, and 88% for LIN2. The 10-year DFS was 77% for ADH, 64% for LIN1, and 72% for LIN2. […] Recent studies evaluating age-specific 10-year absolute risk to realize risk-stratified BC screening indicated a threshold of 6% to define “high-risk” women. […] In order, the three histotypes with a higher risk of future cancer were LIN1 (30%), LIN2 (26%), and ADH (16%); thus, in our opinion and according to the literature, these three categories could benefit from a tailored approach to surveillance, and patients with these lesions should not be discharged from clinical and radiological follow-up.

• #50 Atypical Ductal Hyperplasia and Lobular In Situ Neoplasm: High-Risk Lesions Challenging Breast Cancer Prevention

  https://www.mdpi.com/2072-6694/16/4/837

  Considering that the diagnosis of BC occurs, on average, 38 months after the initial diagnosis of a B3 lesion, we suggest that undergoing at least a 5-year follow-up, with annual bilateral DM and semi-annual breast US examinations, represents a reasonable and cost-effective option for these patients.

Zobacz więcej