Materiały źródłowe

• #1 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 may be treated with surgery to remove the atypical cells. This might be recommended if mammogram images show something concerning. Members of your healthcare team typically decide whether to recommend surgery based on a discussion of your imaging test results, the results of your breast biopsy and other factors. […] Not everyone with atypical hyperplasia of the breast needs surgery. Some healthcare teams may not recommend surgery if there is a low risk of finding cancer. The level of risk may depend on the findings of your mammogram images and other factors, such as your medical history and past breast operations. Your healthcare team carefully considers your biopsy results and your other health conditions when choosing the treatment plan that’s best for you.

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

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

  Your healthcare provider diagnoses ADH with a breast biopsy. A biopsy involves your provider removing tissue from your breast and sending it to a lab for analysis. Treatment for ADH involves more regular breast cancer screenings so that if cancer does occur, it’s found as early as possible. […] The treatment for ADH is a surgical (excisional) biopsy to remove more of the tissue that contains atypical ductal hyperplasia, plus the area immediately surrounding it. Your provider will send this tissue to a lab to make sure there isn’t cancer present. If your biopsy comes back normal, no further treatment is necessary. Your provider usually recommends more breast cancer screenings. If your risk of cancer is very high, they may prescribe medications to reduce your risk. […] People with atypical ductal hyperplasia may benefit from taking a five-year course of certain preventive medications. These medications block estrogen and help decrease the risk of estrogen receptor-positive invasive breast cancer. The effects can remain for up to 15 years after taking them.

• #3 Atypical Breast Hyperplasia – StatPearls – NCBI Bookshelf

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

  Atypical hyperplasia lesions are pre-malignant. Many authorities believe the patient should undergo complete surgical excision to exclude malignancy and prevent the development of advanced neoplasia if found on a breast biopsy. Surgical excision for core biopsies that show ADH is considered standard of care. However, ALH may be an incidental finding in small biopsies, and standard surgical resection of these lesions is more controversial. In general, excision is usually recommended in high-risk patients. In carefully selected lower-risk patients such as those without a family or personal history of breast cancer, without BRCA1 or BRCA2 mutations, solitary lesions, or lower BI-RADS score, surveillance, and/or medical therapy such as estrogen receptor modulators are possible management options. Short-term follow-up with increased mammography frequency should be recommended for patients in whom surgical resection is not performed.

• #4 Atypical Ductal Hyperplasia – StatPearls – NCBI Bookshelf

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

  Once identifying atypical ductal hyperplasia as the diagnosis and ruling out breast carcinoma, it is essential to address risk reduction strategies. […] One such measure is treating these patients with tamoxifen, as the vast majority of lesions are ER+. In the National Surgical Adjuvant Breast and Bowel Project (NSABP) P-1 trial, tamoxifen conferred a risk reduction of 86% in women with ADH. Therefore, we recommend the discussion of tamoxifen in patients diagnosed with ADH. Tamoxifen is known to increase the risk of endometrial cancer, stroke, DVT, and PE – particularly in patients over the age of 50. Therefore the risk-benefit discussion starting tamoxifen would need to include consideration of these risks and the decision to begin tamoxifen be patient dependant. […] If atypical ductal hyperplasia is found on core needle biopsy, additional tissue is necessary by excisional biopsy. A wire or seed localization technique should be used at the time of the core biopsy to later identify the area potentially requiring excision. The reason for re-excision is that with a more extensive tissue specimen, there is a chance the lesion will be upgraded to carcinoma in situ or invasive carcinoma. Studies suggest that 22 to 65% of ADH found on core needle biopsies were upgraded to carcinoma after subsequent excisional biopsy.

• #5 Contemporary management of atypical breast lesions identified on percutaneous biopsy: a narrative review – Amin – Annals of Breast Surgery

  https://abs.amegroups.org/article/view/6578/html

  The management of atypical breast lesions identified on core needle biopsy (CNB) for a breast imaging abnormality is a topic of controversy. […] Contemporary management requires a multidisciplinary approach that does not have a one-size-fits-all option. […] All discordant biopsies require surgical excision or additional sampling with more aggressive CNB. […] Concordant biopsies demonstrating pure flat epithelial atypia (FEA), atypical lobular hyperplasia (ALH), and classic type lobular carcinoma in situ (LCIS) should not routinely undergo surgical excision. […] Of all the atypical breast lesions, atypical ductal hyperplasia (ADH) has the highest risk of upgrade to underlying malignancy and may still be considered for excision, though opportunities for observation for low volume disease may exist.

• #6 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

  Atypical ductal hyperplasia (ADH) is a common diagnosis in the mammographic era and a significant clinical problem with wide variation in diagnosis and treatment. […] After a diagnosis of ADH on biopsy a proportion are upgraded to carcinoma upon excision; however, the remainder of patients are overtreated. […] This article will review the definitions and variable management of the patients diagnosed with ADH as well as the current knowledge of the molecular landscape of ADH and its clonal relationship with ductal carcinoma in situ and invasive carcinoma. […] 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. […] One very recent review stated that 22-65% of ADH diagnosed by CNB were upgraded to carcinoma.

• #7 Atypical Hyperplasia

  https://cbcn.ca/en/atypical-hyperplasia

  Certain drugs that reduce the risk of developing breast cancer by blocking the effects of estrogen may be suggested for individuals diagnosed with atypical hyperplasia. Tamoxifen is used for women not yet in menopause. For women in menopause or who have gone through menopause, exemestane, anastrozole or raloxifene, may be used. Aromatase inhibitors, which stop the enzyme aromatase from changing other hormones into estrogen, may also be used by post-menopausal women to reduce their risk of developing breast cancer following a diagnosis of atypical hyperplasia. Drugs such as these can reduce the risk of women with atypical hyperplasia going on to develop breast cancer by approximately 86%. […] It’s important to weigh the risks and benefits of having surgery to treat atypical hyperplasia since being diagnosed with it does not always mean that you will also be diagnosed with breast cancer. Surgery may be most suitable if you are at high-risk of developing breast cancer due to other factors, other than having atypical hyperplasia. Whether you are high-risk or not, speak to your healthcare team regarding which surgical option would be most ideal for you. Surgical options for treating atypical hyperplasia include:

• #8 Atypical Hyperplasia

  https://cbcn.ca/en/atypical-hyperplasia

  Ultrasound-guided, vacuum-assisted excision A fairly non-invasive method that removes the abnormal areas of the breast tissue. This is a common approach to treating atypical hyperplasia. […] Lumpectomy Involves removing the abnormal areas of the breast tissue along with parts of the surrounding tissue. […] Prophylactic mastectomy The removal of the entire breast tissue in one or both breasts. This option may be considered more ideal for individuals with atypical hyperplasia scattered in various areas of their breast tissue or those who have other high-risk factors for developing breast cancer.

• #9 Hyperplasia and atypical hyperplasia | Breast Cancer Now

  https://breastcancernow.org/about-breast-cancer/breast-lumps-and-benign-not-cancer-breast-conditions/hyperplasia-and-atypical-hyperplasia/

  Atypical hyperplasia (also called epithelial hyperplasia) happens when cells lining the ducts or lobules increase in number and develop an unusual pattern or shape. […] Atypical hyperplasia is also benign (not cancer). However, having atypical hyperplasia has been shown to increase the risk of breast cancer in some people. […] If you have atypical hyperplasia, your doctor may want you to have more tissue removed to examine the area more thoroughly. […] This tissue may be removed by a vacuum assisted excision biopsy or a surgical excision biopsy. […] In both cases, the tissue removed will be sent to a laboratory to be examined under a microscope. This will confirm the diagnosis of atypical hyperplasia and check for any changes that could be breast cancer. […] If you have atypical hyperplasia, you may need follow-up such as yearly mammograms.

• #10 Best Breast Hyperplasia Treatment in Dubai

  https://kingscollegehospitaldubai.com/service/breast-health-clinic/hyperplasia-of-the-breast/

  Hyperplasia of the breast, also known as proliferative breast disease, is a non-cancerous breast condition that doesn’t present any obvious symptoms. […] Although atypical hyperplasia is non-cancerous, there are instances where it has been shown to increase the chances of developing cancer among some people. […] Atypical ductal hyperplasia on the other hand might need a surgical procedure to remove the hyperplasia after a definite diagnosis. […] Also, a vacuum assisted excision biopsy, might be offered. This involves a process of removing the hyperplasia under local anesthesia, without having a full surgical procedure under general anesthesia. […] Although vacuum assisted excision biopsy is considered minimally invasive, there might be bruising and some degree of discomfort after the procedure, which will last for a few days. […] Your follow-up after the procedure includes a mammogram usually after every two years. […] However, with ‘atypical ductal hyperplasia’ the risk is slightly increased. […] At King’s College Hospital London Dubai, our Breast Care Clinic caters to every type of breast cancer and breast conditions.

• #11 Atypical Ductal Hyperplasia: Symptoms and Treatment

  https://www.verywellhealth.com/atypical-ductal-hyperplasia-of-the-breast-430683

  Surgery may be a better choice if you are at high risk of developing breast cancer—for example, you are younger than age 50 with larger tumors or tumors that can be felt on exam. That said, it is also an option if you don’t have such risk factors but are very concerned about your diagnosis of atypical ductal hyperplasia. […] In either case, but particularly if you are not considered high-risk, speak with your healthcare provider about the pros and cons of your surgical options: […] Ultrasound-guided, vacuum-assisted excision: This relatively non-invasive method removes the atypical tissue area. However, it may not be appropriate for everyone. […] Lumpectomy: This involves removing the tissue containing the area of abnormal cells plus a margin of surrounding tissue to help prevent recurrence. […] Mastectomy: Some women have areas of ADH that are widely scattered throughout their breast(s). When this occurs, a woman may opt to have a mastectomy to remove all potentially abnormal breast tissue.

• #12 Atypical hyperplasia of the breast | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/atypical-hyperplasia-breast

  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. You also might consider medicine to lower your risk of breast cancer. […] Atypical hyperplasia of the breast may be treated with surgery to remove the atypical cells. This might be recommended if mammogram images show something concerning. Members of your healthcare team typically decide whether to recommend surgery based on a discussion of your imaging test results, the results of your breast biopsy and other factors. […] Not everyone with atypical hyperplasia of the breast needs surgery. Some healthcare teams may not recommend surgery if there is a low risk of finding cancer. The level of risk may depend on the findings of your mammogram images and other factors, such as your medical history and past breast operations. Your healthcare team carefully considers your biopsy results and your other health conditions when choosing the treatment plan that’s best for you.

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

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

  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. […] These medicines are typically taken daily for five years to reduce the risk of breast cancer. The medicine tamoxifen is sometimes taken in a lower dose every other day. Talk with your healthcare team about which medicine is best for you. […] 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. […] 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. Your risk also may be high if DNA changes that increase the risk of breast cancer run in your family. One operation that can lower the risk of breast cancer is surgery to remove both breasts. This procedure is called a risk-reducing mastectomy or a prophylactic mastectomy.

• #14 Atypical hyperplasia of the breast | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/atypical-hyperplasia-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 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. […] To reduce your risk of breast cancer, your healthcare team may recommend that you: Avoid hormone therapy for menopause. Certain kinds of medicines that use hormones to help control symptoms of menopause can increase the risk of breast cancer. If you have menopause symptoms, ask your healthcare team about treatments that won’t increase your risk of breast cancer.

• #15 Atypical Hyperplasia | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/patient-education/atypical-hyperplasia

  In ADH, new cells look like the cells that grow in your breast ducts. ADH isn’t cancer, but it may raise your risk of getting breast cancer in the future. […] In ALH, new cells look like the cells that grow in your breast lobules. ALH is linked to a higher risk of getting breast cancer. […] Because of the increased breast cancer risk, people with either type of atypical hyperplasia should get regular breast exams and breast imaging tests. […] Taking certain medications can help lower your risk of getting breast cancer. […] Tamoxifen (Nolvadex, Soltamox) and raloxifene (Evista) are medications that lower your risk for breast cancer. […] Aromatase inhibitors are medications that stop an enzyme called aromatase from changing other hormones into estrogen. One of these medications, exemestane (Aromasin), has been shown to lower the risk of breast cancer in people with atypical hyperplasia. […] Some people may choose to have their breasts removed to prevent breast cancer. This is called a bilateral prophylactic (PRO-fih-LAK-tik) mastectomy. This surgery is sometimes used to lower the risk of breast cancer in people with ADH or ALH.

• #16 Atypical Hyperplasia Treatment | New England Breast And Wellness

  https://www.nebreastandwellness.com/treatments/atypical-hyperplasia-treatment/

  Tamoxifen is an oral medication taken daily for five years. […] A clinical study conducted in the 90s found that tamoxifen reduced the risk of breast cancer amongst women with atypia (abnormal cells in the milk ducts or lobules) by 86% this study paved the way for tamoxifen being used for chemoprevention. […] Raloxifene is an oral medication taken daily for five years, meant specifically for post-menopausal women with a high risk of breast cancer. This drug was approved for breast cancer risk reduction after a STAR (Study of Tamoxifen and Raloxifene) trial determined that it offered similar benefits as tamoxifen. […] Chemoprevention may increase the risk of numerous side effects, such as pulmonary embolism (blood clots in the lungs), deep vein thrombosis (blood clots in veins), and strokes. While the risk is relatively small, it shouldn’t be ignored. That’s why you should determine if you want to start chemoprevention after weighing the risks and benefits with your doctor. […] Please schedule an appointment to learn more about atypical hyperplasia treatment.

• #17 Atypical hyperplasia of the breast – Hancock Health

  https://www.hancockhealth.org/mayo-health-library/atypical-hyperplasia-of-the-breast/

  Hormone-blocking medicines that are used to lower breast cancer risk include: Tamoxifen, Raloxifene (Evista), Anastrozole (Arimidex), Exemestane (Aromasin). […] Atypical hyperplasia of the breast increases the risk of breast cancer. So your healthcare team creates a breast cancer screening plan. […] To reduce your risk of breast cancer, your healthcare team may recommend that you: Avoid hormone therapy for menopause. […] Consider surgery to lower the risk of breast cancer.

• #18 Breast Hyperplasia: Is It Cancer? Can It Lead to Cancer?

  https://www.rockymountaincancercenters.com/blog/breast-hyperplasia-is-it-cancer-can-it-lead-to-cancer

  Usual hyperplasia is monitored closely but not typically surgically removed. […] Surgery is sometimes an option for women with atypical hyperplasia so that additional breast tissue can be removed from the area around where the biopsy was performed. That tissue will also be tested for abnormal cells. […] You may be able to slow or stop the transition of atypical breast hyperplasia into estrogen-positive breast cancer by taking estrogen-blocking medication. Because estrogen boosts the growth of hormone-positive breast cancer, medications that block estrogen help lower your breast cancer risk. If taken for five years, they can provide up to 15 years of prevention. […] Medications include Tamoxifen (Nolvadex) for younger women who are not menopausal; Raloxifene (Evista), Exemestane (Aromasin), and Anastrozole (Arimidex) for postmenopausal women. […] Tamoxifen and Raloxifene are also used to treat estrogen receptor cancers (the most common type) and can lower your risk by more than 50%. These medications do not reduce estrogen receptor-negative cancer risk.

• #19 Atypical Hyperplasia of the Breast — Risk Assessment and Management Options – Breast360.org

  https://breast360.org/news/2015/09/15/atypical-hyperplasia-breast-risk-assessment-and-ma/

  The younger a woman is when she receives a diagnosis of atypical ductal hyperplasia, the more likely it is that breast cancer will develop in her lifetime; however, if women with atypical ductal hyperplasia take medication to prevent breast cancer, their risk of developing breast cancer may be reduced by over 40% and up to approximately 80%. […] Clinical trials have shown pharmacologic risk reduction (taking medication to prevent cancer) to be effective in women with atypical hyperplasia Tamoxifen, raloxifene (Evista) and exemestane have been proven to reduce the risk of developing breast cancer in women who have atypical hyperplasia. […] 97% of atypical ductal hyperplasia and 88% of atypical lobular hyperplasia has estrogen receptor staining, meaning it is stimulated by estrogen. Because of this, medications called selective estrogen receptor modulators (for example, tamoxifen and raloxifene) and aromatase inhibitors (for example, exemestane, anastrozole, and letrozole) have been shown in clinical trials to effectively reduce the risk of breast cancer associated with these lesions. A recent meta-analysis of selective estrogen receptor modulator trials found a 38% relative reduction in the risk of breast cancer in those taking the medication. Relative risk reductions in the atypical hyperplasia subgroup were even greater and ranged from 41% up to 79%. […] Despite the evidence that chemoprevention medications work, patients are reluctant to take them due to fear of side effects.

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

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

  Risk-reducing endocrine therapy should be discussed with patients because of increased lifetime risk of breast cancer, estimated at 1% per year. […] As with ADH, risk-reducing endocrine therapy for the prevention of breast cancer is associated with a 41% to 79% relative risk reduction for women with ALH. […] If the excisional biopsy does not show findings of ALH or ADH, risk-reducing endocrine therapy or surveillance with high-risk breast imaging is not required for pure FEA. […] Risk-reducing medications should be offered. […] Tamoxifen should be discontinued if a patient is diagnosed with endometrial hyperplasia. […] Short-term use of an LNG-IUD is an option to manage endometrial hyperplasia for women who want to preserve fertility or are not good surgical candidates. […] A shared decision-making discussion is warranted regarding the use of progestin IUDs because current data do not show an increase in breast cancer risk. […] Current American Cancer Society guidelines recommend achieving and maintaining a healthy weight and limiting alcohol intake and avoiding smoking to reduce cancer risk.

• #21 Atypical Hyperplasia – Tower Love Fund – Breast Cancer Explained

  https://www.towercancer.org/resource/breast-cancer-explained/atypical-hyperplasia/

  Chemoprevention with tamoxifen or raloxifene is not a mandatory treatment. It is a choice. To decide whether it is right for you, you need to weigh the risks versus the benefits. […] If you have a family history of breast cancer in addition to ADH or ALH and you want to understand more about whether your family history may contribute to your breast cancer risk, you should make an appointment with a genetic counselor to discuss testing for the hereditary breast cancer gene mutations, called BRCA1 and BRCA2, which put women at higher risk for breast and ovarian cancer. […] If you decide to have genetic testing and if you are found to carry one of the BRCA gene mutations that put women at higher risk for breast and ovarian cancer, your doctor may suggest that you consider a bilateral prophylactic mastectomy (removal of both breasts). This will reduce the chance of getting breast cancer by about 95%. The surgery is only recommended if you have a strong family history of the disease. It is not recommended for women just because they have had a diagnosis of atypical hyperplasia.

• #21 Atypical Hyperplasia – Tower Love Fund – Breast Cancer Explained

  https://www.towercancer.org/resource/breast-cancer-explained/atypical-hyperplasia/

  If atypical hyperplasia is diagnosed on a core biopsy, the best practice would be to have an excisional biopsy to look at the surrounding tissue and make sure this is not just the tip of the iceberg. If it was diagnosed on the basis of an excisional biopsy, you should get more details about the size and severity of what was seen. […] The standard treatment for atypical hyperplasia is close follow-up. Monitoring is especially important if you have a strong family history of breast cancer. If you do, you may want to ask your doctor to recommend a program for high-risk women. These programs provide close follow-up, which means clinical breast exams every six months and yearly mammograms. […] If you are diagnosed with atypical hyperplasia ductal or lobular your doctor may suggest that you consider taking tamoxifen. If you are postmenopausal, raloxifene (Evista) may be an option for you as well. Both drugs come in pill form and are taken daily for five years. Tamoxifen is a type of hormone therapy routinely used to treat women with breast cancer whose tumors are hormone-sensitive.

• #22 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

  Options for women at higher risk of breast cancer from ADH or ALH may include: Seeing a health care provider more often (such as every 6 to 12 months) for a breast exam along with a yearly mammogram. Additional imaging with breast MRIs may also be recommended, especially if you have other factors that raise your risk of breast cancer. […] Taking medicine to help lower breast cancer risk. For more on this, see Deciding Whether to Use Medicine to Reduce Breast Cancer Risk.

• #23 Atypical Hyperplasia of the Breast: Follow-up and Management – The ObG Project

  https://www.obgproject.com/2017/04/19/atypical-hyperplasia-breast-follow-management/

  Atypical hyperplasia of the breast is a benign but high-risk condition that can be either ductal (ADH) or lobular (ALH); these occur with equal frequency and together are found in about 10% of breast biopsies. […] Surgically excise atypical hyperplasia when found on a core-needle biopsy. […] Current breast cancer risk assessment models perform poorly among women with atypical hyperplasia. […] Follow-up screening recommendations include annual mammography, breast awareness, and clinical encounter every 6 to 12 months. […] Encourage pharmacologic risk reduction with either a selective estrogen-receptor modulator (SERM) or an aromatase inhibitor (AI) for prevention of breast cancer. […] Atypical hyperplasia is generally not an indication for surgical risk-reduction / mastectomy.

• #24 Breast Cancer Risk: Usual and Atypical Hyperplasia | Susan G. Komen®

  https://www.komen.org/breast-cancer/risk-factor/hyperplasia-and-other-benign-breast-conditions/

  With atypical hyperplasia, the proliferating (dividing) cells look abnormal. […] Women with atypical hyperplasia have about 3 to 5 times the breast cancer risk of women without a proliferative breast condition [188-191]. […] For women with atypical hyperplasia who also have a 20% or greater lifetime risk of invasive breast cancer, there are special breast cancer screening recommendations. […] The National Comprehensive Cancer Network (NCCN) recommends women with atypical hyperplasia who also have a 20% or greater lifetime risk of invasive breast cancer [163]: Have a clinical breast exam and risk assessment every 6-12 months, starting by age 25; Have a mammogram with digital breast tomosynthesis every year, starting at age 30; Talk with a health care provider about screening with breast MRI every year, starting at age 25. […] The NCCN strongly recommends women with atypical hyperplasia take a risk-reducing drug (such as tamoxifen) to lower their risk of developing breast cancer [54]. […] These drugs can lower the risk of breast cancer in women with atypical hyperplasia by about 86% [54].

• #25 Hyperplasia and atypical hyperplasia | Breast Cancer Now

  https://breastcancernow.org/about-breast-cancer/breast-lumps-and-benign-not-cancer-breast-conditions/hyperplasia-and-atypical-hyperplasia/

  However, follow-up is on a case-by-case basis and depends on your individual circumstances and the arrangements at the hospital where you are treated. Your treatment team will let you know if and when you need follow-up. […] If you have atypical hyperplasia, your risk of breast cancer is increased. Your treatment team will explain if and how you will be followed up.

• #26 Contemporary management of atypical breast lesions identified on percutaneous biopsy: a narrative review – Amin – Annals of Breast Surgery

  https://abs.amegroups.org/article/view/6578/html

  Because of the low incidence of malignancy at a site of pure ALH, routine surgical excision is not recommended for ALH as an incidental finding with concordance between radiology and pathology. […] The standard of care for the management of DCIS is surgical excision followed by whole breast irradiation after lumpectomy and endocrine therapy. […] However, the standard management of DCIS is being called into question, with several international trials currently accruing offering observation over excision for grade 1-2 hormone-positive DCIS. […] Thus, the routine surgical excision of ADH should also be questioned. […] If the site of ADH is not excised, patients do not appear to be at increased risk of malignancy specifically at that location. […] Whether or not the ADH site is excised, future breast cancer risk persists and is a global risk, not isolated to the site of ADH diagnosis, with 40% of diagnoses being contralateral.

• #27 Contemporary management of atypical breast lesions identified on percutaneous biopsy: a narrative review – Amin – Annals of Breast Surgery

  https://abs.amegroups.org/article/view/6578/html

  Similar to ALH, having a diagnosis of ADH carries a four-fold risk of future breast cancer, translating into 12%/year absolute risk, with no plateau seen with extensive follow up. […] NCCN management recommendations for patients diagnosed with atypia include clinical encounter every six to twelve months, annual MMG after age 30, consider annual MRI after age 25, risk reduction strategies, and breast awareness. […] American Society of Clinical Oncology (ASCO) guidelines recommend chemoprevention be discussed with women with a 5-year absolute risk of breast cancer of 1.7% or higher. […] Chemoprevention with tamoxifen, raloxifene, anastrozole, or exemestane results in a 50% reduction in future malignancy risk. […] This risk reduction is even more significant in women with LN and ADH ranging from 65-70%, when compared to those with a family history of breast cancer without an atypia diagnosis.

• #28 Proliferative Breast Disease with Atypia | Dr. Garvit

  https://drgarvitchitkara.com/blogs/managing-proliferative-breast-disease-with-atypia/

  Proliferative breast disease with atypia treatment usually involves the surgical removal of the area where atypical cells were found through a lumpectomy or excisional biopsy and recently […] Vaccum assisted breast biopsy (VABB) has also been added to the armamentarium of breast biopsy techniques. This is done to both establish a definitive diagnosis and reduce the risk of potential progression to breast cancer. […] After surgery, close monitoring and increased screening are typically advised to detect any potential recurrence or development of breast cancer. This may include regular clinical breast exams every six months and annual mammograms. Some patients, based on their individual risk factors, may also be recommended to undergo additional screening, such as high-risk screening annual MRI scans, alternating with mammograms. Breast MRI can be particularly beneficial for women with dense breast tissue. […] Regular breast checks, imaging tests (such as mammography or breast MRI), and consultations with healthcare professionals to identify an individualized approach are all possible management techniques. Depending on the unique conditions, possible treatments may include surgery or medication.

• #29 Atypical hyperplasia of the breast | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/atypical-hyperplasia-breast

  Consider surgery to lower the risk of breast cancer. 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. Your risk also may be high if DNA changes that increase the risk of breast cancer run in your family. One operation that can lower the risk of breast cancer is surgery to remove both breasts. This procedure is called a risk-reducing mastectomy or a prophylactic mastectomy. […] Clinical trials test new treatments. Trials testing the best way to manage the risk of breast cancer in people with atypical hyperplasia may be available. Ask your healthcare team about clinical trials.

• #30 Atypical Lobular Hyperplasia and Risk of Breast Cancer

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

  Breast cancer risk-reduction strategies are also advised, including: Keeping a healthy weight, Quitting cigarettes, Staying physically active, Avoiding alcohol, Eating a low-fat diet. […] For some, medication such as tamoxifen and raloxifene may reduce the risk of breast cancer by up to 70%. […] 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.

• #31 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/

  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. […] Prior to starting endocrine therapy, numerous additional factors need to be taken into consideration, including a determination of pre- versus postmenopausal status, contraindications to use, risks and side effects of the medication, and overall estimated risk-reduction benefit.

• #32 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/

  However, as some of the medications have menopausal symptom-related side effects, womens health providers should be knowledgeable about risk-reduction medications as to be optimally positioned to answer patient questions and navigate through symptom management. […] For women who have contraindications to hormone therapy, vasomotor symptom management may include a discussion of other treatment modalities, many of which are nonhormonal. […] Management considerations include a change in risk-reduction agent, a change in medication dose, addition of a nonhormonal agent to combat symptoms, or possibly a discontinuation of the medication if symptoms are severe. […] Careful consideration is needed with the accompanying use of tamoxifen and SSRIs, especially paroxetine and fluoxetine, as these medications can diminish tamoxifen’s effectiveness.

• #33 Atypical Hyperplasia as a Predictor of Future Breast Cancer: Focus on Chemoprevention and Screening – The ASCO Post

  https://ascopost.com/issues/february-25-2015/atypical-hyperplasia-as-a-predictor-of-future-breast-cancer-focus-on-chemoprevention-and-screening.aspx

  Atypical hyperplasia of the breast has special importance as a predictor of future breast cancer, according to a special report in The New England Journal of Medicine. That special importance is based on the high incidence of atypical hyperplasia found in around 10% of the 1 million breast biopsies with benign results performed annually in the United States and the high risk with a cumulative incidence of breast cancer approaching 30% at 25 years of follow-up. […] The suggested clinical actions are more intensive screening using magnetic resonance imaging (MRI) and chemoprevention using selective estrogen-receptor modulators and aromatase inhibitors. […] Atypical hyperplasia is generally not an indication for prophylactic mastectomy, according to the report. Ultimately, it is really a matter of a woman’s choice, Dr. Degnim stressed. However, we would favor other approaches, such as prevention medications and MRI screening rather than mastectomy.

• #34 Atypical hyperplasia of the breast – Augusta HealthSearchClose SearchSearch IconSearch IconClose Search IconMobile Menu IconMobile Menu Close IconInstagramFacebookTwitterYoutube

  https://www.augustahealth.com/disease/atypical-hyperplasia-of-the-breast/

  Atypical hyperplasia is generally treated with surgery to remove the abnormal cells and to make sure no in situ or invasive cancer also is present in the area. Doctors often recommend more-intensive screening for breast cancer and medications to reduce your breast cancer risk. […] To reduce your risk of developing breast cancer, your doctor may recommend that you: […] Take preventive medications. Treatment with a selective estrogen receptor modulator, such as tamoxifen or raloxifene (Evista), for five years may reduce the risk of breast cancer. […] Another option for postmenopausal women may be aromatase inhibitors, such as exemestane (Aromasin) and anastrozole (Arimidex), which decrease production of estrogen in the body. […] Consider risk-reducing (prophylactic) mastectomy. If you have a very high risk of breast cancer, a risk-reducing mastectomy — surgery to remove one or both breasts — may be an option to reduce the risk of developing breast cancer in the future. […] Discuss with your doctor the risks, benefits and limitations of this risk-reducing surgery in light of your personal circumstances.

• #35 Atypical ductal hyperplasia: What it is and how it’s treated | MD Anderson Cancer Center

  https://www.mdanderson.org/cancerwise/atypical-ductal-hyperplasia–what-it-is-and-how-to-treat-it.h00-159695967.html

  Atypical ductal hyperplasia is not cancer, but it does put you at a greater risk of developing breast cancer. […] The first step is usually an excisional biopsy. […] If DCIS is found, we treat the patient for cancer. […] If the biopsy just shows atypical ductal hyperplasia and no cancer, we refer the patient for high-risk breast screening, which can include annual mammograms and breast MRIs. Patients will also learn about risk-reducing medications, sometimes called chemoprevention. […] MD Andersons High Risk Breast Screening and Genetics Clinic provides patients with breast cancer screening, risk-reducing medication counseling and genetic risk evaluation. The care is personalized for each patient. Your care team will help determine the best treatment plan for you.

• #36 Atypical Breast Hyperplasia – StatPearls – NCBI Bookshelf

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

  It is important to note that while surgical excision after identifying atypical hyperplasia in a core biopsy is generally considered appropriate, some disagreement persists regarding the management of high-risk lesions in certain cases. Proper management will depend on discussing all factors with the patient, and this includes a review of current treatment modalities and recommendations, patient risk factors, careful radiologic/pathologic correlation, and the overall clinical picture.

• #37 Atypical hyperplasia of the breast: Cancer risk-reduction strategies | MDedge

  https://mdedge.com/obgyn/article/100732/breast-cancer/atypical-hyperplasia-breast-cancer-risk-reduction-strategies

  Women with atypical hyperplasia clearly should receive annual mammographic screening. […] Selective estrogen receptor modulators such as tamoxifen and raloxifene should be more widely used by women with atypical hyperplasia because of their ability to reduce breast cancer risk. Aromatase inhibitors also should be prescribed more widely in this population. […] If the 5-year risk of breast cancer by the Gail model is greater than 1.7%, and the patient is older than 35 years, I counsel her that she qualifies for chemoprevention with prophylactic endocrine therapy with the selective estrogen receptor modulators tamoxifen or raloxifene, or the aromatase inhibitor exemestane. […] Many women are told that their follow-up surgical excision was “benign,” and the subject of “atypia” or risk reduction is never addressed. It’s important that the right diagnostic terminology and coding are documented in the medical record so that the finding of atypia is not downgraded to a “benign breast biopsy.” […] Finally, due to the complexities of this issue, evaluation by a qualified breast specialist or high-risk cancer program is recommended.

• #38 Atypical Ductal Hyperplasia – StatPearls – NCBI Bookshelf

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

  Patients should receive education on the meaning of the diagnosis as well as the actual risk conferred by the diagnosis of atypical ductal hyperplasia. Patients diagnosed with ADH should be followed closely by a clinician, given a higher risk of breast carcinoma in the future. Additionally, standard cancer risk-reducing guidelines are recommended, such as normalizing BMI and smoking cessation.

• #39 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Atypical-Hyperplasia.aspx

  Atypical hyperplasia is thus described as an accumulation of abnormally proliferating cells in the breast. It is not cancer, but can be a pre-cancerous condition, where the abnormal cells causing atypical hyperplasia keep dividing. This may result in non-invasive or invasive breast cancer in the long term. […] For this reason, intensive breast cancer screening and preventive medications to lower the risk of breast cancer is recommended in these cases. However, it is worth noting that the majority of women with atypical hyperplasia never develop breast cancer in their lifetime. […] If cancerous changes are not detected, no treatment is necessary. Follow-up breast imaging and examinations must be scheduled as part of screening. […] Similar to ductal hyperplasia, microscopic examination of tissue reveals the cell growth pattern and based on the results, doctors will decide if more tests are required. Follow up with imaging and physical exams are recommended.

• #40 Metformin Hydrochloride in Preventing Breast Cancer in Patients With Atypical Hyperplasia or In Situ Breast Cancer | Division of Cancer Prevention

  https://prevention.cancer.gov/clinical-trials/clinical-trials-search/nct01905046

  This randomized phase III trial studies metformin hydrochloride to see how well it works compared to placebo in preventing breast cancer in patients with atypical hyperplasia or in situ breast cancer. […] The use of metformin hydrochloride may prevent breast cancer.

• #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

  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. […] Alternatives to surgical excision include treatment with tamoxifen as this has been reported to reduce the risk of developing breast cancer from 21 to 7.5% in 10 years. […] Thus, the recommendation and current clinical practice is to perform an open surgical excision on all ADH diagnosed on CNB or VAB unless ADH is a single focus. […] This practice would certainly overtreat the majority of women diagnosed with ADH and clearly demonstrates the need to identify a robust biomarker to avoid unnecessary surgery and optimal management.

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

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

  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.

• #43

  https://www.kwongbreastclinic.com.sg/breast-health/benign-breast-conditions/atypical-hyperplasia/

  The main form of treatment is surgery and the removal of the abnormal area. […] The risk of cancer may be decreased by taking oral medications like Tamoxifen, Raloxifene, aromatase inhibitors and avoiding hormonal replacement therapy. […] Women with atypical hyperplasia should continue with monthly breast self-examinations in order to detect any early breast changes as well as consider annual mammograms, in view of the increased risk.

• #44

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=acf2776

  Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse advice line (811 in most provinces and territories) if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.

• #45 Atypical Ductal Hyperplasia: Breast Cancer Risk and More

  https://www.healthline.com/health/breast-cancer/atypical-ductal-hyperplasia

  DCIS requires treatment because theres no way of knowing if itll turn into invasive breast cancer. Treatment usually involves removing the cancerous cells, either through a lumpectomy or mastectomy. Afterward, youll receive radiation, hormonal therapy, or both to help prevent the cancer cells from returning. […] If youve been diagnosed with ADH, you have a few options for what to do next. […] In most cases, your doctor will likely suggest just keeping an eye on the affected breast and coming in for regular screenings to ensure nothings changed. Because theres no way of knowing if or when someone with ADH will develop cancer, its important to make sure you schedule more frequent screenings. […] Adopting certain lifestyle changes can also help reduce your risk of developing breast cancer. These include: reducing your alcohol intake, avoiding tobacco, maintaining a moderate weight through exercising regularly and eating a nutrient-rich diet, using nonhormonal treatment options to manage any symptoms of menopause.

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