Atypowa hiperplazja piersi – Rokowania, prognozy i postęp choroby

Atypowa hiperplazja piersi
Rokowania, prognozy i postęp choroby

Atypowa hiperplazja piersi (AH), obejmująca atypową hiperplazję przewodową (ADH) i zrazikową (ALH), jest stanem przedrakowym charakteryzującym się nieprawidłową proliferacją komórek nabłonkowych, który zwiększa względne ryzyko rozwoju raka piersi 4-5-krotnie w ciągu 5 lat. Kumulatywne 25-letnie ryzyko rozwoju raka piersi (inwazyjnego i in situ) u pacjentek z AH wynosi około 30%, przy czym ryzyko to jest wyższe w przypadku wieloogniskowości zmian, obecności zwapnień oraz dodatniego wywiadu rodzinnego. Ryzyko to dotyczy zarówno piersi ipsilateralnej, jak i kontralateralnej, z predylekcją 2:1 na korzyść piersi po stronie zmiany. W 10-30% przypadków biopsja z rozpoznaniem AH może ulec upgradowi do DCIS lub raka inwazyjnego podczas dalszej resekcji, co podkreśla potrzebę dokładnej diagnostyki i monitorowania. Standardowe modele oceny ryzyka (BCRAT/Gail, IBIS) nie są wystarczająco precyzyjne dla tej grupy pacjentek, co utrudnia indywidualizację prognozy.

Atypowa hiperplazja piersi (Atypical hyperplasia of the breast) – Rokowanie

Ryzyko rozwoju raka piersi
Ryzyko kumulacyjne i długoterminowa ocena rokowania
Czynniki modyfikujące ryzyko
Ograniczenia modeli predykcyjnych
Ryzyko upgradu i diagnoza pooperacyjna

Implikacje dla dalszego postępowania i monitorowania

Strategie monitorowania
Strategie prewencyjne

Podsumowanie rokowania

Kolejne rozdziały

Atypowa hiperplazja piersi (Atypical hyperplasia of the breast) – Rokowanie

Atypowa hiperplazja piersi (AH) to nieprawidłowa proliferacja komórek nabłonkowych w tkance piersiowej, która nie spełnia wszystkich kryteriów ilościowych i jakościowych pozwalających na klasyfikację jako rak in situ. Stanowi ona istotny stan przedrakowy występujący zarówno w nabłonku przewodowym (atypowa hiperplazja przewodowa, ADH), jak i zrazikowym (atypowa hiperplazja zrazikowa, ALH). Oba typy są klasyfikowane jako zmiany wysokiego ryzyka, które istotnie zwiększają prawdopodobieństwo rozwoju raka piersi w przyszłości.¹

Ryzyko rozwoju raka piersi

Rozpoznanie atypowej hiperplazji piersi wiąże się ze znaczącym zwiększeniem ryzyka rozwoju raka piersi. Dane epidemiologiczne wskazują, że diagnoza AH (zarówno ADH, jak i ALH) wiąże się z 4-5-krotnym wzrostem względnego ryzyka zachorowania na raka piersi w ciągu następnych 5 lat. Ryzyko to dotyczy zarówno piersi ipsilateralnej, jak i kontralateralnej, choć obserwuje się predylekcję w stosunku 2:1 na korzyść piersi ipsilateralnej.²³⁴ Niektóre badania wskazują nawet na 4-5-krotny wzrost ryzyka w piersi po tej samej stronie co zmiana i jednoczasowo zwiększone ryzyko w piersi przeciwległej.⁵

Co istotne, według niektórych badań, ryzyko to może być jeszcze większe w przypadku atypowych hiperplazji wykrytych w erze przed powszechnym stosowaniem mammografii, gdzie odnotowano nawet 4-5-krotny wzrost ryzyka.⁶

Ryzyko kumulacyjne i długoterminowa ocena rokowania

Długoterminowe badania prowadzone w Mayo Clinic i innych ośrodkach wykazały, że ryzyko zachorowania na raka piersi u pacjentek z atypową hiperplazją narasta z czasem. Najnowsze dane wskazują, że 25-letnie skumulowane ryzyko rozwoju raka piersi (zarówno inwazyjnego, jak i in situ) wynosi około 30%. Inaczej ujmując, spośród 100 kobiet ze zdiagnozowaną atypową hiperplazją, u 30 można spodziewać się rozwoju raka piersi w ciągu 25 lat od diagnozy, podczas gdy 70 nie zachoruje.⁷⁸⁹

Badania przeprowadzone przez Degnim i współpracowników pokazują, że 25-letnie ryzyko rozwoju raka związane z ADH wynosi co najmniej 25%, a może wzrosnąć nawet do 50-60% w przypadkach, gdy ADH jest wieloogniskowa i zwapniała.¹⁰¹¹ W badaniach Mayo Clinic wykazano, że ryzyko zachorowania na raka piersi dla kobiet z trzema lub więcej ogniskami atypowej hiperplazji wzrasta do 47% w ciągu 25 lat obserwacji.¹²

Warto zauważyć, że dane z Mayo Clinic wskazują również, że bezwzględne ryzyko rozwoju raka piersi u pacjentek z atypową hiperplazją rośnie o ponad 1% rocznie.¹³

Czynniki modyfikujące ryzyko

Ryzyko rozwoju raka piersi u kobiet z atypową hiperplazją może być modyfikowane przez różne czynniki. Na szczególną uwagę zasługują:

Wywiad rodzinny – ryzyko związane z ADH ulega podwojeniu w przypadku występowania dodatniego wywiadu rodzinnego, co sugeruje udział czynników dziedzicznych w rozwoju ADH¹⁴
Wieloogniskowość zmian – liczba ognisk atypowej hiperplazji jest bezpośrednio związana ze zwiększonym ryzykiem rozwoju raka piersi¹⁵
Zwapnienia – obecność zwapnień w zmianach typu ADH dodatkowo zwiększa ryzyko transformacji nowotworowej¹⁶

Ograniczenia modeli predykcyjnych

Pomimo wysokiego ryzyka rozwoju raka związanego z atypową hiperplazją, próby identyfikacji biomarkerów klinicznych lub molekularnych, które mogłyby przewidzieć indywidualne ryzyko, nie przyniosły dotychczas zadowalających rezultatów.¹⁷¹⁸ Co więcej, standardowe modele statystyczne oceny ryzyka (takie jak BCRAT/Gail czy IBIS) nie sprawdzają się dobrze u kobiet z atypową hiperplazją, co potwierdził zespół badawczy z Mayo Clinic.¹⁹

Hartmann i współpracownicy zwrócili uwagę, że obecne narzędzia oceny ryzyka raka piersi nie uwzględniają skumulowanej zachorowalności, podczas gdy dane z dużych retrospektywnych badań wskazują na 25-30% ryzyko w ciągu całego życia.²⁰²¹

Ryzyko upgradu i diagnoza pooperacyjna

Istotnym aspektem związanym z oceną rokowania u pacjentek z atypową hiperplazją jest możliwość wystąpienia tzw. upgradu diagnostycznego. Po znalezieniu atypowej hiperplazji w materiale z biopsji, w 10-30% przypadków podczas późniejszej operacyjnej resekcji zmiany może dojść do zmiany rozpoznania na bardziej zaawansowane, np. na przewodowego raka in situ (DCIS) lub raka inwazyjnego. Dotyczy to zwłaszcza przypadków podejrzanych o DCIS już na etapie biopsji.²²

Dotychczasowe badania nie wykazały jednak wiarygodnych, niezależnych wskaźników, które pozwoliłyby przewidzieć, które zmiany typu atypowej hiperplazji są związane z bardziej agresywnymi jednostkami chorobowymi, takimi jak DCIS wysokiego stopnia czy rak inwazyjny.²³

Implikacje dla dalszego postępowania i monitorowania

Ze względu na wysokie ryzyko rozwoju raka piersi u pacjentek z atypową hiperplazją, konieczne jest wdrożenie odpowiednich strategii monitorowania i prewencji.

Strategie monitorowania

Najnowsze dane sugerują, że optymalne schematy badań przesiewowych dla kobiet z ADH lub ALH powinny obejmować okres co najmniej 10 lat i być przeprowadzane w odstępach nie dłuższych niż 2 lata.²⁴ Warto podkreślić, że u kobiet z rozpoznaną atypową hiperplazją większość raków piersi rozwija się po upływie 5 lat od diagnozy, co wskazuje na konieczność długoterminowego nadzoru.²⁵

Na podstawie wyników badań zespół z Mayo Clinic zaleca, aby kobiety z atypową hiperplazją były uznawane za osoby o znacznie zwiększonym ryzyku zachorowania na raka piersi w ciągu życia i w związku z tym kwalifikowały się do badań przesiewowych z wykorzystaniem rezonansu magnetycznego (MRI).²⁶ Nowe dane pokazują poziom ryzyka, który spełnia obecne standardy kwalifikacji do badań MRI zawarte w wytycznych dotyczących badań przesiewowych raka piersi dla kobiet wysokiego ryzyka.²⁷

Strategie prewencyjne

Biorąc pod uwagę wysokie ryzyko rozwoju raka, dla kobiet z atypową hiperplazją zalecane są następujące strategie prewencyjne:

Chemoprewencja – stosowanie selektywnych modulatorów receptora estrogenowego (np. tamoksyfen) lub inhibitorów aromatazy (np. anastrozol) może zmniejszyć ryzyko rozwoju raka piersi nawet o 50% lub więcej.²⁸²⁹ Kobiety z ADH i ALH powinny mieć zapewnioną możliwość przyjmowania terapii prewencyjnej.³⁰
Intensywny nadzór – obejmujący rozszerzone badania obrazowe, w tym MRI piersi.³¹

Warto podkreślić, że atypowa hiperplazja nie jest zazwyczaj wskazaniem do profilaktycznej mastektomii. Eksperci preferują inne podejścia, takie jak leki zapobiegawcze i screening MRI, zamiast tak radykalnego leczenia chirurgicznego.³²

Podsumowanie rokowania

Atypowa hiperplazja piersi stanowi istotny stan przednowotworowy, wiążący się z 4-5-krotnym zwiększeniem względnego ryzyka zachorowania na raka piersi. Kumulacyjne ryzyko rozwoju raka w ciągu 25 lat od rozpoznania AH wynosi około 30%, przy czym ryzyko to może być modyfikowane przez takie czynniki jak wieloogniskowość zmian, obecność zwapnień czy dodatni wywiad rodzinny.³³³⁴³⁵

Co istotne, większość przypadków raka piersi u kobiet z atypową hiperplazją rozwija się po upływie 5 lat od pierwotnej diagnozy, co podkreśla znaczenie długoterminowego monitorowania. Obecnie zaleca się, aby kobiety z rozpoznaną atypową hiperplazją były objęte intensywnym nadzorem obejmującym badania obrazowe, w tym MRI piersi, przez co najmniej 10 lat, oraz rozważenie chemoprewencji z zastosowaniem tamoksyfenu lub anastrozolu.³⁶³⁷

Pomimo istniejących wytycznych, wielu ekspertów zwraca uwagę, że wysokie skumulowane ryzyko (zbliżające się do 30% w ciągu 25 lat) nie jest powszechnie uznawane, a zatem kobiety z atypową hiperplazją nie są uwzględniane w wielu wytycznych dotyczących wysokiego ryzyka. Powoduje to, że poradnictwo i dalsze badania przesiewowe dla tych kobiet mogą być nieadekwatne do rzeczywistego poziomu ryzyka.³⁸³⁹

Kolejne rozdziały

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Wybierz kolejny rozdział z menu poniżej, aby otworzyć nową podstronę kompedium wiedzy i uzyskać szczegółowe informację o leku, substancji lub chorobie.

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. […] Atypical ductal hyperplasia (ADH) is a relatively common lesion reported to be found in about 5% to 20% of breast biopsies. Although not carcinoma, it is classified as a high-risk precursor lesion due to its association with and potential to progress to ductal carcinoma in situ (DCIS) as well as invasive carcinoma. […] Atypical lobular hyperplasia (ALH), like ADH, is another high-risk breast lesion that has been associated with a four-fold to five-fold increased lifetime risk of developing breast cancer in either the ipsilateral or contralateral breast.
#2 Atypical Breast Hyperplasia – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK470258/
When ADH or ALH is identified in a breast biopsy, the risk of developing DCIS or invasive breast cancer increases by four to five times with a 2:1 predilection for the ipsilateral breast versus contralateral. It is unclear if a precursor lesion exists for high-grade DCIS or invasive carcinoma; however, breast cancer relative risk is increased four times when atypical hyperplasia is identified on a breast biopsy. The lifetime risk of developing breast cancer in patients with ADH or ALH on biopsy is 15% to 20%. […] ADH is considered a pre-malignant, high-risk lesion, and ALH only a high-risk lesion. Either can be found in association with or at the periphery of a more advanced lesion; therefore, it is important to remember that atypical hyperplasia found on a biopsy may not accurately represent the greater lesion. Upgrade on surgical excision after atypical hyperplasia is found on biopsy varies from 10% to as high as 30%, with cases of atypical hyperplasia suspicious for DCIS having a higher rate of an upgrade after undergoing excision. Studies have failed to show reliable, independent indicators of which atypical hyperplasia lesions are associated with more aggressive entities such as high-grade DCIS or invasive cancer.
#3 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, and that the lifetime incidence is 25-30% according to multiple large retrospective studies. […] Strikingly, the risk associated with ADH is doubled with family history, suggesting inherited factors are associated with ADH development. […] Unfortunately, risk prediction following ADH diagnosis is controversial, and counseling and further screening for these women diagnosed with ADH are therefore probably not adequate.
#4 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. […] Most literature shows that people with atypical ductal hyperplasia can have up to four times the risk of getting breast cancer compared to someone without it. […] Not everyone who has atypical ductal hyperplasia will develop breast cancer.
#5 Atypical ductal hyperplasia: update on diagnosis, management, and molecular landscape
https://pmc.ncbi.nlm.nih.gov/articles/PMC5932853/
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 (such as Gail/Breast Cancer Risk Assessment Tool, International Breast Cancer Intervention Study (IBIS)), and that the lifetime incidence is 25-30% according to multiple large retrospective studies, each with more than 300 AH (both ductal and lobular) diagnoses. […] Unfortunately, risk prediction following ADH diagnosis is controversial, and counseling and further screening for these women diagnosed with ADH are therefore probably not adequate.
#6 The impact of mammographic screening on the subsequent breast cancer risk associated with biopsy-proven benign breast disease | npj Breast Cancer
https://www.nature.com/articles/s41523-021-00225-9
Benign breast disease (BBD) is a term that encompasses a heterogeneous group of lesions with different levels of subsequent breast cancer risk. […] Atypical hyperplasias are associated with a 45-fold increase in risk. […] In this study, we found similar BBD-breast cancer risk associations from BBDs detected in the pre- vs. post-mammography era. […] Our data suggest that the magnitude of risk associated with BBD subtypes initially reported from women biopsied in the pre-mammography era remains valid for BBD detected after the widespread use of mammography.
#7 Atypical hyperplasia of the breast – Symptoms and causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/atypical-hyperplasia/symptoms-causes/syc-20369773
Atypical hyperplasia of the breast is the development of precancerous cells in the breast. Atypical hyperplasia causes a buildup of cells in the breast tissue. When viewed with a microscope, the cells look different from typical breast cells. […] Atypical hyperplasia of the breast isn’t breast cancer. But it’s a sign that you have an increased risk of breast cancer in the future. […] If you’ve been diagnosed with atypical hyperplasia of the breast, you have an increased risk of getting breast cancer in the future. The risk of breast cancer in those with atypical hyperplasia is about four times higher than in those who don’t have atypical hyperplasia. The risk is similar for atypical ductal hyperplasia and atypical lobular hyperplasia. […] Studies of women with atypical hyperplasia have found that the risk of breast cancer increases over time. At 25 years after diagnosis, about 30% of women with atypical hyperplasia may have breast cancer. Put another way, for every 100 women diagnosed with atypical hyperplasia, 30 can be expected to have breast cancer 25 years after diagnosis. And 70 will not develop breast cancer.
#8 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 high cumulative incidence approaching 30% at 25 years is not widely recognized, and thus women with atypical hyperplasia are not included in many high-risk guidelines, the authors acknowledged. […] More recent data on absolute risk from the Nashville Breast Cohort (unpublished data) and another large cohort at the Mayo Clinic confirm the cumulative high risk of breast cancer among women with atypical hyperplasia. Specifically, 25 years after a biopsy that showed atypical hyperplasia, breast cancer (either in situ or invasive) developed in 30% of the women in the Mayo Clinic cohort.
#9 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. While ADH is considered a non-obligate precursor of invasive carcinoma, the molecular taxonomy remains unknown. […] A recent study with a median of 12 years follow-up showed that only a minority of women (143 among 698; 20%) with atypical hyperplasia (AH; both atypical ductal hyperplasia (ADH) and atypical lobular hyperplasia (ALH)) eventually progressed to malignancy even without any preventative strategies. […] Based on their study and other available data the authors concluded that atypical hyperplasia confers an absolute risk of subsequent breast cancer of 30% at 25 years of follow-up.
#10 Atypical ductal hyperplasia: update on diagnosis, management, and molecular landscape
https://pmc.ncbi.nlm.nih.gov/articles/PMC5932853/
Degnim et al. showed that the 25-year risk of developing cancer associated with ADH is at least 25%, and it could be as high as 50-60% if the ADH is both multifocal and calcified. […] 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.
#11 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
Degnim et al. showed that the 25-year risk of developing cancer associated with ADH is at least 25%, and it could be as high as 50-60% if the ADH is both multifocal and calcified. […] 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.
#12 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
These newer data show a level of risk that meets the current standard for MRI screening in guidelines for breast cancer screening for high-risk women. […] If a woman has a needle biopsy and the pathologist reports one focus of atypia, that does not mean the patient may not have more; to get that information, you would need to excise the site of atypia, get a little more tissue, and find out if it really is just one focus or more, Dr. Degnim said. […] 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. […] Although the majority of all women with atypical hyperplasia do not get breast cancer, the risk is quite high in some individuals. At 25 years, the risk of breast cancer for women with three or more foci of atypical hyperplasia was 47%.
#13 Mayo Clinic: Women with Atypical Hyperplasia are at Higher Risk of Breast Cancer – Mayo Clinic News Network
https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-women-with-atypical-hyperplasia-are-at-higher-risk-of-breast-cancer/
Women with atypical hyperplasia of the breast have a higher risk of developing breast cancer than previously thought, a Mayo Clinic study has found. […] Data from hundreds of women with these benign lesions indicate that their absolute risk of developing breast cancer grows by over 1 percent a year. […] The finding places the more than 100,000 women diagnosed each year with atypical hyperplasia â also known as atypia â into a high-risk category, where they are more likely to benefit from intense screening and use of medications to reduce risk. […] By providing better risk prediction for this group, we can tailor a womanâs clinical care to her individual level of risk. […] Previous research has shown that women with atypia have a fourfold to fivefold increased ârelative riskâ â meaning that they are four to five times more likely to develop breast cancer than women who donât have these lesions.
#14 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, and that the lifetime incidence is 25-30% according to multiple large retrospective studies. […] Strikingly, the risk associated with ADH is doubled with family history, suggesting inherited factors are associated with ADH development. […] Unfortunately, risk prediction following ADH diagnosis is controversial, and counseling and further screening for these women diagnosed with ADH are therefore probably not adequate.
#15 Mayo Clinic: Women with Atypical Hyperplasia are at Higher Risk of Breast Cancer – Mayo Clinic News Network
https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-women-with-atypical-hyperplasia-are-at-higher-risk-of-breast-cancer/
The researchers found that after an average follow-up of 12.5 years, 143 women had developed the disease. […] Importantly, the Mayo findings were validated by researchers at Vanderbilt University using biopsies from a separate cohort of women with atypia. […] The Mayo team had previously showed that two common statistical risk prediction models (the BCRAT and the IBIS models) performed poorly in women with atypical hyperplasia, underscoring the need to provide alternative approaches for predicting risk in this population. […] Instead of relying on a statistical model, our study provides actual data of breast cancer cases that occurred in a population of women with atypia. […] They found that as the extent of atypia in a biopsy increased, as measured by the number of separate atypia lesions or foci, so did the womanâs risk of developing breast cancer.
#16 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
Degnim et al. showed that the 25-year risk of developing cancer associated with ADH is at least 25%, and it could be as high as 50-60% if the ADH is both multifocal and calcified. […] 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.
#17 Atypical ductal hyperplasia: update on diagnosis, management, and molecular landscape
https://pmc.ncbi.nlm.nih.gov/articles/PMC5932853/
Degnim et al. showed that the 25-year risk of developing cancer associated with ADH is at least 25%, and it could be as high as 50-60% if the ADH is both multifocal and calcified. […] 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.
#18 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
Degnim et al. showed that the 25-year risk of developing cancer associated with ADH is at least 25%, and it could be as high as 50-60% if the ADH is both multifocal and calcified. […] 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.
#19 Mayo Clinic: Women with Atypical Hyperplasia are at Higher Risk of Breast Cancer – Mayo Clinic News Network
https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-women-with-atypical-hyperplasia-are-at-higher-risk-of-breast-cancer/
The researchers found that after an average follow-up of 12.5 years, 143 women had developed the disease. […] Importantly, the Mayo findings were validated by researchers at Vanderbilt University using biopsies from a separate cohort of women with atypia. […] The Mayo team had previously showed that two common statistical risk prediction models (the BCRAT and the IBIS models) performed poorly in women with atypical hyperplasia, underscoring the need to provide alternative approaches for predicting risk in this population. […] Instead of relying on a statistical model, our study provides actual data of breast cancer cases that occurred in a population of women with atypia. […] They found that as the extent of atypia in a biopsy increased, as measured by the number of separate atypia lesions or foci, so did the womanâs risk of developing breast cancer.
#20 Atypical ductal hyperplasia: update on diagnosis, management, and molecular landscape
https://pmc.ncbi.nlm.nih.gov/articles/PMC5932853/
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 (such as Gail/Breast Cancer Risk Assessment Tool, International Breast Cancer Intervention Study (IBIS)), and that the lifetime incidence is 25-30% according to multiple large retrospective studies, each with more than 300 AH (both ductal and lobular) diagnoses. […] Unfortunately, risk prediction following ADH diagnosis is controversial, and counseling and further screening for these women diagnosed with ADH are therefore probably not adequate.
#21 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, and that the lifetime incidence is 25-30% according to multiple large retrospective studies. […] Strikingly, the risk associated with ADH is doubled with family history, suggesting inherited factors are associated with ADH development. […] Unfortunately, risk prediction following ADH diagnosis is controversial, and counseling and further screening for these women diagnosed with ADH are therefore probably not adequate.
#22 Atypical Breast Hyperplasia – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK470258/
When ADH or ALH is identified in a breast biopsy, the risk of developing DCIS or invasive breast cancer increases by four to five times with a 2:1 predilection for the ipsilateral breast versus contralateral. It is unclear if a precursor lesion exists for high-grade DCIS or invasive carcinoma; however, breast cancer relative risk is increased four times when atypical hyperplasia is identified on a breast biopsy. The lifetime risk of developing breast cancer in patients with ADH or ALH on biopsy is 15% to 20%. […] ADH is considered a pre-malignant, high-risk lesion, and ALH only a high-risk lesion. Either can be found in association with or at the periphery of a more advanced lesion; therefore, it is important to remember that atypical hyperplasia found on a biopsy may not accurately represent the greater lesion. Upgrade on surgical excision after atypical hyperplasia is found on biopsy varies from 10% to as high as 30%, with cases of atypical hyperplasia suspicious for DCIS having a higher rate of an upgrade after undergoing excision. Studies have failed to show reliable, independent indicators of which atypical hyperplasia lesions are associated with more aggressive entities such as high-grade DCIS or invasive cancer.
#23 Atypical Breast Hyperplasia – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK470258/
When ADH or ALH is identified in a breast biopsy, the risk of developing DCIS or invasive breast cancer increases by four to five times with a 2:1 predilection for the ipsilateral breast versus contralateral. It is unclear if a precursor lesion exists for high-grade DCIS or invasive carcinoma; however, breast cancer relative risk is increased four times when atypical hyperplasia is identified on a breast biopsy. The lifetime risk of developing breast cancer in patients with ADH or ALH on biopsy is 15% to 20%. […] ADH is considered a pre-malignant, high-risk lesion, and ALH only a high-risk lesion. Either can be found in association with or at the periphery of a more advanced lesion; therefore, it is important to remember that atypical hyperplasia found on a biopsy may not accurately represent the greater lesion. Upgrade on surgical excision after atypical hyperplasia is found on biopsy varies from 10% to as high as 30%, with cases of atypical hyperplasia suspicious for DCIS having a higher rate of an upgrade after undergoing excision. Studies have failed to show reliable, independent indicators of which atypical hyperplasia lesions are associated with more aggressive entities such as high-grade DCIS or invasive cancer.
#24 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. […] In women with ADH/LN most BCs occur beyond 5 years. […] 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.
#25 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. […] In women with ADH/LN most BCs occur beyond 5 years. […] 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.
#26 Mayo Clinic: Women with Atypical Hyperplasia are at Higher Risk of Breast Cancer – Mayo Clinic News Network
https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-women-with-atypical-hyperplasia-are-at-higher-risk-of-breast-cancer/
Based on these results, the research team recommends that women with atypical hyperplasia be recognized as having significantly increased lifetime risk of breast cancer and thus be candidates for screening MRI. […] Moreover, anti-estrogen medications like tamoxifen have already been tested in clinical trials in women with atypia and shown to lower their risk of breast cancer by 50 percent or more.
#27 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
These newer data show a level of risk that meets the current standard for MRI screening in guidelines for breast cancer screening for high-risk women. […] If a woman has a needle biopsy and the pathologist reports one focus of atypia, that does not mean the patient may not have more; to get that information, you would need to excise the site of atypia, get a little more tissue, and find out if it really is just one focus or more, Dr. Degnim said. […] 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. […] Although the majority of all women with atypical hyperplasia do not get breast cancer, the risk is quite high in some individuals. At 25 years, the risk of breast cancer for women with three or more foci of atypical hyperplasia was 47%.
#28 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
Several statements in the special report support the use of selective estrogen-receptor modulators and aromatase inhibitors to prevent breast cancer in women with atypical hyperplasia. […] Chemopreventive agents, however, are infrequently prescribed and infrequently used, according to the report. […] We hope that having more accurate assessment of an individual woman’s risk will help patients to benefit from prevention medications, Dr. Degnim said. Knowing that their risk approaches 30% at 25 years may motivate them more strongly to stay on their risk-reduction medication.
#29 Mayo Clinic: Women with Atypical Hyperplasia are at Higher Risk of Breast Cancer – Mayo Clinic News Network
https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-women-with-atypical-hyperplasia-are-at-higher-risk-of-breast-cancer/
Based on these results, the research team recommends that women with atypical hyperplasia be recognized as having significantly increased lifetime risk of breast cancer and thus be candidates for screening MRI. […] Moreover, anti-estrogen medications like tamoxifen have already been tested in clinical trials in women with atypia and shown to lower their risk of breast cancer by 50 percent or more.
#30 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. […] In women with ADH/LN most BCs occur beyond 5 years. […] 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.
#31 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
These newer data show a level of risk that meets the current standard for MRI screening in guidelines for breast cancer screening for high-risk women. […] If a woman has a needle biopsy and the pathologist reports one focus of atypia, that does not mean the patient may not have more; to get that information, you would need to excise the site of atypia, get a little more tissue, and find out if it really is just one focus or more, Dr. Degnim said. […] 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. […] Although the majority of all women with atypical hyperplasia do not get breast cancer, the risk is quite high in some individuals. At 25 years, the risk of breast cancer for women with three or more foci of atypical hyperplasia was 47%.
#32 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
These newer data show a level of risk that meets the current standard for MRI screening in guidelines for breast cancer screening for high-risk women. […] If a woman has a needle biopsy and the pathologist reports one focus of atypia, that does not mean the patient may not have more; to get that information, you would need to excise the site of atypia, get a little more tissue, and find out if it really is just one focus or more, Dr. Degnim said. […] 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. […] Although the majority of all women with atypical hyperplasia do not get breast cancer, the risk is quite high in some individuals. At 25 years, the risk of breast cancer for women with three or more foci of atypical hyperplasia was 47%.
#33 Atypical ductal hyperplasia: update on diagnosis, management, and molecular landscape
https://pmc.ncbi.nlm.nih.gov/articles/PMC5932853/
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. While ADH is considered a non-obligate precursor of invasive carcinoma, the molecular taxonomy remains unknown. […] A recent study with a median of 12 years follow-up showed that only a minority of women (143 among 698; 20%) with atypical hyperplasia (AH; both atypical ductal hyperplasia (ADH) and atypical lobular hyperplasia (ALH)) eventually progressed to malignancy even without any preventative strategies. […] Based on their study and other available data the authors concluded that atypical hyperplasia confers an absolute risk of subsequent breast cancer of 30% at 25 years of follow-up.
#34 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. […] In women with ADH/LN most BCs occur beyond 5 years. […] 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.
#35 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 high cumulative incidence approaching 30% at 25 years is not widely recognized, and thus women with atypical hyperplasia are not included in many high-risk guidelines, the authors acknowledged. […] More recent data on absolute risk from the Nashville Breast Cohort (unpublished data) and another large cohort at the Mayo Clinic confirm the cumulative high risk of breast cancer among women with atypical hyperplasia. Specifically, 25 years after a biopsy that showed atypical hyperplasia, breast cancer (either in situ or invasive) developed in 30% of the women in the Mayo Clinic cohort.
#36 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. […] In women with ADH/LN most BCs occur beyond 5 years. […] 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.
#37 Mayo Clinic: Women with Atypical Hyperplasia are at Higher Risk of Breast Cancer – Mayo Clinic News Network
https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-women-with-atypical-hyperplasia-are-at-higher-risk-of-breast-cancer/
Based on these results, the research team recommends that women with atypical hyperplasia be recognized as having significantly increased lifetime risk of breast cancer and thus be candidates for screening MRI. […] Moreover, anti-estrogen medications like tamoxifen have already been tested in clinical trials in women with atypia and shown to lower their risk of breast cancer by 50 percent or more.
#38 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 high cumulative incidence approaching 30% at 25 years is not widely recognized, and thus women with atypical hyperplasia are not included in many high-risk guidelines, the authors acknowledged. […] More recent data on absolute risk from the Nashville Breast Cohort (unpublished data) and another large cohort at the Mayo Clinic confirm the cumulative high risk of breast cancer among women with atypical hyperplasia. Specifically, 25 years after a biopsy that showed atypical hyperplasia, breast cancer (either in situ or invasive) developed in 30% of the women in the Mayo Clinic cohort.
#39 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, and that the lifetime incidence is 25-30% according to multiple large retrospective studies. […] Strikingly, the risk associated with ADH is doubled with family history, suggesting inherited factors are associated with ADH development. […] Unfortunately, risk prediction following ADH diagnosis is controversial, and counseling and further screening for these women diagnosed with ADH are therefore probably not adequate.