What is atypical hyperplasia?
Hyperplasia
is the first type of abnormality in a cell's appearance. It means that
there are more cells than you would expect to see in the walls of the
ducts or lobules, but that all of these cells appear normal. A
diagnosis of hyperplasia does not put you at any increased risk for
developing breast cancer.
Atypia
means that the cells look different from normal cells, but that they
don't have all the features of cancer cells. You can have atypia with
hyperplasia, which means that the cells look different from normal and
that there are more cells than you would expect to see. You can also
have atypia without having hyperplasia.
The terms ductal and lobular indicate where the cells originated. Ductal means that the unusual cells are in the ducts, the passages that the milk travels through to get to the nipple. Lobular
means that the unusual cells are in the lobules, the parts of the
breast capable of making milk. Atypia and hyperplasia are thought to be
reversible, although it isn't clear what can nudge them back to normal.
[Enlarge image]
[Enlarge image]
How is it treated?
If atypical hyperplasia is diagnosed on a core biopsy, the best
practice would be to have an excisional biopsy (sometimes this is a
wire localization excision) 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. In many
ways, a diagnosis of atypical hyperplasia is similar to getting an
abnormal Pap smear that is not cancerous: Both need to be monitored.
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.
You also may want to 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. The National Cancer Institute and the National Society of Genetic Counselors can help you locate a genetic counselor near you.
More controversial is the question of tamoxifen for five years to
reduce your risk of developing breast cancer. Tamoxifen is a type of
hormone therapy routinely used to treat women with breast cancer whose
tumors are hormone-sensitive. It is currently the only drug approved
for breast cancer risk reduction. When used in this way it is commonly
referred to as chemoprevention. It is not safe to take tamoxifen if you
are pregnant or trying to get pregnant. Since tamoxifen has side
effects, you need to discuss the risks and benefits with your
physician, as the risks may outweigh the benefit you would receive.
If you are postmenopausal and decide you are interested in chemoprevention, another option would be to enroll in the ExCel study.
This study is exploring the effectiveness of the aromatase inhibitor
exemestane (brand name Aromasin) in preventing breast cancer.
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