What is Atypical Breast Hyperplasia?
Atypical hyperplasia of the breast refers to unusual growth of breast cells that are not quite abnormal enough to be classified as carcinoma in situ, a type of early stage cancer. These growths can happen in both male and female breast tissue, but they’re quite rare and are typically found by accident in samples from men with enlarged breasts (gynecomastia). This article mainly discusses atypical hyperplasia in female breast tissue, both in the milk ducts and the regions of the breast that produce milk (lobes). Both of these growths are considered to raise a woman’s risk of developing more dangerous types of growths.
Atypical ductal hyperplasia (ADH), abnormal growth in the milk ducts, is fairly common and is reported to be found in about 5% to 20% of breast biopsies. Even though it’s not a cancer, it’s regarded as a high-risk because it can possibly progress to ductal carcinoma in situ (DCIS), a type of early stage breast cancer, as well as invasive carcinoma, a more serious form of breast cancer.
Atypical lobular hyperplasia (ALH), abnormal growth in the lobes of the breast, is another high-risk condition similar to ADH. It has been associated with a four to five times higher lifetime risk of developing breast cancer in either the same or opposite breast.
What Causes Atypical Breast Hyperplasia?
Atypical lobular and ductal hyperplasias are abnormal growths in the breast that are considered to be high risk. It is believed that they could either progress to advanced tumors, or be a warning sign of future breast cancer. Studies suggest that these growths can be a result of changes in the genes of normal breast tissue, that lead to uncontrolled growth. One of the main causes of these genetic changes is thought to be exposure to damaging substances related to cancer.
One such damaging substance could be estrogen, a hormone that women are exposed to in varying amounts throughout their lives. Estrogen and its byproducts have been linked with causing damage to the DNA, leading to abnormal growth, mainly in luminal progenitor cells – the cells lining the breast ducts and lobules. Over a lifetime, it’s believed that continuous exposure to estrogen can result in a build-up of these genetic changes, which could potentially result in atypical growths in the breast.
Turning to specifics, genetic studies have found similarities between certain growths such as ductal hyperplasia (ADH) and low-grade ductal carcinoma in situ (DCIS). This has led scientists to believe that over time, ADH can develop into low-grade DCIS. However, lobular hyperplasia (ALH) isn’t considered a direct precursor to cancer, but is seen as a significant risk factor. Finding either ADH or ALH in a biopsy can increase the risk of developing DCIS or invasive breast cancer by four to five times. Interestingly, one is twice as likely to develop cancer in the same breast as the biopsy, compared to the other one.
At the molecular level, researchers have identified key elements related to uncontrolled cell growth, which include overproduction of cyclin D1, inactivation of p16 and HOXA, and activation of telomerase. These changes can inhibit cell death and promote the development of cancer. The exact order and interconnection of these events are still not completely understood. However, it’s hoped that future research will help us understand more about these abnormal growths, leading to more accurate risk assessment, prognosis, and early identification of advanced tumors.
Risk Factors and Frequency for Atypical Breast Hyperplasia
About 10% of breast biopsies in females reveal an unusual growth of cells, with the majority of these cases occurring in women in their 40s.
It’s also worth noting that this unusual cell growth, known as atypical hyperplasia, can occur in males undergoing breast reduction for oversized male breasts, though this is extremely rare. In fact, it’s so rare that in a study of over 5000 samples, less than 1% showed signs of atypical hyperplasia.
Signs and Symptoms of Atypical Breast Hyperplasia
Atypical hyperplasia are abnormal growths that usually get spotted during routine mammograms, during breast biopsies meant to investigate calcium deposits on imaging, or when looking at other benign or malignant lesions. Even though these lesions don’t develop into cancer, they still considerably raise the risk of breast cancer. Therefore, it’s important to talk about risk factors like exposure to estrogen and family history of breast cancer.
Although an all-encompassing physical checkup with a specific focus on the breast is important for patient assessment, these atypical hyperplasia lesions are very small and very unlikely to be detected in a normal physical examination. Only when there’s a solitary focus of Atypical Ductal Hyperplasia (ADH) that is larger than 0.2 cm, it is more likely to be identified as Ductal Carcinoma In Situ (DCIS), a non-invasive cancer that is contained within the milk ducts.
Testing for Atypical Breast Hyperplasia
Atypical hyperplasia, an uncommon type of cell growth, cannot be spotted on imaging scans. However, it can be detected when a breast biopsy or surgical removal of tissue is examined under a microscope. These procedures are usually undertaken due to other signs spotted on scans, such as calcifications or suspicious lesions.
It’s less likely for atypical hyperplasia to be the main revelation if a biopsy is taken due to a noticeable breast lump or mass. Therefore, it’s essential for women to get regular mammogram screenings and breast exams. The frequency of these assessments should be as advised by medical professionals, based on the woman’s individual risk level.
Treatment Options for Atypical Breast Hyperplasia
Atypical hyperplasia is a condition where cells are abnormal and are usually associated with a higher risk of developing into cancer. Many doctors suggest patients should have the abnormal cells completely removed through surgery. This prevents the possibility of a more advanced form of abnormal cell growth from developing if the patient has already had a breast biopsy. It’s standard practice to have surgery for atypical hyperplasia after biopsies.
However, in smaller biopsies, atypical hyperplasia might be discovered unexpectedly, and deciding whether to remove these through surgery can be more debatable. In general, surgery is advised in patients who are at a high risk of developing cancer. However, for patients who have been identified as lower-risk (those without a family or personal history of breast cancer, who haven’t got BRCA1 or BRCA2 genetic information suggesting a likelihood of cancer, or those who have only one abnormal lesion), surveillance or treatment with medicines like estrogen receptor modulators can be alternatives to surgery. For these patients, it is generally recommended to have more frequent mammograms.
Atypical hyperplasia is seen as a higher-risk condition and can sometimes be found alongside another severe condition or even near it. However, it’s essential to remember that when atypical hyperplasia is discovered in a biopsy, it might not fully represent what’s really going on in the body. In fact, when atypical hyperplasia is found in a biopsy, follow-up surgical removal can reveal more advanced cell changes 10-30% of the time, particularly in cases where the atypical hyperplasia was suspected to be a specific type of breast cancer known as DCIS (ductal carcinoma in situ).
There’s still some disagreement over how to handle these conditions in some cases. The best way to manage it depends on discussing all factors with the patient. This includes reviewing the current treatments and suggestions, the patient’s personal risk factors, examining all test results carefully, and considering the overall health situation.
What else can Atypical Breast Hyperplasia be?
When suspecting atypical ductal hyperplasia (ADH) or atypical lobular hyperplasia (ALH), a few conditions that doctors usually consider include:
- Usual ductal hyperplasia, a benign increase in cells in the ducts of the breasts.
- Ductal carcinoma in situ, early-stage breast cancer that starts in the ducts.
- Lobular carcinoma in situ, breast cancer that starts in the milk-producing glands.
- Flat epithelial atypia, abnormal cells in the breast ducts.
The key to distinguishing these conditions is to decide if the irregularity is ADH or low-grade ductal carcinoma in situ (DCIS). These differences can be identified based on the distinct characteristics revealed in tissue samples taken from the breast. However, some cases can be challenging, with borderline lesions that might be identified as “ADH bordering on DCIS” or “ADH suspicious for DCIS”. So, careful observation and analysis are required.
What to expect with Atypical Breast Hyperplasia
Atypical ductal hyperplasia (ADH) is a condition commonly found in around 5% to 20% of breast biopsies. Although it isn’t cancer, it’s seen as a high-risk precursor. This means it is closely associated with, and has the potential to turn into, a condition called ductal carcinoma in situ (DCIS), as well as invasive cancer.
Similarly, atypical lobular hyperplasia (ALH), just like ADH, is another high-risk condition of the breast. It has been linked with a four to five times higher risk of developing breast cancer in either the same (ipsilateral) or the opposite (contralateral) breast.
Possible Complications When Diagnosed with Atypical Breast Hyperplasia
The complications associated with atypical hyperplasia of the breast mostly arise from the surgical treatment for this condition. These potential issues can include:
- Infection
- Bleeding
- Complications from anesthesia
- Changes to physical appearance
- Pain
These represent just some of the potential complications one might experience.
Preventing Atypical Breast Hyperplasia
Atypical hyperplasia of the breast is a complex condition. Most experts agree that surgery is the right course of action to treat it. However, patients should be given personalized advice, because each case may be influenced by different aspects. For example, the range of the disease, abnormalities, family health background, past health history, genetic factors, and the overall health of the patient all might influence the treatment plan.
