What is Atypical Ductal Hyperplasia?
Atypical ductal hyperplasia (ADH) is a condition detected in breast tissue. It’s often found by accident during a needle biopsy, which is a procedure often carried out after unusual results on a mammogram. ADH is associated with a higher risk of breast cancer, leading it to be labeled a “high risk” condition. However, it’s not seen as a direct “forerunner” to cancer, because the breast cancer linked to ADH could pop up anywhere in the breasts, not just where ADH is spotted. Since ADH is typically discovered unexpectedly, we don’t know exactly how common it is. Though, we do know that once it’s been found, it increases the chances of developing breast cancer by about five times.
What Causes Atypical Ductal Hyperplasia?
While the exact cause of atypical ductal hyperplasia (ADH), a breast condition, is not clearly understood, it seems to occur more frequently in patients who have a strong family history of breast cancer. This was evidenced in a study which revealed that about half the women who chose to have their breasts surgically removed to prevent breast cancer (due to a high family risk) had high-risk breast conditions, and 39% of these were ADH. This suggests that the condition might have a genetic connection, although further research is still needed to confirm this hypothesis.
A 2009 study also showed that the occurrences of ADH dropped as the usage of hormone therapies after menopause decreased. This alludes to the possibility that these therapies might have been a factor in causing ADH.
Risk Factors and Frequency for Atypical Ductal Hyperplasia
Atypical ductal hyperplasia, which often goes unnoticed on medical imaging, is usually discovered by chance during a pathology examination. It’s most commonly found during a core needle biopsy, but it can also show up during other types of breast procedures, including cancer surgeries, cosmetic reductions, and any other operation involving the examination of breast tissue.
Atypical ductal hyperplasia is present in about 3.5% to 5% of biopsy samples, and it’s most often found during a core needle biopsy. In a large study from 2009 looking at nearly 31,000 biopsies, the frequency of this condition increased along with a rise in breast cancer awareness, screening mammograms, preventive mastectomies, and the use of hormone therapy after menopause. This led to the highest number of atypical ductal hyperplasia cases in 1999. However, since hormone therapy after menopause has fallen out of favor, the number of these cases has dipped slightly.
Atypical ductal hyperplasia mostly affects women between their 50s and 60s who are likely to be getting breast biopsies. Even though it can occur in men, it’s less common. For instance, a Dutch study of over 5,000 male breast tissue samples revealed the condition in only 0.4% of the cases.
Signs and Symptoms of Atypical Ductal Hyperplasia
Atypical ductal hyperplasia, often referred to as ADH, is a condition typically discovered during a biopsy examination of breast tissue. It is often identified because of calcifications, which are areas of calcium build-up, seen during mammography or other types of breast imaging. It can also be discovered unexpectedly in breast tissue samples sent for evaluation due to various reasons such as cancer removal surgeries, plastic surgery procedures, or excisional biopsies. It’s important to note that ADH does not present any visible or physical symptoms like a lump in the breast, changes in the color of the breast, or noticeable changes in the shape of the breast.
Testing for Atypical Ductal Hyperplasia
The type of sample where Atypical Ductal Hyperplasia (ADH) is spotted matters a lot, as it determines how the condition is managed.
For instance, if ADH is detected in a tissue sample taken with a core needle biopsy, then more tissue should be collected using a surgery known as an excisional biopsy. Doctors often use a wire or seed during the initial biopsy to mark the specific area that may need to be removed later.
This is done because, with a larger tissue sample, there’s a chance that the ADH could turn out to be a cancerous condition named breast carcinoma. Studies found that 22 to 65% of ADH spotted in core needle biopsies were later confirmed as carcinoma after an excisional biopsy. While these usually turn out to be a type called DCIS, sometimes it can be IDC, another form of breast cancer.
However, if ADH is identified during an excisional biopsy and is the only condition diagnosed, additional surgery is not needed, even when there are positive margins. This is because ADH, while a high-risk condition, is not classified as pre-cancerous or cancerous.
Treatment Options for Atypical Ductal Hyperplasia
Once the diagnosis of an unusual condition called ductal hyperplasia is confirmed and breast cancer is ruled out, it’s important to focus on ways to reduce further health risks.
One of these strategies is to treat patients with a medication called tamoxifen, as the majority of these conditions react positively to this drug. In a significant study called the National Surgical Adjuvant Breast and Bowel Project P-1 Trial, it was found that tamoxifen reduced the risk of the condition getting worse by 86% in women who have ductal hyperplasia. So, a discussion with patients regarding the benefits of tamoxifen is strongly advised. However, it’s worth noting tamoxifen can increase the risk of womb cancer, stroke, and serious blood clots, particularly in patients over 50. Therefore, it’s crucial to weigh these risks before deciding on treatment.
Additionally, it’s also important to monitor the condition closely and make sure patients are aware of any changes. This way, any potential issues can be spotted and treated early on.
What else can Atypical Ductal Hyperplasia be?
If a needle biopsy reveals abnormal growth in the milk ducts of the breast, doctors will typically proceed with a larger, more thorough biopsy. This is done because the growth could potentially be breast cancer, and they need a larger tissue sample to confirm or rule this out. It’s also worth highlighting that two conditions, low-grade DCIS (a non-invasive form of breast cancer) and ADH (abnormal duct cell growth) can appear quite similar under the microscope. Hence, it’s crucial for the doctor to carefully study the biopsy results to make sure DCIS isn’t mistaken for ADH.
Surgical Treatment of Atypical Ductal Hyperplasia
Atypical ductal hyperplasia (ADH) is a condition that has often been overtreated surgically in the past. If it is diagnosed through a procedure called core needle biopsy, a larger biopsy, known as an excisional biopsy, will be needed to make sure there isn’t any breast cancer present. However, if the excisional biopsy results show only ADH and nothing else, even if the margins are positive, then surgical treatment for the patient is considered complete. This is because ADH is not a type of cancer, so there is no need for any further procedures like node sampling or mastectomy, which are designed to check for or treat cancer.
Possible Complications When Diagnosed with Atypical Ductal Hyperplasia
Atypical ductal hyperplasia (ADH) can lead to various complications, due both to over-treatment and under-treatment. If ADH is not treated enough, there’s a risk that a possible breast cancer could be missed or not tested further. Over-treatment, on the other hand, could involve surgeries like a mastectomy or large biopsies, even when there’s no cancer present. Additionally, using chemotherapy drugs to treat ADH – when it’s mistaken for cancer or a pre-cancerous growth – can also be risky. Also, using the medication tamoxifen, comes with its own set of complications that should be considered before it’s included in a treatment plan.
Common Complications of ADH:
- Missing a possible breast cancer due to under-treatment
- Undergoing unnecessary surgeries due to over-treatment
- Potential harm from chemotherapy drugs when ADH is mistaken for a cancerous lesion
- Complications from using tamoxifen
Preventing Atypical Ductal Hyperplasia
Patients diagnosed with atypical ductal hyperplasia (ADH), a type of breast cell abnormality, should be thoroughly educated about what the diagnosis means and the actual risks involved. It’s important to understand that this diagnosis increases the future risk of breast cancer. Therefore, close monitoring by a healthcare professional is essential. It is also advised to follow standard guidelines to reduce cancer risk, such as maintaining a healthy body weight and quitting smoking.
