Atypical Hyperplasia of the Breast: Common, Important, and Not Adequately Recognized

January 13, 2015

Atypical Hyperplasia of the Breast: Common, Important, and Not Adequately Recognized

  1. Andrew M. Kaunitz, MD

Clinicians should pay more attention to this condition with respect to counseling, screening, and chemoprophylaxis.

  1. Andrew M. Kaunitz, MD

Of the approximately one million benign breast biopsies performed annually in U.S. women, some 10% yield a diagnosis of atypical hyperplasia (AH, histologically classified as ductal or lobular). AH is associated with a 25-year cumulative risk for breast cancer approaching 30%. In a special report, experts make several points about AH:

  • Given the high lifetime malignancy risk associated with AH, commonly used breast cancer risk prediction models are not accurate in women with this diagnosis. When counseling women with AH, it is best to refer to the 25-year cumulative risk.

  • Screening guidelines should be updated to indicate that women with AH are candidates for magnetic resonance screening in addition to mammography. Likewise, women with AH should be included in future trials of new breast imaging technologies.

  • Selective estrogen-receptor modulators (e.g., tamoxifen, raloxifene) and aromatase inhibitors reduce breast cancer risk in patients with AH; thus, these agents should be more widely used by such women.

  • In general, a diagnosis of AH should not be considered an indication for risk-reducing bilateral mastectomy.

Comment

These authors do a service to women and their clinicians by pointing out the high long-term risk for malignancy faced by women with AH. They also appropriately emphasize that breast cancer will not develop in most women with AH and that, when breast cancer is diagnosed in such women, it may occur at an age when death from other causes is more likely than from breast cancer.

Editor Disclosures at Time of Publication

  • Disclosures for Andrew M. Kaunitz, MD at time of publication Consultant / Advisory board Actavis plc; Bayer AG; Merck; Teva Pharmaceutical Industries Limited; UpToDate Royalties UpToDate Grant / Research support Trimel Pharmaceuticals Corp; TherapeuticsMD; NIH Editorial boards Contraception; Menopause; Contraceptive Technology Update; OBG Management; Medscape OB/GYN & Women’s Health Leadership positions in professional societies North American Menopause Society (Secretary)

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