Breast Lesion: Atypical Ductal Hyperplasia

Diagnosis of atypical ductal hyperplasiaAtypical Ductal Hyperplasia (ADH) refers to the development of a breast lesion due to proliferation of abnormal cells within the milk ducts of the breasts. ADH is considered to be a risk factor or precursor to low-grade ductal carcinoma in situ, which is why prompt treatment and follow-up become extremely essential for those who have been diagnosed with ADH. The following write-up provides information on this condition.

The term ‘hyperplasia’ refers to the overgrowth of cells in a particular part of the body. Hyperplasia of the breast, which is also known as proliferative breast disease, refers to an overgrowth of the cells in the glandular part of the breast. Glandular tissue, which is one of the two main types of tissues that is found in the breast, comprises the lobules and ducts. The supportive tissue, which consists of the fatty tissue and the connective tissue, affects the shape and size of breasts. Lobules are the glands that make breast milk, whereas the ducts carry milk from the lobules to the nipple. Hyperplasia of the glandular part of the breast is categorized into ductal hyperplasia and lobular hyperplasia. The overgrowth of abnormal cells in a duct is medically referred to as atypical ductal hyperplasia (ADH). In case of atypical ductal hyperplasia, the cells look abnormal under a microscope.

ADH is a precancerous condition. Those who are affected by this condition are certainly at a greater risk of developing breast cancer. The risk is higher, especially in case of women affected by lobular hyperplasia.

Diagnosis

ADH is asymptomatic, and doesn’t cause specific symptoms. It may be incidentally detected during a clinical exam. Diagnostic procedures such as mammography are conducted when women complain of breast pain, or other visible breast changes such as formation of lumps, or any abnormal changes in the texture of the breast. If doctors suspect any abnormality after conducting a clinical breast exam, they may recommend breast imaging studies or a mammogram. Microcalcifications on the mammogram may be an indicator, but ADH can be detected only through a biopsy.

The abnormal cells can be detected when a tissue sample is examined under a microscope. Different types of biopsy procedures may be employed to extract samples of tissue. These include:

➞ Fine-needle aspiration biopsy (insertion of a small needle to remove a sample of cells from the breast)
➞ Core needle biopsy (insertion of a large needle to extract bigger samples of tissue)
➞ Incisional biopsy (removal of a small piece of tissue)
➞ Excisional biopsy (removal of the entire lump of tissue)

Incisional or excisional biopsy is conducted if the fine-needle biopsy or core biopsy don’t give conclusive results. More often than not, an excisional biopsy is conducted after a core needle biopsy.

In case of ADH, the breast lesion may have some of the characteristic features of DCIS (Ductal Carcinoma In Situ refers to a non-invasive cancer that is characterized by the uncontrolled growth of abnormal cells within the milk ducts), but it may not meet the complete criteria.

Treatment and Preventive Measures

Since ADH increases the risk of breast cancer, medical assistance must be sought by the affected individuals. The treatment options may include surgery, as well as drug therapy. Here are some of the treatment options and precautionary measures that are generally recommended.

➞ If the breast lesion seems to be progressive, doctors may suggest the removal of the growth through a wide local excision, or lumpectomy (removal of the abnormal tissue along with the margin or the normal surrounding tissue).

➞ Women who have ADH need to be extremely careful about the changes in shape and size of the breasts. Other symptoms that should not be ignored include nipple discharge, or the presence of a lump near the breast or under the arm. An oncologist must be consulted in the event of any unusual change in the breasts or the skin around them.

➞ Women who have been diagnosed with ADH must examine their breasts frequently. It’s extremely essential to do a breast self-examination, at least once every month. Ensure that you get a clinical breast exam done twice a year. The follow-up also involves an annual screening mammogram or an MRI.

➞ If breast cancer runs in the family, and you carry BRCA gene mutations that increases the risk for breast and ovarian cancer, doctors may recommend bilateral prophylactic mastectomy (surgery for removal of both breasts. This minimizes the chances of developing breast cancer in the future.

➞ Elevated levels of estrogen are believed to increase the risk of breast cancer. Selective estrogen receptor modulator (SERM) refers to a class of drugs that prevent estrogen from binding to the estrogen receptors that are found in the breast tissue. Tamoxifen (Nolvadex) and raloxifene (Evista) are drugs that are classified as selective estrogen receptor modulators. Women who come in high-risk group may be asked to take these drugs for a period of five years.

➞ Hormone replacement therapy could increase the risk of breast cancer in menopausal women. Thus, women who have ADH must avoid hormone therapy during menopause.

➞ Smoking, alcohol abuse, the use of chewing tobacco, obesity, and sedentary lifestyle could put women at an increased risk of developing breast cancer, which is why the necessary lifestyle modifications must be made.

It is believed that 20% of the women who have been diagnosed with ADH may develop breast cancer within 15 years. Since early detection and timely treatment of atypical ductal hyperplasia minimizes the risk of breast cancer, women must immediately seek medical assistance on noticing any unusual change in the breasts.

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