THURSDAY, Jan. 30, 2014 (HealthDay News) -- Two types of breast
tissue abnormality may have the same potential of progressing to
breast cancer, contrary to current belief, according to a new
One abnormal tissue finding is known as "atypical ductal
hyperplasia" (ADH), an accumulation of abnormal cells in a breast
duct. The other abnormal finding is "atypical lobular hyperplasia"
(ALH), an accumulation of abnormal cells in a lobule, a small part
of a breast lobe that makes milk.
Previously, many experts believed that ADH leads to low-grade
ductal breast cancer in the same breast where the biopsy was done,
and so it requires complete surgical excision. Meanwhile, many
believed that ALH was simply an indicator of increased risk of
breast cancer later in both breasts, so it did not require complete
surgical removal but perhaps just closer monitoring.
The new research challenges that thinking, suggesting that the
two types of abnormalities actually behave in similar ways.
"We were not so sure what to do with ALH before," said study researcher Dr. Lynn Hartmann, a professor of oncology at the Mayo Clinic, in Rochester, Minn. "This is suggesting, treat it the same as ADH. What we are saying is, it doesn't matter which kind [of abnormality]."
The study is published in the February issue of
Cancer Prevention Research.
In the study, Hartmann's team identified nearly 700 women (from
a larger group of Mayo patients who'd undergone breast biopsies)
who had confirmed abnormal cells but no cancer. While 330 of them
had ADH, 327 women had ALH and 32 had both.
Hartmann followed the women for an average of 12.5 years. During
that time, 143 developed breast cancer.
A similar number of women with either abnormality developed
breast cancer in the same breast within five years, the study
found. That suggests that ALH may be both a precursor to cancer and
an indicator of increased risk, Hartmann said. While some experts
believed ALH mostly would lead to lobular cancer, the study found
it actually resulted in more ductal cancers, which is how ADH
The findings may apply to many women who have to undergo a
biopsy, she said. "There are over a million biopsies a year with
benign findings," Hartmann said. "About 10 percent of those
biopsies reveal atypical hyperplasia." Those findings are
classified as either ADH or ALH.
Atypical hyperplasia is different from usual hyperplasia, which
is an overgrowth of cells, according to the American Cancer
Society. In usual hyperplasia, the pattern of cells is very close
The new findings suggest that women with either kind of atypical
cells -- ductal or lobular -- ask their doctor about closer
surveillance and preventive treatment, or chemoprevention (taking
anti-cancer drugs to lower the risk), Hartmann said.
Both types of abnormal cells found on a benign biopsy need
attention, another expert agreed.
"This is a diagnosis you should pay attention to," said Dr. Steven Chen, an associate professor of surgery at the City of Hope Comprehensive Cancer Center in Duarte, Calif. He reviewed the new study.
When he finds either of these abnormalities on a benign breast
biopsy, he tells women: "You do not have cancer, but you have these
If a woman has a needle biopsy and finds out she has atypical
cells -- either kind -- she should see a surgeon, Chen said. "The
typical response will be, 'You need a surgical biopsy, in which a
larger sample is taken.' "
In most cases, a woman will also be followed more closely,
usually with instructions to return to the doctor's office every
six months, Chen said. The doctor will usually perform a breast
exam or also repeat a mammogram or other type of imaging more
frequently than for a lower-risk women, he said.
"This [diagnosis] makes you high risk," he said. "Find a doctor who knows about high-risk management."
The study was funded by the Mayo Clinic Breast Cancer
Specialized Program of Research Excellence, the U.S. National
Institutes of Health and the Komen Foundation. One co-author
reported a research grant from the drug company Pfizer, and another
is a Pfizer consultant.
To learn more about abnormal breast exam findings, visit the
American Cancer Society.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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