ATYPICAL DUCTAL HYPERPLASIA AND OTHER PRE-CANCEROUS FINDINGS ON BREAST BIOPSY

This page contains information regarding situations in which a biopsy has been done, whether for a lump or other abnormality on exam, or for an abnormal mammogram, and the biopsy shows “abnormal cells” but does not show cancer.

I had a biopsy, and it showed one of the following— pre-cancerous cells, atypical ductal hyperplasia, ADH, atypical lobular hyperplasia, lobular carcinoma in situ, or LCIS. What should be done now?
The term “pre-cancerous cells” might be used for different situations. There are some benign cells that are more heaped up and irregular than normal breast cells, which are considered to be an indication that a woman is at higher risk for developing a cancer. There are a few such categories, atypical ductal hyperplasia (ADH), and atypical lobular hyperplasia (ALH) or lobular carcinoma in situ (LCIS). Although these findings are not cancerous, the possibility of finding a tiny cancer nearby is high enough to consider a larger surgical excision of surrounding breast tissue, if these cell types are seen on a core needle biopsy. Though estimates vary, the possibility of finding a nearby hidden cancer in this case is probably about 10%.

The term “lobular carcinoma in situ” requires a little more explanation. Although the name includes the term carcinoma, lobular carcinoma in situ (LCIS) is not really cancer, but rather a noninvasive condition that increases the risk of developing cancer in the future. LCIS, also known as lobular neoplasia, occurs when abnormal cells accumulate in the breast lobules. Each breast has countless milk producing lobules, which are connected to the milk ducts. In LCIS, the abnormal cells are often found throughout the breast lobules, and both breasts are affected about 30 percent of the time.

Although we don’t think that LCIS itself becomes breast cancer, about 25 percent of patients who have LCIS will develop breast cancer at some point in their lifetime. (By way of comparison, for women in general, the risk of having breast cancer in their lifetime is about 12%.) This increased risk applies to both breasts, regardless of which breast is affected with LCIS, and in those who develop cancer, it may be either of the lobular or ductal type.

If any of these abnormal cell types are seen on a biopsy in which the sampling was done with some sort of needle (core biopsy, or stereotactic biopsy), in most cases a surgical excision should now be done, to get a larger sampling of tissue. In about 90% of cases, there will be nothing more significant seen, and no other treatment would be needed. But in about 10% of cases, some cancer “seeds”, or actual invasive cancer may be seen, which will require additional treatment.

This surgical excision can usually be done as an outpatient. Many surgeons still do what is called a “wire localization” procedure to help them know what breast tissue to remove. At DeKalb Surgical we rarely need to resort to this additional step, since our experience with ultrasonography allows us to more directly identify and remove the appropriate tissue. The use of ultrasound instead of a wire is much easier, simpler, and less expensive for the patient.

There is reason to consider taking a medication to prevent the development of cancer if you have had a biopsy showing these atypical cell types. This sort of treatment is called “chemoprevention”. There are two drugs available for this type of treatment, tamoxifen, and Evista. Studies have shown that by taking either of these drugs, once a day, for five years, that women at higher risk for developing breast cancer can decrease their risk by about half. Not all women choose this option, but it is important that you are at least aware of this option. Both drugs have a list of possible side effects, and one needs to balance the value of the potential benefit (decreased cancer risk) versus the risks (possibly experiencing one or more of the side effects).

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