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Hyperplasia is also known as epithelial hyperplasia or proliferative breast disease. It’s an overgrowth of the cells that line the ducts or the milk glands (lobules) inside the breast.
Ductal hyperplasia (also called duct epithelial hyperplasia) is an overgrowth of the cells that line the small tubes (ducts) inside the breast, while lobular hyperplasia is an overgrowth of cell lining the milk glands (lobules). Ductal and lobular hyperplasia occur at about the same rate, and have about the same effect on breast cancer risk.
Hyperplasia is often described as either usual or atypical based on how the cells look under a microscope.
- • In usual hyperplasia, the cells look very close to normal.
- • In atypical hyperplasia (or hyperplasia with atypia), the cells are more distorted. This can be either atypical ductal hyperplasia (ADH) or atypical lobular hyperplasia (ALH).
Diagnosis
Hyperplasia doesn’t usually cause a lump that can be felt, but it can cause changes that can be seen on a mammogram. It’s diagnosed by doing a biopsy. (A hollow needle may be used to remove a small piece of tissue that’s checked in the lab. Or, surgery may be done to take out the abnormal breast tissue.)
How does hyperplasia affect your risk for breast cancer?
Hyperplasia can affect your risk for breast cancer, but how much depends on what type it is:
- • Mild hyperplasia of the usual type: This does not increase the risk for breast cancer.
- • Moderate or florid hyperplasia of the usual type (without atypia), also known as usual hyperplasia: The risk of breast cancer is about 1½ to 2 times that of a woman with no breast abnormalities.
- • Atypical hyperplasia (either ADH or ALH): The risk of breast cancer is about 4 to 5 times higher than that of a woman with no breast abnormalities.
Treatment
Most types of usual hyperplasia do not need to be treated. But if atypical hyperplasia (ADH or ALH) is found on a needle biopsy, more breast tissue around it might be removed with surgery to be sure that there is nothing more serious nearby, such as cancer. (This is more likely to be recommended for ADH than for ALH.)
Reducing breast cancer risk or finding it early
Atypical hyperplasia (ADH or ALH) is linked to a higher risk of breast cancer. Even though most women with atypical hyperplasia will not develop breast cancer, it's still important to talk with a health care provider about your risk and what, if any, options are best for you.
Options for women at high risk of breast cancer from atypical hyperplasia may include:
- • Seeing a health care provider more often (such as every 6 to 12 months) for a breast exam along with a yearly mammogram. Additional imaging with breast MRIs may also be recommended.
- • Making lifestyle changes to lower breast cancer risk.
- • Taking medicine to help lower breast cancer risk.
An Overview of Atypical Lobular Hyperplasia of the Breast
Atypical lobular hyperplasia (ALH) occurs in the epithelial cells lining the lobes of the breast. Instead of one even layer of uniformly shaped cells, overgrowth yields several layers, with some cells being irregular in shape and size. Atypical lobular hyperplasia is not breast cancer, but it is considered a precancerous condition. Because your risk of breast cancer is higher than average if you have ALH, you will need close monitoring.
ALH is similar to atypical ductal hyperplasia (ADH), which causes more cells to develop in the lining of the breast ducts (milk producing glands).
ALH is also known as lobular hyperplasia with atypia, mammary atypical lobular hyperplasia, epithelial atypical hyperplasia, and proliferative breast disease.
Symptoms
Atypical lobular hyperplasia typically doesn't cause any notable symptoms, though it may cause breast pain in some cases. Most women are unaware of the condition until they get the results of routine breast imaging.
That said, since atypical lobular hyperplasia can lead to breast cancer, make sure you bring any abnormalities you notice during a breast self-exam to the attention of your doctor. These may include:
- • Breast swelling or chest pain
- • Pain in the armpit or traveling from the breast to the armpit
- • A breast lump or mass
- • Nipple discharge that is white, yellow, or bloody
- • Misshapen or uneven breasts
Causes
An exact cause of atypical lobular hyperplasia is unknown. Doctors believe it is a natural part of breast changes for some women as they get older. It often affects women over 35, but it can affect women regardless of age. It may also affect men but is very rare.
Risk factors of ALH are similar to those for other benign breast conditions, including:
- • Postmenopausal hormone use
- • Family history of breast cancer and benign breast conditions
- • Certain lifestyle factors, including over-consumption of alcohol, smoking, being overweight, and having an unhealthy diet
Diagnosis
Imaging and a tissue biopsy are needed to confirm an atypical lobular hyperplasia diagnosis.
- Mammogram: ALH appears as a cluster of microcalcifications on a mammogram.
- Ultrasound: A breast ultrasound uses sound waves to reveal groups of microcalcifications.
- Breast biopsy: A breast biopsy is the most definitive method for diagnosis of ALH. It allows a pathologist to determine the location and nature of your cells. The pattern of growth seen in atypical lobular hyperplasia is abnormal and may contain cells that are characteristic of lobular carcinoma in situ (LCIS)—an overgrowth of cells in the lobules.
In some cases—for example, when someone has a family history of breast or ovarian cancer, or is positive for a BRCA gene mutation—an excisional biopsy may be done to remove the suspicious tissue.
Treatment
Some women with atypical lobular hyperplasia may benefit from undergoing surgery to remove abnormal cells and make sure no in-situ and invasive cancer cells are also present in the area. However, most cases of ALH do not require treatment.
It is difficult to predict which cases of atypical lobular hyperplasia will remain benign and which may become malignant, so surveillance is essential.
This will include extra screening mammograms and/or breast magnetic resonance imaging (MRIs) to identify any breast changes as early as possible. A commitment to risk-reduction strategies is also recommended.
While having atypical lobular hyperplasia increases one's lifetime risk of breast cancer by up to 2%, prevention methods have been found to reduce that risk by up to 70% in women with ALH or other high-risk breast conditions.
Your doctor will advise you to avoid oral contraceptives and hormone replacement therapy (HRT), as both further increase your risk of developing breast cancer. Adopting certain lifestyle strategies, such as getting regular exercise and eating a low-fat diet, can also help prevent the disease. For some, medication to reduce breast cancer risk may be recommended as well.
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