Cancer & Chemo Atypical hyperplasia of the breast

Atypical hyperplasia is a
precancerous condition that affects cells in the breast. Atypical
hyperplasia describes an accumulation of abnormal cells in a breast duct
(atypical ductal hyperplasia) or lobule (atypical lobular hyperplasia).

Atypical hyperplasia isn't cancer, but it can be a forerunner to the
development of breast cancer. Over the course of your lifetime, if the
atypical hyperplasia cells keep dividing and become more abnormal, your
condition may be reclassified as carcinoma in situ or noninvasive breast
cancer.

If you've been diagnosed with atypical hyperplasia, you have an
increased risk of developing breast cancer in the future. For this
reason, doctors sometimes recommend more frequent breast cancer
screening and careful consideration of medications and other strategies
to reduce breast cancer risk.

Symptoms

Atypical hyperplasia doesn't cause any specific signs or symptoms.

When to see a doctor
Make an appointment with your doctor if you have any signs or symptoms that worry you.

Atypical hyperplasia doesn't cause signs and symptoms, but it's often
discovered during a breast biopsy to investigate breast signs and
symptoms or an abnormality found on a mammogram.

Causes

It's not clear what causes atypical hyperplasia. Atypical hyperplasia
forms when breast cells become abnormal in number, size, shape,
appearance and growth pattern. Location of the abnormal cells within the
breast tissue — the lobules or the milk ducts — determines whether the
cells are atypical lobular hyperplasia or atypical ductal hyperplasia.

Atypical hyperplasia is thought to be part of the complex, multistep
process by which breast cancer develops. The process begins when normal
cell development and growth become disrupted, causing an overproduction
of normal-looking cells (hyperplasia). Atypical hyperplasia occurs when
the excess cells stack upon one another and begin to take on an abnormal
appearance. The abnormal cells can continue to change in appearance and
multiply, evolving into noninvasive (in situ) cancer, in which cancer
cells remain confined to the area where they start growing. Left
untreated, the cancer cells may eventually become invasive cancer,
invading surrounding tissue, blood vessels or lymph channels.

Complications

Increased risk of breast cancer
If you've been diagnosed with atypical hyperplasia, you have an
increased risk of breast cancer in the future. Women with atypical
hyperplasia have a risk of breast cancer that is four to fives times
higher than that of women with no atypical hyperplasia.

Being diagnosed with atypical hyperplasia at a younger age may increase
the risk of breast cancer even more. Women diagnosed with atypical
hyperplasia before age 45 have the greatest risk of breast cancer,
compared with older women, especially those older than 55.

Preparing for your appointment

If a mammogram reveals a suspicious area in your breast, your family
doctor or general practitioner may refer you to a breast health
specialist.

What you can do
Because appointments can be brief, and because there's often a lot of
ground to cover, it's a good idea to be well prepared for your
appointment. To prepare for your appointment, try to:

* Be aware of any pre-appointment restrictions. At the time you make
the appointment, be sure to ask if there's anything you need to do in
advance, such as restrict your diet.
* Write down any symptoms you're experiencing, including any that
may seem unrelated to the reason for which you scheduled the
appointment.
* Write down key personal information, including any major stresses or recent life changes.
* Make a list of all medications, as well as any vitamins or supplements, that you're taking.
* Take a family member or friend along, if possible. Sometimes it
can be difficult to absorb all the information provided during an
appointment. Someone who accompanies you may remember something that you
missed or forgot.

Questions to ask
Your time with your doctor is limited, so prepare a list of questions
ahead of time. List your questions from most important to least
important in case time runs out. For atypical hyperplasia, some basic
questions to ask your doctor include:

* Can you explain my pathology report to me?
* Do I need any more tests?
* Will I need surgery for atypical hyperplasia?
* What treatments do you suggest?
* What can I do to reduce my risk of breast cancer?
* What signs or symptoms of breast cancer should I be watchful for?
* How often should I have a mammogram to screen for breast cancer?
* Should I also have an MRI to screen for breast cancer?
* What would you recommend to a friend or family member in my situation?
* Are there any restrictions that I need to follow?
* Should I see a breast health specialist? What will that cost, and will my insurance cover it?
* Should I consider genetic counseling?
* Are there any brochures or other printed material that I can take with me? What Web sites do you recommend?

In addition to the questions that you've prepared, don't hesitate to ask
questions during your appointment at any time that you don't understand
something.

Tests and diagnosis

Atypical hyperplasia is usually discovered after a biopsy to evaluate a
suspicious area in your breast. During the biopsy, tissue samples are
removed and sent for analysis by a specially trained doctor
(pathologist). The tissue samples are examined under a microscope, and
the pathologist identifies atypical hyperplasia, if it's present.

To further evaluate atypical hyperplasia, your doctor may recommend
surgery to remove a larger sample of tissue to look for breast cancer. A
diagnosis of atypical hyperplasia often leads to a surgical biopsy
(wide local excision or lumpectomy) to remove all of the affected
tissue. The pathologist looks at the larger specimen for evidence of in
situ or invasive cancer.

Treatments and drugs

Atypical hyperplasia is generally treated with surgery to remove the
abnormal cells and to make sure no in situ or invasive cancer also is
present in the area. Doctors often recommend more frequent screening for
breast cancer and strategies to reduce your breast cancer risk.

Follow-up tests to monitor for breast cancer
Your doctor may recommend you undergo follow-up tests to screen for
breast cancer. This may increase the chance that breast cancer is
detected early, when a cure is more likely. Talk about your breast
cancer screening options with your doctor. Your options may include:

* Monthly breast self-exams to develop breast familiarity and to detect any unusual breast changes
* Clinical breast exams by your health care provider once or twice a year
* Screening mammograms every year
* Screening breast magnetic resonance imaging (MRI), depending on
other risk factors, such as a strong family history or a genetic
predisposition to breast cancer

Ways to reduce your risk of breast cancer
To reduce your risk of developing breast cancer, your doctor may recommend that you:

* Take preventive medications. Treatment with a selective estrogen
receptor modulator (SERM), such as tamoxifen or raloxifene (Evista), for
five years may reduce the risk of breast cancer. These drugs work by
blocking estrogen from binding to estrogen receptors in breast tissue.
Estrogen is thought to fuel the growth of some breast cancers.
*

Avoid menopausal hormone therapy and herbal treatments.
Researchers have concluded that combination hormone therapy to treat
symptoms of menopause — estrogen plus progestin — increases breast
cancer risk in postmenopausal women. Many breast cancers depend on
hormones for growth. Hormone therapy may also increase the risk of
atypical hyperplasia.

Little is known about the safety of herbal supplements, which many
women use to relieve menopausal symptoms. However, some herbal
supplements work like estrogen in your body and could increase the risk
of breast cancer.
* Participate in a clinical trial. Clinical trials test new
treatments, not yet available to the public at large, that may prove
helpful in reducing breast cancer risk associated with atypical
hyperplasia. Ask your doctor if you're a candidate for any clinical
trials, based on your particular situation.
*

Consider preventive (prophylactic) mastectomy. For women at very
high risk of breast cancer, preventive mastectomy — surgery to remove
one or both breasts — reduces the risk of developing breast cancer in
the future. You might be considered at very high risk of breast cancer
if you have a genetic mutation in one of the breast cancer genes or you
have a very strong family history of breast cancer that suggests a
likelihood of having such a genetic mutation.

But this surgery isn't right for everyone. Discuss with your
doctor the risks, benefits and limitations of this risk-reducing surgery
in light of your personal circumstances. If you have a strong family
history of breast cancer, you might benefit from also meeting with a
genetic counselor to evaluate your risk of carrying a genetic mutation
and the role of genetic testing in your situation.

Coping and support

An atypical hyperplasia diagnosis can be stressful, since it increases
your risk of breast cancer. Not knowing what the future holds may make
you fearful for your health. With time, every woman develops her own way
of coping with atypical hyperplasia and her increased risk of breast
cancer. Until you find your way of coping, consider trying to:

* Understand your individual risk of breast cancer. Breast cancer
risk statistics can be overwhelming and frightening. Breast cancer risk
statistics are developed by following thousands of women and can give
you an idea of your prognosis, but the statistics can't tell you about
your own risk of breast cancer. Ask your doctor to explain your
individual risk of breast cancer. Once you understand your personal risk
of breast cancer, you can feel more comfortable making decisions about
your treatment.
* Go to all of your follow-up appointments. If you've been diagnosed
with atypical hyperplasia, your doctor may recommend more frequent
breast cancer screening exams and tests. You may find yourself
distracted with worry before each exam because you're afraid that your
doctor will find breast cancer. Don't let your fear stop you from going
to your appointments. Instead, accept that fear is normal and find ways
to cope. Relax, write your feelings in a journal or spend time with a
close friend who can lift your spirits.
* Keep your body healthy. Make healthy lifestyle choices to keep
yourself healthy. For instance, maintain a healthy weight, eat a healthy
diet full of fruits and vegetables, get enough sleep so that you wake
feeling rested, and limit the amount of alcohol you drink, if you choose
to drink alcohol. You can't control whether or not you get breast
cancer, but you can keep healthy so that you're well enough for breast
cancer treatment, should you need it.
* Talk with other women in your situation. Talk to other women who
have been diagnosed with atypical hyperplasia. Ask your doctor about
support groups in your community. Another option is online message
boards. Breast cancer organizations, such as BreastCancer.org, offer
message boards for women with a high risk of breast cancer to connect
with each other.

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