Atypical Lobular Hyperplasia

Atypical Lobular Hyperplasia

Risk of Developing Breast Cancer Is Not the Same in Both Breasts for Women with Atypical Lobular Hyperplasia

Page DL, et al.
The Lancet, January 11, 2003

 

Background and importance of the study: Atypical lobular hyperplasia (ALH) is a condition in which abnormal cells grow inside the milk-making glands of the breast. ALH is not considered a cancer. But past research has suggested that this condition is associated with an increased risk of developing invasive breast cancer in both breasts. This is true even though the abnormality is usually found in only one breast. But until now researchers haven't known whether the risk is the same for both breasts, or greater in the one with ALH.

ALH is closely related to another benign (non-cancerous) breast disease, LCIS (lobular carcinoma in situ), that's also associated with an increased risk of breast cancer. Because LCIS is more strongly linked than ALH with increased breast cancer risk, doctors tend to focus on it more in their clinical practice. But even though ALH involves less of a risk, it's still important to understand what it means, to best help women who have this condition.

Another condition involving abnormal cell growth that is not considered a cancer is ADH (atypical ductal hyperplasia). In this condition, the abnormal cells grow in the milk ducts (the "pipes" that drain the milk).

It's important to understand how all of these conditions may be related to breast cancer. With greater understanding, doctors can help women who have these conditions to lower their risk of developing invasive cancer in either breast.

This study looked at women with ALH, some with and some without ADH, and their risk for developing breast cancer in either breast.

Study design and results: Researchers at Vanderbilt University Medical Center in Nashville, Tennessee, followed 252 women who had ALH. Fifty of the 252 women (20%) developed invasive breast cancer. Of these 50 women, about three times as many developed it in the breast with ALH than in the other breast.

The researchers also found that women who had both ALH and ADH in one breast had equal risk of developing cancer in either the left or right breast. But having both ALH and ADH in the same breast is uncommon. In this study, only 15 of the 252 women who had ALH, or 6%, also had ADH. Of these 15, six were later diagnosed with breast cancer.

Conclusions: This study suggests that for women with ALH in one breast, the risk of future breast cancer is significantly higher in that breast than on the other side. But for women with both ALH and ADH, the risk is equally high in both breasts.

Take-home message: This study is important for three reasons:

1. 1.It helps us better understand the connection between ALH and ADH and risk of future breast cancer, both in the affected breast and on the other side.
   

2. 2.It emphasizes how important it is for women with ALH (with or without ADH) to monitor their breasts closely for any changes.
   

3. 3.It provides important information for women with ALH who are trying to figure out effective ways to reduce their risk of cancer.
   

If you know you have ALH, ADH, or both, be sure to tell your doctor, and to provide other information about your family history and other risk factors for breast cancer. Considering all this information together, you and your doctor can make the best decisions for lowering your risk of developing invasive breast cancer in the future.

One might consider extra-close surveillance. Some women may also consider taking a drug to reduce breast cancer risk, like tamoxifen (brand name: Nolvadex). And some women with ALH and/or ADH who have another risk factor for breast cancer—such as a strong family history—may choose to be even more aggressive about reducing their relatively high risk of breast cancer. These women may even consider prophylactic (preventive) mastectomies.

Right now, prophylactic mastectomies are not recommended for women whose only risk factor is ALH or ADH. For these women, doctors recommend close follow-up, lifestyle changes to reduce risk (not smoking, having no more than five drinks a week, getting regular exercise, eating a balanced diet, controlling weight), and medication to reduce risk.

Choosing what preventive measures to take is very difficult. Remember that no single choice is right for everyone.

 

http://www.breastcancer.org/research_genetics_011103.html