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Atypical Ductal Hyperplasia Of The Breast

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Updated April 25, 2011

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Atypical Ductal Cells

Atypical Ductal Cells

Illustration © Pam Stephan

Description Of Atypical Ductal Hyperplasia:

Atypical ductal hyperplasia (ADH) is not breast cancer, but is considered a precancerous condition. Atypical ductal hyperplasia indicates that there are more cells lining the duct than would normally be there, and some of these cells are not typical -- they are irregular in shape and size. Usually, a milk duct is lined with one even layer of uniformly shaped cells, but in ductal hyperplasia there may be many layers of cells. This is similar to atypical lobular hyperplasia.

Increased Risk For Breast Cancer:

If you've been diagnosed with atypical ductal hyperplasia, your risk of developing breast cancer is 4 to 5 times the average lifetime risk. Atypical cells are abnormal and have greater potential for developing into noninvasive breast cancer, such as ductal carcinoma in situ (DCIS). Discuss the pros and cons of removing any atypical hyperplasia with your doctor.

Also Known As:

Intraductal hyperplasia with atypia, mammary atypical ductal hyperplasia, epithelial atypical hyperplasia or proliferative breast disease

Signs And Symptoms:

Atypical ductal hyperplasia usually doesn't cause any notable symptoms. It is usually found when having a benign breast lump or thick area of tissue examined. In rare cases, atypical ductal hyperplasia may cause breast pain. Hyperplasia will show up on a mammogram or ultrasound, and then a tissue sample can be taken to get a clear diagnosis.

Tests Used to Diagnose ADH:

  • Mammogram - appears as a pattern of calcifications on a mammogram
  • Ultrasound - uses sound waves to reveal groups of calcifications
  • Ductal Lavage - atypical ductal cells may be flushed out and examined under a microscope
  • Breast Biopsy - a core needle biopsy, or open surgical biopsy will be used to take a tissue sample for testing in the pathology lab

Follow-Up After Diagnosis:

Because it is very hard to predict which cases of atypical ductal hyperplasia will continue to be benign and which may turn malignant, you have some options after diagnosis. Many patients just need extra screening mammograms, to keep track of any changes. A study by Korean surgeons in 2008 found that a little less than half of all patients diagnosed with ADH developed breast cancer. Those patients were under 50 years old, had microcalcifications on their mammogram, a mass smaller than 15 mm, and a lump that could be found by touch. Some patients may choose a type of surgery to remove the suspicious tissue.

Treatments for Atypical Ductal Hyperplasia:

Many doctors advise their patients to take a "wait and see" approach to atypical ductal hyperplasia. Most cases will never develop into breast cancer. But if you are worried or are at high risk for breast cancer, then you can have that tissue removed.

  • Ultrasound-Guided, Vacuum-Assisted Excision - a relatively noninvasive method of removing the atypical area of tissue
  • Lumpectomy - surgery to remove the tissue and a margin of surrounding tissue, to help prevent recurrence

What A Diagnosis of Atypical Ductal Hyperplasia Means:

About one out of every 25 women will be diagnosed with atypical hyperplasia – either in their milk ducts or breast lobes. About one in five of those women will develop invasive breast cancer within 15 years after their diagnosis. So, if your diagnosis is atypical ductal hyperplasia, this could be a good time to improve your overall health with an anticancer diet, regular exercise, lower stress levels, and regular breast self exams and screenings.

Sources:

Non-Cancerous Breast Conditions: Hyperplasia. American Cancer Society. Last Revised: 09/16/2010.

Scoring system for predicting malignancy in patients diagnosed with atypical ductal hyperplasia at ultrasound-guided core needle biopsy. Ko E, Han W, Lee JW, Cho J, et al. Breast Cancer Res Treat. 2008 Nov;112(1):189-95.

Ultrasound-Guided, Vacuum-Assisted, Percutaneous Excision of Breast Lesions: An Accurate Technique in the Diagnosis of Atypical Ductal Hyperplasia. Ian Grady, Heidi Gorsuch, Shelly Wilburn-Bailey. Journal of the American College of Surgeons, 1 July 2005, Volume 201, Issue 1, Pages 14-17.

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