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Atypical Lobular Hyperplasia Of the Breast

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Updated May 08, 2014

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

Description of Atypical Lobular Hyperplasia:

Atypical lobular hyperplasia (ALH) is not breast cancer, but is considered a precancerous condition. Atypical lobular hyperplasia occurs in the epithelial cells lining the milk lobes, producing more cells than would normally grow there. Some of these cells are irregular in shape and size, thus they are called atypical. Usually, a lobe is lined with one even layer of uniformly shaped cells, but in lobular hyperplasia there may be several layers of cells. This is similar to atypical ductal hyperplasia.

Increased Risk for Breast Cancer:

A diagnosis of atypical lobular hyperplasia means that your lifetime risk for developing breast cancer is 4 to 5 times the average risk. Atypical lobular cells are abnormal and have the potential for developing into lobular carcinoma in situ (LCIS), a type of noninvasive breast cancer. You will need to be vigilant about your breast health, and may possibly have a breast MRI along with your annual screening mammogram. Women between the ages of 45 to 55 with atypical hyperplasia have the highest future risk of developing breast cancer.

Also Known As:

Lobular hyperplasia with atypia, mammary atypical lobular hyperplasia, epithelial atypical hyperplasia or proliferative breast disease

Signs and Symptoms:

Atypical lobular hyperplasia doesn't cause any notable symptoms. It is usually found on a routine screening mammogram. In a few cases, atypical lobular hyperplasia may cause breast pain. When hyperplasia shows up on a mammogram or ultrasound, a tissue sample can be taken to get a clear diagnosis.

Tests Used to Diagnose ALH:

You may not need all of these diagnostic tests, but some imaging and a tissue sample will be needed to get a clear diagnosis.

  • Mammogram - appears as a cluster of microcalcifications on a mammogram
  • Ultrasound - uses sound waves to reveal groups of microcalcifications
  • Core Needle Biopsy - a core needle, or open surgical biopsy will be used to take tissue samples
  • Stereotactic Biopsy - a core needle guided by mammogram images and a computer

Follow-Up After Diagnosis:

It is difficult to predict which cases of atypical lobular hyperplasia will remain benign and which may become malignant, and doctors can disagree on what your options are after diagnosis. Many patients just need extra screening mammograms to keep track of any changes. Some patients may choose a type of surgery to remove the suspicious tissue. If you have a family history of breast or ovarian cancer, or if you have a BRCA genetic mutation, you'll need to balance that in with your treatment decisions.

Treatment Options for Atypical Lobular Hyperplasia:

Some doctors advise their patients to be extra mindful of their breast health with atypical lobular hyperplasia. Most cases may never develop into breast cancer. But if you are worried or are at high risk for breast cancer, then you might consider surgery and medications to lower your risk.

  • Lumpectomy - surgery to remove the tissue and a small margin of surrounding tissue
  • Tamoxifen - a daily pill that selectively blocks the estrogen receptor, for women with a family history of breast cancer
  • Raloxifene - also a daily pill that selectively blocks the estrogen receptor
  • Avoid HRT - hormone replacement therapy uses estrogen and progestin, two hormones which reduce menopause symptoms, but which also fuel most breast tumors

Living With a Diagnosis of Atypical Lobular Hyperplasia:

About one out of every 25 women will be diagnosed with atypical hyperplasia – either in their milk ducts or breast lobes. About 20% percent of those women may develop lobular carcinoma in situ or invasive lobular carcinoma within 15 years after their diagnosis. So, if your diagnosis is atypical lobular hyperplasia, this is a good time to improve your overall health with an anticancer diet, regular exercise, slimming down, and lowering your stress levels. Avoid alcohol and tobacco to keep your overall health in great shape.

Sources:

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

Tests For Risk: Precancer Found on Biopsy. Pp. 180-183. Dr. Susan Love's Breast Book. Susan M. Love, M.D. Fifth Edition, 2010.

The diagnosis and management of pre-invasive breast disease: Pathology of atypical lobular hyperplasia and lobular carcinoma in situ. Peter T Simpson, Theodora Gale, Laura G Fulford, Jorge S Reis-Filho, and Sunil R Lakhani. Breast Cancer Res. 2003; 5(5): 258-262.

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  5. When It's Not Cancer
  6. Atypical Lobular Hyperplasia or ALH - Overview

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