February 4, 2014 | by Denise Heady
Two breast tissue abnormalities — known as atypical ductal hyperplasia (ADH) and atypical lobular hyperplasia (ALH) — have long been a source of concern to physicians, specifically as the conditions relate to breast cancer risk.
ADH, marked by abnormal cells in a breast duct, has been considered a precursor to breast cancer in the breast where it occurs, and doctors usually recommend surgical excision.
ALH, marked by abnormal cells in a breast lobule, has been considered a less alarming condition, even though it suggests a heightened risk of breast cancer in both breasts. For this condition, many doctors have simply recommended monitoring.
A new study suggests both breast abnormalities are equally worrisome. The research, conducted at Mayo Clinic in Rochester, Minn., and published in Cancer Prevention Research, suggests that both conditions are just as likely to lead to breast cancer.
"ADH and ALH behave similarly in terms of later breast cancer endpoints," the authors wrote.
Women who have either condition should consult a surgeon, Steven Chen, M.D., associate professor of surgery at City of Hope, told HealthDay. “This is a diagnosis you should pay attention to," he said.
Lead researcher Lynn C. Hartman, M.D., professor of oncology at the Mayo Clinic, said in a press release that even though the types of conditions look different, they behave similarly. She found that a similar number of women with either ADH or ALH developed breast cancer in the same breast within five years of diagnosis.
But the presence of abnormal cells is not the same as a breast cancer diagnosis, and City of Hope's Chen stressed the importance of clarifying the difference — and of finding a physician who understands high-risk management.
When Chen finds either ADH or ALH on a patient’s breast biopsy, he makes it clear: "You do not have cancer, but you have these atypical cells."
Once a woman has a breast biopsy and finds out she has abnormal cells, either ADH or ALH, she should see a surgeon, Chen told HealthDay.
"The typical response will be, 'You need a surgical biopsy, in which a larger sample is taken.'"
Women with these atypical cells are monitored more closely, often with doctor visits every six months, Chen told HealthDay. The doctor will usually perform a breast exam or repeat a mammogram or other type of imaging more frequently than for lower-risk women, he said.
"This [diagnosis] makes you high risk," he said. "Find a doctor who knows about high-risk management."