Atypical Ductal Hyperplasia (ADH) is a breast condition characterized by changes within breast tissue. Understanding ADH involves learning about its characteristics, how it is identified, and its implications for future breast health.
What is Atypical Ductal Hyperplasia?
Atypical ductal hyperplasia (ADH) refers to an abnormal overgrowth of cells within the milk ducts of the breast. While it involves unusual cell growth, ADH itself is not considered breast cancer. The term “hyperplasia” describes the increased number of cells, while “atypical” indicates that these cells appear unusual in their size, shape, or arrangement compared to normal breast cells. It is categorized as a benign breast lesion.
In a healthy milk duct, cells form a single, even layer. With ADH, multiple layers of these atypical cells accumulate within the duct. This condition is recognized as a specific pathology finding, often discovered incidentally during a breast biopsy.
How ADH is Diagnosed
Atypical ductal hyperplasia is discovered during evaluations for other breast concerns. It may be identified when a mammogram reveals tiny calcifications, which can prompt further investigation. Sometimes, ADH is found during a physical breast exam or incidentally on breast tissue sent for pathology. It does not cause a palpable lump or visible discoloration.
The definitive diagnosis of ADH is made through a breast biopsy. If an initial core needle biopsy reveals ADH, a surgical biopsy, also known as an excisional biopsy or lumpectomy, is recommended. This subsequent procedure collects more tissue to ensure no associated malignancy or an upgrade to cancer is present.
The Link Between ADH and Breast Cancer Risk
A diagnosis of atypical ductal hyperplasia signifies an increased likelihood of developing breast cancer. ADH is classified as a “high-risk” lesion because its presence indicates a heightened risk of breast cancer. The increased risk applies to either breast, not solely to the specific area where the ADH was identified.
Statistics demonstrate this elevated risk; approximately 7% of women with ADH may develop breast cancer within five years, and 13% within ten years. ADH is associated with a 30% lifetime risk of developing breast cancer. Certain factors, such as the presence of multiple areas of ADH or specific genetic characteristics, can further amplify this risk.
Management and Follow-up for ADH
Following an ADH diagnosis, a preventive mastectomy is not considered necessary. The management strategy depends on how the ADH was initially diagnosed, whether through a core biopsy or a surgical biopsy. If ADH is found on a core biopsy, a surgical biopsy is recommended to remove the affected area and confirm no other abnormalities are present.
If the diagnosis of ADH is confirmed after a surgical biopsy, additional treatment beyond continued monitoring is not required. Regular follow-up is a standard component of management for individuals with ADH. This involves routine physical breast exams and annual mammograms to monitor breast health. Consulting with a comprehensive breast center can provide personalized guidance regarding individual risk and appropriate follow-up care.