Atypical cells in the breast refer to abnormal cell changes that are not cancerous but indicate an elevated risk for developing breast cancer in the future. These cellular alterations require careful evaluation and often lead to specific management strategies. Their presence prompts healthcare providers to develop personalized plans for follow-up and increased vigilance to monitor breast health.
Understanding Atypical Breast Cells
Atypical breast cells represent abnormal, yet non-cancerous, growths within the breast tissue. The most common types are Atypical Ductal Hyperplasia (ADH) and Atypical Lobular Hyperplasia (ALH). ADH involves disorganized cell growth within the milk ducts. ALH refers to abnormal cell changes in the lobules, the milk-producing glands.
These atypical cells are considered “high-risk lesions” because they serve as markers for an increased likelihood of developing breast cancer later in life, typically raising the risk by about three to five times. They are usually discovered incidentally when a biopsy is performed for other breast concerns, such as an abnormal finding on a mammogram or a palpable lump. Atypical cells themselves usually do not cause any noticeable symptoms. While abnormal, atypical cells are distinct from benign breast changes and are not considered cancer; instead, they signify a higher risk for future cancer development.
Treatment and Management Approaches
The primary approach for managing many atypical breast cells, particularly Atypical Ductal Hyperplasia (ADH) identified on a core needle biopsy, involves surgical excision. This procedure, often a lumpectomy, aims to remove the atypical cells along with a surrounding margin of healthy tissue. The goal is to ensure no hidden cancer cells are present, as there is a chance of finding associated carcinoma (ranging from 10% to over 30%) following the initial biopsy diagnosis. If no cancer is found after the excisional biopsy, further surgery is typically not needed.
For individuals with an elevated risk of breast cancer, medical management through chemoprevention is considered. Medications such as tamoxifen or raloxifene (SERMs) may be prescribed. For post-menopausal women, aromatase inhibitors like anastrozole or exemestane can also be an option. These medications work by blocking estrogen’s effects, lowering the risk of developing estrogen receptor-positive breast cancer. Studies indicate these drugs can reduce the risk of breast cancer in women with atypical hyperplasia by a significant margin, up to 86%. The decision to pursue medical management is a personalized discussion between the individual and their healthcare provider, taking into account individual risk factors and potential side effects.
Active surveillance is a less common primary management approach for ADH or ALH, but it is an area of ongoing research. In certain situations, such as when Atypical Lobular Hyperplasia (ALH) is found incidentally and imaging and pathology findings are consistent, observation might be considered instead of immediate surgical removal. This approach involves close monitoring with regular imaging and clinical examinations to detect any changes early.
Ongoing Care and Risk Reduction
Following a diagnosis of atypical breast cells, regular follow-up is important to monitor breast health. This typically involves increased surveillance, including routine clinical breast exams and imaging studies like mammograms. For some individuals, particularly those with a lifetime breast cancer risk of 20% or higher, annual breast magnetic resonance imaging (MRI) may also be recommended. While some research questions the added benefit of routine MRI screening over mammography alone, healthcare providers develop personalized surveillance plans based on an individual’s specific risk factors and overall health.
In addition to medical surveillance, certain lifestyle adjustments can contribute to reducing breast cancer risk. Maintaining a healthy weight through balanced nutrition and regular physical activity is often recommended. Limiting alcohol consumption and adopting a diet rich in fruits, vegetables, and whole grains are also considered beneficial. These modifications aim to support overall health and lower the long-term risk.
Genetic counseling and testing may be considered, especially if there is a strong family history of breast cancer or other inherited risk factors. This can provide further insight into an individual’s risk profile and inform long-term management strategies. Ongoing vigilance and a collaborative relationship with healthcare providers ensure comprehensive and personalized care.