A diagnosis of a high-risk breast lesion indicates that abnormal cells have been found in the breast tissue. This finding is not breast cancer, but it does signify an increased potential for developing breast cancer in the future. These lesions are a diverse group of cellular changes that are considered precursors to cancer.
Receiving this diagnosis means that while there is no immediate threat, your health requires a more watchful approach. The cells identified are irregular but have not crossed the threshold to be classified as malignant. The presence of these lesions suggests a need for a clear plan developed with your healthcare team to monitor your breast health closely over time.
Identifying High-Risk Lesions
The journey to diagnosing a high-risk lesion often begins with routine breast screening. A mammogram or breast ultrasound may reveal an area of concern that requires further investigation. These imaging techniques can identify suspicious calcifications, masses, or distortions in the breast architecture that warrant a closer look.
To get a precise diagnosis, a biopsy is necessary. The most common procedure is a core needle biopsy, where a radiologist uses imaging for guidance to insert a hollow needle and remove small samples of tissue from the suspicious area. This procedure is minimally invasive and provides the tissue needed for a definitive analysis.
The tissue samples are then sent to a pathologist, a doctor who specializes in analyzing cells and tissues to identify disease. By examining the tissue under a microscope, the pathologist can determine if the cells are normal, cancerous, or fall into the category of a high-risk lesion. This detailed microscopic examination is what confirms the diagnosis and provides the specific type of high-risk lesion present.
Common Types of High-Risk Lesions
There are several common types of high-risk lesions.
- Atypical ductal hyperplasia (ADH) is an overgrowth of abnormal cells lining the milk ducts. While these cells have some features of low-grade ductal carcinoma in situ (DCIS), they are not extensive enough to be classified as such. A diagnosis of ADH moderately increases the future risk of developing breast cancer.
- Atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS) are related conditions involving the milk-producing glands. Despite the term “carcinoma” in its name, LCIS is not considered an active cancer but a significant marker that increases breast cancer risk substantially. Both are often discovered incidentally.
- A radial scar, also known as a complex sclerosing lesion, is another high-risk finding. On a mammogram, a radial scar can look like a cancerous tumor because of its star-like shape, but it is a benign lesion. The presence of a radial scar is associated with a slightly increased risk of breast cancer.
- An intraductal papilloma with atypia is a small, wart-like growth into a milk duct that contains atypical cells. A simple papilloma without atypia is benign, but when atypical cells are present, the lesion is classified as high-risk, signaling a higher likelihood of future cancer development.
Management and Treatment Approaches
Following a high-risk lesion diagnosis from a core needle biopsy, the most common recommendation is a surgical procedure called an excisional biopsy, or lumpectomy. The primary reason for this surgery is to remove the entire lesion and a small margin of surrounding healthy tissue. This allows the pathologist to examine the entire area of concern, as a core needle biopsy only samples a small portion. Sometimes, a small, hidden area of cancer can be located next to the high-risk lesion, which would have been missed by the initial biopsy.
In some specific situations, active surveillance may be considered instead of immediate surgery. This approach is an option for certain low-risk lesions where the initial biopsy is thought to have removed most of the abnormal area and the imaging findings are not highly suspicious. This decision is made on a case-by-case basis after a thorough discussion between the patient and a multidisciplinary team of specialists.
For some women, risk-reducing medications, a strategy known as chemoprevention, may be offered. Drugs like tamoxifen or raloxifene work by blocking the effects of estrogen on breast tissue, which can help lower the future risk of developing estrogen-receptor-positive breast cancer. This is not a treatment for the existing lesion but a proactive measure to reduce long-term risk.
Long-Term Monitoring and Risk Reduction
After the initial management of a high-risk lesion, a long-term monitoring plan is established. This plan, often called enhanced surveillance, is more intensive than standard screening. It involves an annual mammogram, often alternated with an annual breast MRI. This staggered schedule results in a screening test every six months and is supplemented by regular clinical breast exams.
Alongside enhanced imaging, lifestyle modifications can play a part in managing overall breast cancer risk. Maintaining a healthy body weight through a balanced diet and regular physical activity is consistently recommended. Limiting alcohol consumption is another impactful step, as alcohol is a known risk factor for breast cancer. These strategies empower individuals to take an active role in their long-term health.