When to Worry

Breast Biopsy Results

I recently had a breast biopsy, and the pathology report diagnosed the tissue removed as "fibrocystic changes, including atypical hyperplasia." What exactly does this mean? Am I more likely to get breast cancer?

Fibrocystic breast changes are very common in women. They are changes in the fibrous tissue and ducts of the breast that increase the tendency for lumps or cysts to form. These lumps are benign-just a variation on normal breast tissue. I spend a lot of time in my practice reassuring women that a breast biopsy diagnosis indicating fibrocystic changes alone does not increase your risk of developing cancer in the future.

Conditions That Increase Cancer Risk
A biopsy report may indicate hyperplasia, or proliferative fibrocystic changes. In this case, the breast cells divide and multiply a little faster than normal, but they continue to look like normal cells. According to the College of American Pathologists, mild hyperplasia carries no increased risk for breast cancer.

Some benign conditions, however, can increase your risk for breast cancer. Moderate hyperplasia is considered to increase your risk slightly-by 1.5 to 2 times-compared to a woman without such breast changes. What this means is that if you're age 40, your normal risk of developing cancer in the next 10 years rises from 1 in 67 to 1 in 34. (The difference between mild and moderate hyperplasia is an increase in the number of cell layers.)

The greatest cause for concern is when the biopsy indicates fibrocystic changes with either atypical ductal or lobular hyperplasia. Atypical hyperplasia means that the cells are dividing and growing unusually fast, giving them a disorganized appearance, and that the cells themselves appear abnormal. Even though it's considered a benign condition, it's an early warning sign that you're four times more likely to develop breast cancer than a woman with no known breast changes (meaning that you have a 1 in 17 chance of developing cancer in the next 10 years if you're age 40).

There is some research indicating that atypical lobular hyperplasia is more strongly associated with an increased risk of breast cancer than atypical ductal hyperplasia. Your pathology report should indicate which type of hyperplasia was found. Be sure to request a copy for your files.

Best Follow-Up Plan
I'm not telling you this to panic you. You're not doomed. There are things that you can do to protect yourself.

"Knowing that you're at increased risk for breast cancer if you have atypical hyperplasia means being extra vigilant about performing monthly breast self-exams, getting an annual clinical breast exam, and-especially if you're 40 or older-getting a yearly mammogram," says Kristen Zarfos, MD, assistant professor of surgery and a physician at the Breast Health Center at the University of Connecticut in Farmington.

Discuss with your doctor how often you should be taking these measures. He may want to see you more frequently, depending on your individual needs and perhaps other risk factors. Here are some factors that can put you at increased risk for breast cancer:

number of first-degree relatives (mother, sister, daughter) diagnosed with breast cancer
no children, or first child after age 30
first menstrual period before age 13
increasing age
personal or family history of ovarian, uterine, or colon cancer
What about Tamoxifen?
The drug tamoxifen was recently approved by the FDA to help reduce the risk of breast cancer in women who are at increased risk. "With atypical hyperplasia, it's reasonable to ask your physician how the preventive use of tamoxifen applies to you," says Dr. Zarfos.

To help you and your health care provider evaluate your individual risk of breast cancer and determine if tamoxifen might be right for you, the National Cancer Institute (NCI) in Bethesda, MD, has developed a computer program called "The Breast Cancer Risk Assessment Tool," which calculates your estimated 5-year and lifetime risk.

To get your free computer disk (PC or MAC), complete the Risk Assessment Tool order form on NCI's Web site at www.nci.nih.gov, or call (800) 4-CANCER (422-6237).

Nab It Early
Prevention recommends that women take the following steps for detecting breast cancer as early as possible:

Check yourself monthly by doing a breast self-examination
Get a yearly clinical breast exam
Starting at age 40, get a mammogram every year.
What Do Breast Calcifications Mean?
These tiny calcium deposits sometimes form in breast tissue. Because they're so small, they can't be felt during a breast exam but do tend to be detected when your mammogram is read by the radiologist.

Breast calcifications are a marker for increased activity in some breast cells. When the cells are more active, they absorb calcium circulating throughout the body. However, the calcifications are not related to the amount of calcium that you're consuming either thought your diet or from supplements.

About 80 to 90% of calcifications are noncancerous. But based on their shape, size, and pattern, or if the pattern has changed from a previous mammogram, the radiologist can usually determine if they indicate something suspicious. If so, your doctor may recommend that you repeat the mammogram in 4 to 6 months or have a biopsy to better evaluate the calcifications.

PHOTO (COLOR): If breast cancer runs in your family, preventive drug therapy may be your best bet

PHOTO (COLOR): Some benign breast changes mean extra TLC to reduce breast cancer risk.

PHOTO (COLOR): Mary Jane Minkin, MD

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By Mary Jane Minkin, MD, with Toby Hanlon, EdD

Dr. Minkin is a board-certified obstetrician/gynecologist in New Haven, CT, clinical professor at Yale University School of Medicine, and coauthor of What Every Woman Needs to Know about Menopause (Yale University Press, 1996).

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