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Breast Cancer

Atypical Hyperplasia of the Breast

01/11/2011

Question:

My 23 year old daughter had a breast reduction in July 2010 and the pathology report came back positive for atypical hyperplasia of the right breast, we had it tested a second time to make sure and it was positive. There is a history of breast cancer of maternal and paternal side of the family. I have gone on line to get information and read up on it. Some say pre-cancerous and some say not pre-cancerous and the medication that the oncologist wants to give her will put her in pre-menopausal stage. We are unsure about what to do. Her appointments are at Georgetown University Ourisman Breast Health Center, which is suppose to be one of the best breast health centers in this area.

Answer:

Atypical ductal hyperplasia is not really precancerous, but a marker of increased risk for cancer and depending on how close the relatives are and their ages of diangosis, this family history may also increase the risk.  Tamoxifen, the medication likely discussed, is a selective estrogen receptor modulator.  In other words, it acts like estrogen on some tissue and like an anti-estrogen on others (the breast in particular).  It is safe for use in pre-menopausal women but should not be used if pregnancy is being planned. 

A large prevention trial found that in women over 35 who have a 5 year risk over 1.7%, Tamoxifen lowers the risk by about 50%.  It has not been used extensively in younger women, to my knowledge, but is a relatively well tolerated drug, and would probably be OK.  The side effects include menopausal symptoms and small risks of blood clots and uterine cancer, which occur more frequently in the older women on the medication.

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Response by:

Doreen M Agnese, MD Doreen M Agnese, MD
Clinical Associate Professor of Surgery
College of Medicine
The Ohio State University