From the Guidelines
Patients with atypical lobular hyperplasia (ALH) should undergo annual mammography and clinical breast examinations every 6-12 months, and consider supplemental screening with breast MRI, as well as discuss risk-reducing medications such as tamoxifen, raloxifene, or anastrozole, to reduce the risk of breast cancer, which is increased 4-5 times compared to the general population 1. The management of patients with ALH should prioritize enhanced surveillance and consideration of risk-reducing strategies to minimize the risk of breast cancer.
- Annual mammography is recommended, as it is essential for early detection of breast cancer, and digital breast tomosynthesis (DBT) can be considered to improve cancer detection rates, especially in women with dense breasts 1.
- Clinical breast examinations every 6-12 months are also crucial for detecting any changes or abnormalities in the breast tissue.
- Supplemental screening with breast MRI may be recommended for women with additional risk factors, such as a family history of breast cancer or prior radiation therapy, as it can provide more detailed images of the breast tissue and improve cancer detection rates 1.
- Risk-reducing medications, such as selective estrogen receptor modulators (SERMs) like tamoxifen (20 mg daily for 5 years) or raloxifene (60 mg daily for 5 years), or aromatase inhibitors such as anastrozole (1 mg daily for 5 years), should be discussed with postmenopausal women, as they can reduce breast cancer risk by 50-65% 1.
- Lifestyle modifications, including maintaining a healthy weight, limiting alcohol consumption, regular physical activity, and avoiding hormone replacement therapy when possible, are also essential for reducing breast cancer risk 1. The choice between risk-reducing medications should consider the patient's menopausal status, risk of side effects, and comorbidities, and the decision to use these medications should be made on a case-by-case basis, taking into account the individual patient's risk factors and medical history 1.
From the Research
Risk of Cancer with Atypical Lobular Hyperplasia
- The risk of breast cancer with atypical lobular hyperplasia (ALH) is substantial, with estimated 10-year cancer risks of 20.7% 2.
- A study found that the risk of breast cancer with ALH is about three times more likely to arise in the breast diagnosed with ALH than in the opposite breast without these initial findings 3.
Management and Surveillance Recommendations
- Surgical excision is still recommended after diagnosis of ALH on core needle biopsy, but in specific circumstances, ALH can safely be managed by imaging surveillance 4.
- Chemoprevention use significantly reduced breast cancer risk for all atypia types, including ALH, with a 10-year risk of 7.5% compared to 21.3% for those who received no chemoprevention 2.
- Management strategies for women with ALH could include excisional biopsy, enhanced breast cancer surveillance, and risk-reducing medications 5.
- A study found that 44% of patients with ALH took chemopreventative treatment, and after a mean follow-up of three years, none of the patients who received chemoprevention developed breast cancer 6.
Reduction of Breast Cancer Risk
- Chemoprevention has been shown to decrease the risk of breast cancer in women with ALH, with a significant reduction in breast cancer risk for all atypia types 2, 6.
- Risk-reducing medications and enhanced breast cancer surveillance are also considered as management strategies to mitigate the future risk of breast cancer in women with ALH 5.