Management of Non-Proliferative Breast Changes
Patients with non-proliferative breast changes require routine clinical surveillance with physical examinations every 3-6 months for the first 3 years, then every 6-12 months for years 4-5, and annually thereafter, combined with annual mammography—but do NOT require extensive laboratory testing or imaging beyond mammography. 1
Risk Stratification Context
Non-proliferative breast changes carry minimal increased breast cancer risk (relative risk 1.27) compared to proliferative disease without atypia (RR 1.88) or atypical hyperplasia (RR 4.24), making aggressive surveillance unnecessary. 2 This risk persists for at least 25 years but remains modest enough that standard surveillance protocols are appropriate. 2
Clinical Examination Schedule
- Conduct examinations every 3-6 months for the first 3 years after diagnosis by a physician experienced in breast examination and cancer surveillance. 1
- Transition to every 6-12 months for years 4 and 5, maintaining the same quality of examination. 1
- Continue with annual examinations thereafter for ongoing surveillance. 1
- Follow-up can be performed by either oncology specialists or primary care physicians, with transfer to primary care appropriate approximately 1 year after diagnosis. 1
Mammographic Surveillance Protocol
- Perform annual mammography as the cornerstone of imaging surveillance. 1
- For patients who underwent breast-conserving surgery, schedule the first post-treatment mammogram 1 year after the initial mammogram but no earlier than 6 months after completing radiation therapy. 1
- Use bilateral mammography to monitor both the affected and contralateral breast. 1
Patient Self-Monitoring
- Instruct all women to perform monthly breast self-examination as part of routine surveillance. 1
- Counsel patients to report immediately: new breast lumps, bone pain, chest pain or dyspnea, abdominal pain, and persistent headaches. 1
Genetic Counseling Indications
Refer patients for genetic counseling if they meet any of these criteria: 1
- Ashkenazi Jewish heritage
- Personal or family history of ovarian cancer
- First-degree relative with breast cancer diagnosed before age 50
- Two or more first- or second-degree relatives with breast cancer at any age
What to AVOID in Routine Surveillance
Do NOT perform the following tests in asymptomatic patients with non-proliferative changes: 1
- Complete blood counts or automated chemistry panels
- Chest x-rays
- Bone scans
- Liver ultrasounds
- CT scans or PET scans
- Breast MRI (unless other specific indications exist)
- Tumor markers (CA 15-3, CA 27.29, CEA)
These tests add no value to surveillance and increase costs and false-positive findings without improving outcomes. 1
Special Considerations for Risk Modification
Women with non-proliferative disease and no family history of breast cancer have no increased breast cancer risk, making them the lowest-risk category within benign breast disease. 2 However, temporal decreases in mammographic breast density (≥5% reduction) may further reduce breast cancer risk, particularly in women ≥50 years old, suggesting that strategies to reduce breast density could be beneficial. 3
Common Pitfalls to Avoid
- Do not confuse non-proliferative changes with proliferative disease or atypical hyperplasia—the risk profiles and management differ substantially, with non-proliferative changes requiring only standard surveillance. 2
- Avoid over-surveillance—the modest risk elevation does not justify intensive imaging or laboratory monitoring beyond annual mammography and clinical examination. 1
- Do not neglect bilateral surveillance—both breasts require monitoring even though the contralateral breast has standard population risk. 1