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 for this lower-risk group. 2 This risk persists for at least 25 years after biopsy, justifying long-term but appropriately scaled monitoring. 2
Clinical Examination Schedule
- First 3 years: Physical examination every 3-6 months by a physician experienced in breast examination and cancer surveillance 1
- Years 4-5: Physical examination every 6-12 months 1
- After year 5: Annual physical examination 1
- Care can be transferred from oncology specialists to primary care physicians approximately 1 year after diagnosis 1
Mammographic Surveillance Protocol
- Annual mammography is the standard for routine surveillance 1
- The first post-diagnosis mammogram should be performed 1 year after the initial mammogram, but no earlier than 6 months after completing radiation therapy if breast-conserving surgery was performed 1
- Bilateral mammography is required to monitor both the affected and contralateral breast 1
Patient Self-Monitoring
- All women must be instructed to perform monthly breast self-examination 1
- Patients should immediately report: new breast lumps, bone pain, chest pain or dyspnea, abdominal pain, and persistent headaches 1
What to AVOID in Asymptomatic Patients
Do NOT perform routine surveillance with: 1
- Complete blood counts or automated chemistry panels
- Chest x-rays
- Bone scans
- Liver ultrasounds
- CT scans or PET scans
- Breast MRI
- Tumor markers (CA 15-3, CA 27.29, CEA)
These tests are not recommended in asymptomatic patients with non-proliferative changes and provide no mortality or morbidity benefit. 1, 3
Genetic Counseling Indications
Refer patients for genetic counseling if they have: 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
Common Pitfall to Avoid
The most critical error is over-surveillance—ordering unnecessary imaging (MRI, CT, PET) or laboratory tests (tumor markers, routine blood work) in asymptomatic patients with non-proliferative changes. 1, 3 This low-risk histology does not warrant the intensive monitoring protocols used for proliferative disease with atypia or invasive cancer, and excessive testing increases patient anxiety, healthcare costs, and false-positive results without improving outcomes.