Screening Recommendations for Atypical Ductal Hyperplasia
Women with a history of atypical ductal hyperplasia (ADH) should undergo annual screening mammography and clinical breast examination every 6 to 12 months, with consideration of annual supplemental breast MRI screening. 1
Core Screening Protocol
Mammography
- Annual mammography is the foundation of screening for all women with ADH, starting from the time of diagnosis but not before age 30 2
- Digital breast tomosynthesis (DBT) is preferred over standard mammography as it increases cancer detection rates and decreases false-positive recall rates 2
- Women with ADH may have decreased mammographic specificity compared to average-risk women, though sensitivity remains unchanged 2
Clinical Breast Examination
- Clinical breast examinations should be performed every 6 to 12 months 1
- This more frequent clinical surveillance complements annual imaging given the elevated cancer risk
Supplemental MRI Screening
- Annual breast MRI should be considered as an adjunct to mammography for women with ADH, particularly those with additional risk factors or extensive/multifocal disease 1, 2
- The American College of Radiology supports MRI screening in women with ADH due to their elevated breast cancer risk, with MRI demonstrating 91-98% sensitivity for cancer detection in high-risk women when combined with mammography 2
- MRI is recommended for women aged 25 years or older with atypical hyperplasia 1
Risk Context and Rationale
Cancer Risk Profile
- ADH is classified as a proliferative lesion with atypia that significantly increases breast cancer risk 2
- Approximately 25% of women with proliferative lesions with atypia may develop breast cancer 2
- Women with ADH have an estimated 10-20% risk of developing cancer in either breast over 15 years 1
- The upgrade rate to invasive carcinoma or DCIS at surgical excision ranges from 29-37% in various studies 3, 4, 5
Important Clinical Considerations
- Breast awareness should be encouraged in all women with ADH 1
- Risk reduction strategies should be discussed in accordance with breast cancer risk reduction guidelines 1
- Continue screening as long as the patient remains in good health with a life expectancy of at least 5-7 years 2
Common Pitfalls to Avoid
- Do not use short-interval (6-month) follow-up mammography as the primary surveillance strategy—annual screening is appropriate and evidence-based 2
- Do not assume ADH on core biopsy represents the final diagnosis—the underestimation rate for malignancy is substantial (29-37%), which is why enhanced surveillance is critical 3, 4, 5
- Do not overlook the contralateral breast—ADH increases risk in both breasts, not just the ipsilateral side 1