From the Guidelines
Proliferative diseases of the breast without atypia include usual ductal hyperplasia, sclerosing adenosis, complex fibroadenomas, radial scars/complex sclerosing lesions, papillomas, and papillomatosis. These conditions are characterized by an overgrowth of normal-appearing cells within the breast ducts or lobules without cellular abnormalities that would suggest pre-cancerous changes 1. The key features of these diseases are:
- Usual ductal hyperplasia: an increase in the number of cells lining the ducts
- Sclerosing adenosis: a condition where the breast tissue becomes distorted and scarred
- Complex fibroadenomas: benign tumors that contain a mixture of glandular and fibrous tissue
- Radial scars/complex sclerosing lesions: areas of scar tissue that can mimic cancer on imaging studies
- Papillomas: benign growths that occur in the ducts of the breast
- Papillomatosis: a condition where there are multiple papillomas in the breast
These conditions are often discovered incidentally during breast biopsies performed for other reasons, and management typically involves regular breast cancer screening according to age-appropriate guidelines rather than surgical excision in most cases 1. It's essential to distinguish between proliferative diseases without atypia and those with atypia, such as atypical ductal hyperplasia, as the latter carry a significantly higher breast cancer risk 1. Understanding these benign proliferative conditions helps clinicians provide appropriate counseling and avoid unnecessary interventions while ensuring adequate surveillance.
From the Research
Proliferative Diseases with No Atypia of the Breast
The following are proliferative diseases with no atypia of the breast:
- Usual ductal hyperplasia (UDH) 2
- Adenosis 2
- Sclerosing adenosis (SA) 2
- Fibro cystic disease 2
- Mucocele-like lesion (MLL) without atypia 2
- Radial scar (RS) without atypia 2
- Flat epithelial atypia (FEA) without atypia is not typically considered a proliferative disease with no atypia, as it is often associated with an increased risk of breast cancer 3
- Proliferative disease without atypia, which has been shown to have an approximately 1.5x increased risk of subsequent breast cancer 4
Key Characteristics
These diseases are characterized by:
- An increased risk of breast cancer, although the risk is generally lower than for atypical hyperplasia (AH) 4
- A variety of mammographic appearances, including clustered microcalcifications 5
- A need for careful clinical and radiologic follow-up to monitor for any changes or development of breast cancer 4, 5