From the Guidelines
Focal ductal hyperplasia is not cancerous and is considered a benign breast condition. It is characterized by an overgrowth of cells within the breast ducts, but unlike cancer cells, these cells maintain their normal appearance and function, and do not invade surrounding tissues or spread to other parts of the body. The key difference between focal ductal hyperplasia and atypical ductal hyperplasia is that the latter can be associated with a slightly increased risk of breast cancer, as noted in a study published in the Journal of the American College of Radiology 1.
Key Points to Consider
- Focal ductal hyperplasia is a benign condition and does not increase the risk of developing breast cancer in the future.
- Atypical ductal hyperplasia, on the other hand, can increase the risk of breast cancer, with a relative risk of 4- to 5-fold for invasive cancer, as reported in a study 1.
- If focal ductal hyperplasia is found during a breast biopsy, no specific treatment is typically needed, but regular breast screenings as recommended by your healthcare provider should be continued as part of routine preventive care.
- The American College of Radiology recommends screening guidelines based on overall risk for breast cancer, which can be found in their topics on “Breast Cancer Screening” and “Supplemental Breast Cancer Screening Based on Breast Density” 1.
Management and Screening
The management of focal ductal hyperplasia typically involves continued routine preventive care, including regular breast screenings. There is no relevant literature to support the routine use of diagnostic mammography, breast US, or digital breast tomosynthesis in this clinical scenario, as noted in studies published in the Journal of the American College of Radiology 1. However, it is essential to follow the recommended screening guidelines based on overall risk for breast cancer.
Conclusion is not allowed, so the answer will be ended here.
From the Research
Focal Ductal Hyperplasia and Cancer Risk
- Focal ductal hyperplasia is not explicitly mentioned in the provided studies, but atypical ductal hyperplasia (ADH) is discussed in detail.
- ADH is considered a non-obligate precursor of invasive carcinoma, and its molecular taxonomy remains unknown 2.
- The risk of ADH upgrading to carcinoma upon excision varies, with studies reporting upgrade rates ranging from 10% to 53% 3 and 29% 4.
Diagnostic Challenges and Management
- ADH is a challenging diagnosis, and its management varies widely due to the uncertainty of its malignant potential 2, 4.
- Surgical excision is often performed, but some studies suggest that surveillance may be a viable option for selected subgroups, particularly those with pure ADH and no enhancement on magnetic resonance imaging (MRI) 3, 4.
- The use of contrast-enhanced breast imaging and artificial intelligence may improve the prediction of ADH-associated malignancy and reduce overtreatment 4.
Molecular Landscape and Biomarkers
- The molecular landscape of ADH is not well understood, and large prospective cohorts are needed to develop biomarkers of progression to carcinoma 2.
- Recent studies have identified potential biomarkers, such as EZH2 overexpression, which may have a future role in identifying cases of ADH that will be upgraded to carcinoma 5.