Oct 28, 2008 07:45AM Beesie wrote:

chezshoes,

Ductal hyperplasia does double your breast cancer risk as the Mayo Clinic site says, however ductal hyperplasia is not considered to be a pre-cancerous or "high risk" condition.   It's all related to how risk is calculated. 

You are probably familiar with the commonly mentioned fact that 1 in 8 women will get breast cancer during their lifetime.  Another way of saying the same thing is to say that the lifetime risk of being diagnosed with breast cancer for the average woman is 12.7%.  The 'average' woman in this statement is in fact a blend of all women - those who have no risk factors, those who have some risk factors and those who are very high risk.  However, when individual risk is assessed - your own personal risk level - it is built up from base risk, not average risk.  Base risk is the risk level for all women before any personal risk factors are considered.  The numbers I've seen for base risk range from 4% to 6%.   So that's your starting point.  That's the starting point for all of us.  In your case, it's now known that you have ductal hyperplasia.  This doubles your risk.  So this means that your lifetime breast cancer risk may now be in the range of 8% to 12%.  If this is your only personal risk factor, your risk level is still below the average.  If you have other personal risk factors, adding ductal hyperplasia may take you up above the average.  But ductal hyperplasia alone does not put you into a 'high risk' category.

I hope my explanation is clear and I hope it eases your mind.  One other point.  The risk numbers that I gave you are lifetime risk numbers - total breast cancer risk up to the age of 90.  Risk varies by age - it's lower when you are younger and higher when you are older.  The average annual risk level of someone in their 30s is only 1 in 233, or 0.43% for the entire decade of their 30s, or 0.043% per year.  The average annual risk level of someone in their 60s is 1 in 27, or 3.65% for the entire decade of their 60s, or 0.365% per year (i.e. less than a 1/2 percent per year).  These are the average numbers again, not base risk, but if your ductal hyperplasia has put your risk level at around the average, these would be approximately your annual risk levels.  http://www.cancer.gov/cancertopics/factsheet/Detection/probability-breast-cancer

Hope that helps!

Oct 28, 2008 01:26PM leaf wrote:

I thought the risk of atypical  hyperplasia was quite a bit more than plain hyperplasia.

Breast cancer is characterized by the overgrowth of abnormal cells, a multistep process called carcinogenesis. The process begins when normal cell development and growth become disrupted, causing an overproduction of normal-looking cells (hyperplasia). Atypical hyperplasia occurs when the excess cells stack upon one another and begin to take on an abnormal appearance. The abnormal cells can continue to change in appearance and multiply, evolving into noninvasive (in situ) cancer, in which cancer cells remain confined to the area where they start growing. Left untreated, the cancer cells may eventually become invasive cancer, invading surrounding tissue, blood vessels or lymph channels. http://www.mayoclinic.com/health/atypical-hyperplasia/DS01018/DSECTION=causes

Also you may want to see http://www.pathologyoutlines.com/breast.html#epithelialductalhyperplasia

Also, note that if you have multiple risk factors, that does NOT necessarily means you can add the various risks together to get your risk.  If you have a risk A of 5% and a risk B of 8%, your total risk may be 13%, but it may be 5% or 20%.  You have to compare your list of risk factors to the populations that have your same risk factors.

Oct 28, 2008 01:39PM PSK07 wrote:

Thanks, leaf. I'm sitting here in my low-BP haze wondering the difference between "usual" ductal hyperplasia and "atypical". Like, if atypical is atypical, then usual has to be ok?

I'm waiting for my path from my surgery this past Friday. Hoping there wasn't anything beyond the LCIS and ALH.

Oct 28, 2008 04:47PM Beesie wrote:

Atypical ductal hyperplasia (ADH) is a further progression from ductal hyperplasia.  ADH is a high risk condition.  Whereas usual ductal hyperplasia increases risk by about double, atypical ductal hyperplasia increases risk by 4 - 5 times.  So this means that for someone with no other significant risk factors, a diagnosis of ADH would put their lifetime BC risk level in the range of about 20% - 25%.  That's high risk, but it still means that 75% - 80% of women who have ADH (and no other significant risk factors) won't ever get breast cancer.  I didn't mention ADH or the associated risk in my original post because chezshoes' pathology report was very clear in saying that she had "usual ductal hyperplasia.  chezshoes, don't start worrying now that your ductal hyperplasia will progress to become ADH.   

The following website from ACS includes a good explanation of hyperplasia and the risk levels associated with the various types of hyperplasia. 

Based on how the cells look under the microscope, hyperplasia may be grouped as:

• mild hyperplasia
• hyperplasia of the usual type (without atypia) -- also known as usual hyperplasia
• atypical hyperplasia -- either atypical ductal hyperplasia (ADH) or atypical lobular hyperplasia (ALH)

A woman with mild hyperplasia is not at increased risk for breast cancer. A woman with usual hyperplasia has a slightly higher chance of developing breast cancer. The risk is 1½ to 2 times that of a woman with no breast abnormalities. The risk for a woman with atypical hyperplasia is 4 to 5 times higher than that of a woman with no breast abnormalities.  http://www.cancer.org/docroot/CRI/content/CRI_2_6X_Non_Cancerous_Breast_Conditions_59.asp

And in the picture below you can see how breast cells change as they go from normal to ductal hyperplasia (minor increased risk) to ADH (pre-cancerous high risk) to DCIS (Stage 0 breast cancer) to DCIS with a microinvasion (early Stage I breast cancer) to IDC (invasive breast cancer, Stages I - IV).

Nov 1, 2008 08:15AM - edited Nov 1, 2008 08:15AM by BessB

Beesie,

The picture is a great example.  I was diagnosed with ADH after years of abnormal mammograms.  Since I had previous blood clots I could not take Tamoxifan.  The docs felt that I was "progressing" so when I inquired about PBM there were no questions asked.  In January 08 I had a bi-lateral w/DIEP reconstruction and I have never looked back.  Your picture shows how ductal hyperplasia can progress.   For some it will never progress - but for me it did.  I kept getting too many clustered microcalcifications and I did not want to just sit and wait any longer.  I was comfortable with the fact that I had time to make the decision.  Good luck to you PS:) - Bessie