Question: Hello, I just received the results of my core biopsy, I would like you opinion on it. Proliferated fibrocystic changes comprised of ductal epithelial hyerlasia with focal atypia, duct single minute microcalcification seen in benign fibrotic tissue. Patient needs surgery consult for breast biopsy. At this point, what do you think my risk is for cancer? I am scheduled for a wire localization open excisional biopsy this week. Thank you very much

Answer: I’m assuming based on your report that the pathologist meant there is a focus of atypical ductal hyperplasia (ADH). Atypical ductal hyperplasia is considered a risk marker for the subsequent development of breast cancer based on epidemiologic data. It is not felt to be a “precursor” to breast cancer. There are many things that can influence a patient’s risk of developing cancer and ADH is one of them but without knowing family history and other risk factors it’s not easy to come up with a simple number.  I would have that conversation with your physician who would likely know much more of your personal history and other risk factors.

The reason surgery is recommended for a core biopsy of ADH is that based on most studies, approximately 20-30% of the time the surgery reveals a more significant lesion, such as ductal carcinoma in situ or invasive carcinoma. That also means that around 70-80% of the time there is nothing more severe seen on surgical biopsy.

There has been some data published on the significance of only “focal” ADH and some have argued that those cases seen on core don’t need a surgical excision, but to my knowledge that has not become a universal standard in the breast community. However, it might be worth checking what was meant by “focal” ADH and if that case was shown to another pathologist where you had your biopsy done.

Best wishes and I hope nothing more shows up on your surgical excision.