Question: I had a stereotactic core biopsy of cluster of calcifications in the upper inner left breast. Path diagnosis columnar cell change and hyperplasia with focal atypical micropapillary hyperplasia with microcalcifications. surgicial excision is recommended. From my understanding this is not cancer but has the potential to be cancer down the road. I am not in favor of doing surgical excision. Is there any other alternative for this type of situation. Any advice would be helpful.

Answer:  Thank you for your question.  I’m sorry you are faced with this uncertainty. While it is true none of the findings you have mentioned are a “cancer”, the finding on core biopsy of atypical micropapillary hyperplasia (a type of atypical ductal hyperplasia) can be associated with a more significant lesion on excisional biopsy (such as ductal carcinoma in situ or even invasive carcinoma).  The literature gives varying rates of “upgrades” from atypical ductal hyperplasia to ductal carcinoma in situ or invasive carcinoma, but in general the average is 20-30%. Thus, the standard of care is to proceed on to surgical excision.

Of note (and I fully support this idea), there has been some data in the breast literature suggesting that “focal” atypical ductal hyperplasia may not need to be excised. It is a very interesting area of research because it could help save a lot of women from an open surgical biopsy, but it requires meticulous correlation between pathology and radiology to determine if the area in question was likely fully excised. While promising, I have not seen enough data supporting that yet, so to my knowledge this is not widely accepted and the standard is still for surgical excision.  It might be worthwhile to get a second opinion on the “focal atypical micropapillary hyperplasia” because otherwise simple columnar cell change, even with hyperplasia, does not necessarily need surgical excision.