When you receive a pathology report after a breast biopsy, it can be filled with medical terms that are hard to understand. This article aims to clarify one of these terms: atypical lobular hyperplasia (ALH), and help you understand what it means for your breast health.
Pathology reports are generated after a breast biopsy, a procedure used to take tissue samples from suspicious areas in the breast. Biopsies can be done using a needle or through surgery. A needle biopsy involves using a thin, hollow needle to extract tissue samples. A surgical biopsy might be needed in some cases, and can be either incisional, removing only a portion of the abnormal area, or excisional, removing the entire abnormal area along with some surrounding healthy tissue. An excisional biopsy is similar to a lumpectomy, a breast-conserving surgical procedure.
The normal breast tissue is composed of ducts (small tubes carrying milk) and lobules (sacs where milk is produced). Hyperplasia is a medical term indicating an increased number of cells within these ducts or lobules that are not cancerous.
Normally, the ducts and lobules have two layers of cells lining them. Hyperplasia occurs when there are more than these two layers of cells.
When the cell growth in the ducts appears similar to the normal pattern under a microscope, it’s called usual ductal hyperplasia. If the cell growth looks more abnormal, it’s termed atypical hyperplasia. This can be further categorized into atypical ductal hyperplasia (ADH) or atypical lobular hyperplasia (ALH).
Atypical Lobular Hyperplasia (ALH) Explained
Atypical lobular hyperplasia (ALH) is a condition characterized by the abnormal growth of cells within the lobules of the breast. It is not cancer, but it is considered a benign breast condition that increases a woman’s risk of developing breast cancer in the future. Think of ALH as an indicator that the breast tissue has a higher tendency to develop abnormal cells.
ALH and Breast Cancer Risk
Having ALH means you have an increased risk of breast cancer compared to women without this condition. It is important to understand that ALH itself is not breast cancer, nor is it a pre-cancer in the same way that ductal carcinoma in-situ (DCIS) is. However, it serves as a marker for increased risk. The presence of ALH suggests that the environment within the breast tissue is more conducive to the development of cancerous changes over time.
ALH on Needle Biopsy: What’s Next?
If ALH is diagnosed from a needle biopsy, the next steps can vary depending on your doctor’s recommendation and individual circumstances. Historically, some doctors routinely advised further surgical removal of tissue around the biopsy site to ensure no more serious conditions, like cancer, were present nearby.
However, current medical consensus leans towards a more conservative approach for many ALH cases found on needle biopsy. Many doctors now believe that close monitoring with regular clinical breast exams and imaging tests, such as mammograms, is sufficient. This is especially true if there are no other concerning factors. The decision to proceed with further surgery often depends on factors like the extent of ALH, any associated imaging findings, and your personal risk factors for breast cancer.
ALH on Excisional Biopsy: What’s Next?
If ALH is diagnosed from an excisional biopsy, which removes a larger area of tissue, typically no further surgical treatment is needed. Because an excisional biopsy removes the entire area of concern, it’s generally considered that any ALH present has been completely removed.
Follow-up and Risk Reduction for ALH
Regardless of how ALH is diagnosed, because it increases your future breast cancer risk, your doctor will recommend a proactive approach to breast health. This typically includes:
- More frequent follow-up: This involves regular clinical breast exams by your doctor and routine imaging tests like mammograms, often more frequently than the standard screening guidelines.
- Risk reduction strategies: Your doctor may discuss lifestyle changes that can lower breast cancer risk, such as maintaining a healthy weight, regular exercise, limiting alcohol consumption, and not smoking. In some cases, for women at higher risk, medications to reduce breast cancer risk (chemoprevention) might be considered.
It’s crucial to have an open conversation with your doctor about your ALH diagnosis, your individual risk factors, and the most appropriate follow-up and risk reduction plan for you.
Other Findings in Your Breast Pathology Report
Besides hyperplasia, your pathology report might include other terms describing benign (non-cancerous) breast changes, such as:
- Usual ductal hyperplasia
- Adenosis
- Sclerosing adenosis
- Radial scar, complex sclerosing lesion
- Papillomatosis
- Papilloma
- Apocrine metaplasia
- Cysts
- Columnar cell change
- Collagenous spherulosis
- Duct ectasia
- Fibrocystic changes
- Flat epithelial atypia
- Columnar alteration with prominent apical snouts and secretions (CAPSS)
These are generally benign conditions and often are not significant if found alongside atypical hyperplasia.
Microcalcifications or calcifications are small calcium deposits that can be found in both benign and cancerous breast conditions. Their presence on a mammogram might lead to a biopsy. Pathologists check biopsy samples for calcifications to confirm the correct area was sampled.
E-cadherin is a protein tested in some cases to help distinguish between ductal and lobular conditions. ALH cells are typically negative for E-cadherin. If E-cadherin isn’t mentioned in your report, it simply means the test wasn’t necessary for your diagnosis.
Other lab tests like High Molecular Weight Cytokeratin (HMWCK), CK903, CK5/6, p63, and others are specialized tests used to further classify breast lesions when needed. Their presence or absence in your report does not affect the accuracy of your diagnosis.
Understanding your pathology report, especially terms like atypical lobular hyperplasia (ALH), is a key step in taking charge of your breast health. Always discuss your report and any concerns with your healthcare provider for personalized guidance and care.
