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GYN
CMECNE

Atypical Hyperplasia of the Breast: Follow up and Management

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Learning Objectives and CME/Disclosure Information

This activity is intended for healthcare providers delivering care to women and their families.

After completing this activity, the participant should be better able to:

1. Be able to list the two types of atypical hyperplasia of the breast
2. Identify the next step when atypical hyperplasia is found on a core needle biopsy

Estimated time to complete activity: 0.25 hours

Faculty:

Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project

Disclosure of Conflicts of Interest

Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.

The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.

Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.

Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.

Method of Participation and Request for Credit

Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Jan 25 2023, participants must read the learning objectives and faculty disclosures and study the educational activity.

If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.

For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Medical Education

Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Nursing Education

The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.

Designated for 0.1 contact hours of pharmacotherapy credit for Advance Practice Registered Nurses.

Read Disclaimer & Fine Print

CLINICAL ACTIONS:

Atypical hyperplasia of the breast is a benign but high-risk condition that can be either ductal (ADH) or lobular (ALH); these occur with equal frequency and together are found in about 10% of breast biopsies. Either entity confers a long-term risk of breast cancer that approaches 30% at 25 years of follow-up.

  • Surgically excise atypical hyperplasia when found on a core-needle biopsy
    • Necessary to avoid missing invasive cancer due to sampling error
    • Upgrading can be ≥15 to 30%
  • Exception: Clinical and radiologic follow-up appropriate when atypical hyperplasia is an incidental finding at the site of a targeted biopsy
  • Current breast cancer risk assessment models perform poorly among women with atypical hyperplasia
    • Atypical hyperplasia associated with a relative risk of 4 for future breast cancer
  • Current NCCN screening recommendations include annual mammography, breast awareness, and  clinical encounter every 6 to 12 months, and in addition
    • Consider tomosynthesis
    • Consider annual MRI to begin at diagnosis
    • Based on emerging evidence, ACOG also recommends consideration of yearly breast MRI for atypical hyperplasia
  • Encourage pharmacologic risk reduction with either a selective estrogen-receptor modulator (SERM) or an aromatase inhibitor (AI) for prevention of breast cancer
  • Counsel about healthy lifestyle including ideal body weight and alcohol reduction
  • Atypical hyperplasia is generally not an indication for surgical risk-reduction / mastectomy

SYNOPSIS:

Atypical hyperplasia of the breast reflects proliferation of dysplastic epithelial cell populations.  It is felt to be a transitional zone between benign and malignant breast disease, containing some but not all features of a cancer. Although statistically the long term risk of breast cancer equals or exceeds that conferred by family history and other risk factors, current guidelines in screening do not reflect this.  Similarly, pharmacologic risk reduction strategies have been adopted by <1% of women who could potentially benefit from them.

KEY POINTS:

  • Atypical lobular hyperplasia is histologically similar to lobular carcinoma in situ, but less extensive
  • Atypical ductal hyperplasia and ductal carcinoma in situ share histologic features
  • Both types of hyperplasia share molecular characteristics and gene expression, indicating possibly a continuum of abnormalities.
  • ICD-10: N60.89

Learn More – Primary Sources:

Atypical Hyperplasia of the Breast—Risk Assessment and Management Options

Understanding the premalignant potential of atypical hyperplasia through its natural history: a longitudinal cohort study

National Comprehensive Cancer Network. Breast cancer screening and diagnosis.

ACOG: Diagnosis and Management of Benign Breast Disorders

Take a post-test and get CME credits

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Related ObG Topics:

Office Evaluation of Breast Disorders
BI-RADS: Standardizing Breast Imaging and Reporting 

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Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

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