Atypical Hyperplasia of the Breast: Follow up and Management
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
Susan J. Gross, MD, FRCSC, FACOG, FACMG President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.
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 Dec 31 2021, 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.
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 ≥ 15-30%
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 6–12 months, and in addition
Consider annual MRI to begin at diagnosis
Based on emerging evidence, ACOG also recommends that 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
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.
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.
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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.
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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