high risk?

Well, there is controversy, including about definitions.

There are a lot of complications with the subject of breast cancer risk.  When the ACS is talking about  1 1/2-2 times normal, they are NOT NOT NOT saying this is 1 1/2 - 2 times 12.5%, but 1 1/2 - 2 times the risk of a woman WITHOUT any particular risk factor, which is something like 3-5%.  So a person with a 2 times normal risk would have a risk of about 6-10% lifetime risk.  This means that in this group of people (with 2x normal risk), 90-94% of these people would NEVER get breast cancer.

Here's what the ACS says:

Non-proliferative lesions: These conditions are not associated with overgrowth of breast tissue. They do not seem to affect breast cancer risk, or if they do, it is to a very small extent. They include:

• fibrocystic disease (fibrosis and/or cysts)
• mild hyperplasia
• adenosis (non-sclerosing)
• simple fibroadenoma
• phyllodes tumor (benign)
• a single papilloma
• fat necrosis
• mastitis
• duct ectasia
• other benign tumors (lipoma, hamartoma, hemangioma, neurofibroma)

Proliferative lesions without atypia: These conditions show excessive growth of cells in the ducts or lobules of the breast tissue. They seem to raise a woman's risk of breast cancer slightly (1½ to 2 times normal). They include:

• usual ductal hyperplasia (without atypia)
• complex fibroadenoma
• sclerosing adenosis
• several papillomas or papillomatosis
• radial scar

Proliferative lesions with atypia: In these conditions, there is excessive growth of cells in the ducts or lobules of the breast tissue, and the cells no longer appear normal. They have a stronger effect on breast cancer risk, raising it 4 to 5 times higher than normal. They include:

• atypical ductal hyperplasia (ADH)
• atypical lobular hyperplasia (ALH)http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_What_are_the_risk_factors_for_breast_cancer_5.asp

• Women at high risk include those who:

• have a known BRCA1 or BRCA2 gene mutation
• have a first-degree relative (mother, father, brother, sister, or child) with a BRCA1 or BRCA2 gene mutation, but have not had genetic testing themselves
• have a lifetime risk of breast cancer of 20% to 25% or greater, according to risk assessment tools that are based mainly on family history (see below)
• had radiation therapy to the chest when they were between the ages of 10 and 30 years
• have Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or have one of these syndromes in first-degree relatives

• Women at moderately increased risk include those who:

• have a lifetime risk of breast cancer of 15% to 20%, according to risk assessment tools that are based mainly on family history (see below)
• have already had breast cancer, ductal carcinoma in situ (DCIS), lobular carcinoma in situ (LCIS), atypical ductal hyperplasia (ADH), or atypical lobular hyperplasia (ALH)
• have extremely dense breasts or unevenly dense breasts when viewed by mammograms

 http://www.cancer.org/docroot/CRI/content/CRI_2_6X_Non_Cancerous_Breast_Conditions_59.asp

So you have one aunt who had premenopausal breast cancer.  Were the other aunt and great aunt's breast cancer premenopausal?  

Here are the USPTF guidelines on who is likely to be a candidate for BRCA 1/2 testing:

These recommendations apply to women who have not received a diagnosis of breast or ovarian cancer. They do not apply to women with a family history of breast or ovarian cancer that includes a relative with a known deleterious mutation in BRCA1 or BRCA2 genes; these women should be referred for genetic counseling. These recommendations do not apply to men.

Although there currently are no standardized referral criteria, women with an increased-risk family history should be considered for genetic counseling to further evaluate their potential risks.

Certain specific family history patterns are associated with an increased risk for deleterious mutations in the BRCA1 or BRCA2 gene. Both maternal and paternal family histories are important. For non-Ashkenazi Jewish women, these patterns include 2 first-degree relatives with breast cancer, 1 of whom received the diagnosis at age 50 years or younger; a combination of 3 or more first- or second-degree relatives with breast cancer regardless of age at diagnosis; a combination of both breast and ovarian cancer among first- and second-degree relatives; a first-degree relative with bilateral breast cancer; a combination of 2 or more first- or second-degree relatives with ovarian cancer regardless of age at diagnosis; a first- or second-degree relative with both breast and ovarian cancer at any age; and a history of breast cancer in a male relative.

For women of Ashkenazi Jewish heritage, an increased-risk family history includes any first-degree relative (or 2 second-degree relatives on the same side of the family) with breast or ovarian cancer.

About 2 percent of adult women in the general population have an increased-risk family history as defined here. Women with none of these family history patterns have a low probability of having a deleterious mutation in BRCA1 or BRCA2 genes.http://www.ahrq.gov/clinic/uspstf05/brcagen/brcagenrs.htm

Its hard to know who just has hyperplasia, then went on to get atypical hyperplasia, then went on to get cancer.  A big factor with this is that for the people who had hyperplasia on a biopsy, we really don't know if there is hyperplasia, DCIS, LCIS, invasive cancer, or whatever in the rest of the breast(s).  We'd have to do bilateral mastectomies to find that out.

But, as you can see, the VAST majority of women with hyperplasia will NEVER go on to get breast cancer.

angie----hyperplasia without atypia is good news, it's benign; it raises your overall risk but only slightly. Just be vigilant with your yearly mammos and your monthly self breast exams.

Anne

angie----wonderful news!!!! Now you can relax!

Anne