ADH Question..Is risk affected by amount of ADH?

I am chiming in... I am still very confused by the whole ADH diagnosis... I was diagnosed 11 years ago and was told to just watch it. I had a biopsy at the time and the ADH was on the path report (the biopsy was just fibroids)... then for 6 years I had yearly mammograms and met with the surgeon yearly and the gyno yearly... Now this year, after yearly mammograms, ultrasounds etc, I have cancer. So of course I question if I could have done more 11 years ago. My oncologist said I could have taken tamoxifen, but that was never suggested to me... and even now with my cancer pathology report it mentions hyperplasia, so I asked my surgeon and oncologist again, and they say not to worry... plus I will be taking tamoxifen for that. 

anne--sometimes (but not always) an excisional biopsy is recommended after ALH to make sure nothing more serious is in there along with the ALH. Perhaps you could ask your BS why he is not recommending one for your situation. I had one following a finding of LCIS on stereotactic core biopsy, but that is because LCIS is often found along with invasive bc. (I'm not sure how often ALH is found with invasive bc). The general recommendation for ALH/ADH is just yearly mammos and twice yearly breast exams, unless there are other significant risk factors such as family history. (then the addition of tamoxifen is sometimes recomended.)

Anne

This study does NOT look at the risk of subsequent invasive breast cancer (after excision) in people who get ADH (and nothing worse) on their core biopsy.  But it does correlate the extent of ADH with the risk of DCIS **at  excision**. http://www.ncbi.nlm.nih.gov/pubmed/19095574

Note: This is a small study.

This study, as with the other, found the extent of ADH correlated with the risk of something worse *on excision*. http://www.ncbi.nlm.nih.gov/pubmed/20173103

This paper doesn't deal with the microscopic extent of ADH as seen on a slide of core biopsy, but of surgical margins on excision. This paper said clean margins were NOT associated with subsequent risk of breast cancer.  Only 1 out of the 155 ADH patients in this study went on to get invasive breast cancer in a mean of 26 months (range 0-119 months). None of the women with unknown or positive ADH margins went on to have malignancy. http://www.ncbi.nlm.nih.gov/pubmed/16978959  

This is a rather short term study (mean of just over 2 years), and one can always ask for a bigger study, but it implies dirty margins of ADH were not associated with increased invasive breast cancer risk.  However, that  conclusion is based on comparing 1 to 0, which is very tenuous statistically.

If this study correctly estimates the risk of ADH to subsequent invasive cancer (when the ADH area was excised), then these kind of studies would be very hard to do, since the number of women who get breast cancer is so very low (<1% over 2 years.)  You'd need a much larger study to actually get ideas about the risk of ADH, with or without information about ADH extent.

All these studies are small, with subject sizes <=200 or so, and the number of people who subsequently get DCIS or invasive much, much smaller.

I can't find studies that look at extent of ADH (after surgical excision) and long term (>=5 year) DCIS or invasive breast cancer risk.But I haven't looked at all the Pubmed references.  You are free to try :-).

Anne 1962:

 My mother is a bc survivor. She was diagnosed at 56, post menapausal.   I also have second degree relatives on both paternal and maternal side an Aunt and two cousins, whether they count or not is unclear.  I also have dense breast tissue. My first path just continues to show ALH.  I will let you know what the second opinion says and what my dr. says.  Good luck to you too.  tj1961