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Breast Cancer
  What Conditions Can Turn Into Cancer?

By Jill Simonsen

Reviewed by Andrea Fishbach, MS, MPH
Last updated October 14, 2011



Several conditions of the breast commonly occur before the development of breast cancer. Some of these conditions, such as intraductal hyperplasia with atypia and lobular carcinoma in situ (LCIS), are microscopic risk factors that can indicate that a woman is at increased risk of developing breast cancer. Women who have ductal carcinoma in situ (DCIS) are very likely to develop breast cancer if not properly treated.

To understand how breast cancer develops, you need to know a little bit about the anatomy of the breasts themselves. Each adult female breast contains 15 to 20 glands, called lobules, which produce milk after a woman has a baby. This milk is transported to openings in the nipple via tubes called ducts. Breasts also contain fatty, connective, and lymphatic tissue, the last of which is made up of lymphatic vessels and lymph nodes. This vital lymphatic system circulates a clear fluid that contains immune system cells, which the body uses to combat infections. Most lymphatic vessels of the breast lead to nodes under the arm called auxillary nodes.

 
 
 

Intraductal Hyperplasia With Atypia

Women with intraductal hyperplasia with atypia are four times more likely to get breast cancer than women without the condition
Over time, it's not uncommon for women to get a few extra cells in their ducts — a condition called intraductal hyperplasia (Latin for "too many cells in the duct"). In itself, this isn't a problem. However, sometimes the appearance of these extra cells begin to change — what doctors refer to as intraductal hyperplasia with atypia (also called atypical hyperplasia or ADH)-and this can be a sign of trouble. Researchers have found that women who display this condition are four times more likely to get breast cancer than women with no atypical hyperplasia, especially if they already have a family history of breast cancer.

However, because neither hyperplasia nor atypical hyperplasia cause lumps, they won't show up on mammograms nor will a doctor or patient detect them through physical examination of the breasts. Usually a doctor will come across them accidentally during a biopsy— that is, when he or she is determining whether a lump that's been removed is cancerous. In this case, the hyperplasia isn't in the lump itself but in the rim of the "normal" tissue next to the lump. While a finding of atypical hyperplasia isn't likely to prompt any radical preventive measures (such as the removal of a breast), most doctors will recommend that women with the condition be screened more frequently so that if a cancer does develop, it can be identified in its earliest stages.

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Lobular Carcinoma In Situ (LCIS)

Having LCIS increases a woman's risk of developing breast cancer over 30 years from 11 percent to 16 to 27 percent
Just as an accumulation of cells in the breast ducts leads to intraductal hyperplasia, an accumulation of cells in the lobules (where there are usually no cells) leads to lobular hyperplasia. As is the case with intraductal hyperplasia, a few extra cells that are normal in appearance do not present a problem. However, when these cells fill the entire lobule and are abnormal in appearance, they cause a condition called lobular carcinoma in situ, or LCIS. Although doctors don't consider LCIS a true precancerous condition, since it doesn't itself develop into cancer, it is considered a risk factor because it significantly increases a women's risk of developing breast cancer later on.

Studies suggest that women with LCIS and a family history of breast cancer may be more likely to develop invasive cancer than women with LCIS alone. LCIS does not show up on a mammogram and is usually discovered by accident when doctors are doing a biopsy for some other suspicious breast condition. LCIS often occurs in multiple areas of the same breast or in both breasts. When a woman with LCIS develops an invasive cancer it is not always confined to the area where the original LCIS was found. In fact, it may be either invasive ductal or invasive lobular cancer.

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Ductal Carcinoma In Situ (DCIS)

Ductal carcinoma in situ (DCIS) can be thought of as the next step after the overgrowth of unusual cells that happens with atypical hyperplasia. It occurs when cell accumulation continues, and these odd-looking cells multiply to the point that they begin to clog up the ducts. Although doctors consider these clogged ducts (which often do not form palpable lumps, but can sometimes turn up on mammograms) to be a developing cancer at its earliest stage, not all of them go on to become invasive cancers. Some of these cells will revert to either atypical hyperplasia or even just plain intraductal hyperplasia. However, approximately 30 to 50 percent of the women diagnosed with DCIS go on to develop an invasive cancer over 25 to 30 years if they do not receive treatment. This is reduced to 25 to 30 percent if the woman is treated with lumpectomy and radiation after discovering DCIS.

For more information about these conditions and their treatment, we recommend the National Institutes of Health Cancer Web Site.

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References

Bodain CA et al. (1993). Prognostic significance of benign proliferative breast disease. Cancer 71(12):3896-907.

Frykberg E and Bland KI. (1994). Overview of the biology and management of ductal carcinoma in situ. Cancer 74:350-62.

Love, SM and Lindsey, K. (2000). Dr. Susan Love’s Breast Book. (3rd ed.) Pennsylvania: Perseus.

Page, DL, DuPont WD, Rogers LW, et al. (1982). Intraductal carcinoma of the breast: Follow-up after biopsy only. Cancer 49:751.

Solin I.J., Recht A., Fourgnet A, et. al. (1991). Ten-year results of breast conserving surgery and definitive irradiation for intraductal carcinoma DCIS of the breast. Cancer 68:2337.

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