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Luellen celebrated her 50th birthday with a mammogram. Well, OK, she celebrated her 50th birthday with a nice dinner with friends. She celebrated the day after her 50th birthday with a mammogram. Her mammogram demonstrated microcalcifications that necessitated a needle biopsy. Luellen did the whole “come back and get more pictures thing” and then “the biopsy thing.” She did not have cancer, but she had some weird thing called, “atypia.”

Did she have cancer. No? Was it completely benign and not worry about? No. Well then, what was it? What is this thing called, ”atypia?”

Atypia is an abnormal collection of cells that are not cancerous but carry a risk of cancer.

Breasts are composed of lobules, which make milk, and ducts, which carry the milk to the nipple. Both of these structures are lined by two layers of cells. It is these cells that can turn into cancer. Quite often, prior to turning into cancer, these cells will first become abnormal or atypical. Atypia is an abnormal collection of the cells lining the lobules or ducts of the breast. Women who have atypia are at increased risk for developing breast cancer.

When the cells lining the lobules or ducts grow, the collection of cells is called hyperplasia. Usual hyperplasia poses no risk and is not a problem of any sort. When the cells grow to look funny, then the collection is described as atypical hyperplasia. Depending on the location of this collection, this collection of abnormal cells can be called by numerous different names.

Atypia includes:

  • atypical ductal hyperplasia (ADH)
  • atypical lobular hyperplasia (ALH)
  • Lobular Neoplasia (LIN)
  • Lobular Carcinoma In-Situ (LCIS)

All of these non-cancerous, i.e. benign, diagnoses carry an increased risk of developing breast cancer. The risk is usually 4x your baseline risk or up to 20% over the next ten years for LCIS.

What can you do if you have a diagnosis of atypia?

  1. Get your mammogram every year.
  2. Consider Breast MRI, especially if you have LCIS.
  3. Discuss lowering your risk for breast cancer by taking tamoxifen or raloxifene (EVISTA).

Luellen saw a surgeon and had an excisional biopsy. No cancer was identified but she did have some atypical ductal hyperplasia. Luellen saw a medical oncologist, who recommended raloxifene. Raloxifene will not only reduce her risk of breast cancer but raloxifene will strengthen her bones as well, a win-win. Luellen will continue to get her annual screening mammograms every year. She will also start exercising daily, lift weights, eat healthy and reduce her weight so that she is no longer overweight. Thus will she reduce her risk as much as  possible from breast cancer.

She lived happily ever after.

And the eight things to know about atypia:

  1. atypia is abnormal
  2. atypia is not cancer
  3. atypia on needle biopsy requires a surgical / excisional biopsy
  4. atypia puts you at increased risk for developing cancer
  5. yearly mammograms can help you identify a breast cancer earlier
  6. if your risk is high enough, breast MRI can also help identify breast cancer earlier
  7. you should reduce your risk by taking tamoxifen or raloxifene
  8. have a frank discussion with a breast surgeon or medical oncologist about your risk of developing breast cancer and your need for tamoxifen or raloxifene