Breast proliferation

Mastopathy refers to a benign pathology in which precancer may occur. The proliferation of the mammary gland with cellular atypia is detected during the examination – the presence of obligate precancer requires complex therapy with the obligatory removal of the focus of pre-invasive changes in the glandular or ductal cells of the breast.

Precancer variants

In most cases, precancer is asymptomatic: a woman can be observed and treated for a long time for mastopathy, but it is not always possible to anticipate or prevent the development of oncology. On ultrasound or mammography, there are no typical signs of a tumor, and atypical breast proliferation is detected by chance when a biopsy is taken from breast tissue. There are 2 main variants of pathology:

  1. Lobular neoplasia;
  2. Intraductal proliferation.

Depending on the severity of cellular changes, the risk of cancer in the breast increases dramatically – often the proliferation of the breast becomes cancer in situ.

Lobular neoplasia

Precancerous cellular changes in the glandular tissue of the breast indicate a high risk of oncopathology. There are 2 forms:

  1. Atypical lobular hyperplasia;
  2. Lobular carcinoma in situ.

Regardless of the woman’s age, any of the options is dangerous by the potential development of a malignant tumor (the likelihood of breast cancer formation increases 12 times). There are 3 degrees of precancer:

  1. Minimal presence of cell proliferation and atypia (risk of degeneration 11%);
  2. Moderately pronounced proliferative-atypical changes (the likelihood of cancer rises to 47%);
  3. Severe cellular pathology (transition to oncology in 86% of cases).

It is impossible to detect lobular neoplasia with mammography or echography. The only option for early diagnosis is the study of a biopsy taken from breast tissue with mastopathy.

Intraductal proliferation

The defeat of the milk ducts in the chest can be of 3 types:

  1. Simple hyperplasia;
  2. Atypical ductal hyperplasia;
  3. Ductal carcinoma in situ.

In the first case, the risk of a malignant tumor increases by 1.5 times, in the second – 5 times, in the third – 10 times. The intraductal proliferation of the mammary gland is an obligate precancer that requires surgery if found.

Diagnostic algorithm

Typical examination tactics include all possible diagnostic methods that must be carried out taking into account the result of a preliminary examination by a mammologist. A woman aged 20 to 35 years, it is desirable to conduct an ultrasound scan of the breast at least 1 time in 2 years, choosing for the procedure 1 phase of the menstrual cycle (from 6 to 11 days from the first day of menstruation). After 35 years, mammography is performed. Puncture biopsy is performed in the following cases:

Any variant of nodular mastopathy;

  • Detection of a cystic cavity in the chest;
  • Identification of a local group of microcalcifications (a sign of the intraductal proliferation of the mammary gland).

Only a cytological or histological conclusion is the basis for a diagnosis of a precancerous process.

Therapy tactics

The optimal methods of treating pre-invasive forms of breast cancer are surgery and drug therapy. Indications for surgery include:

  • A high degree of proliferative and atypical processes in the biopsy;
  • The presence of altered cells in the aspirate obtained from the cystic cavity or node;
  • Negative dynamics when using conservative treatment methods.

Conservative techniques are carried out under the constant and regular supervision of a mammologist – it is impossible to get rid of a precancerous condition with the help of pills, therefore, you should visit a specialist at least once every six months to identify progressive atypical or proliferative processes in time.

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After an in-depth review of the strongest available science on the benefits and harms of screening mammography, as well as input from the public and health care professionals during the public comment period, the Task Force issued its final recommendations on breast cancer screening on January 12, 2016. You can learn more about how the Task Force’s final recommendations converge with other evidence-based guidelines in an editorial published in Annals of Internal Medicine.


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