Did the biopsy report say ADH? Don't worry, let's talk about this! (Atypical Ductal Hyperplasia)

You may have noticed a change in your breast, or your doctor may have recommended a biopsy after a mammogram. When you get that biopsy report and see that it says "Atypical Ductal Hyperplasia" or "ADH," it's normal to feel scared and anxious. "Is this cancer?" "What's going to happen to me now?" You may have many questions on your mind. But don't worry. Today, we'll talk about what ADH is, why it occurs, and what to do about it in a simple, understandable way.

What exactly is Atypical Ductal Hyperplasia (ADH)?

Simply put, ADH is an abnormal growth of cells inside the milk ducts of your breasts. It's not cancer. But it's not normal either.

Imagine, the milk ducts in our breasts are like little tubes. The inner wall of these tubes is made of cells. In a healthy person, these cells are arranged in two layers, very neatly, beautifully lined up.

But in someone with ADH, these cells are a bit messy, piled up on top of each other, and grow in several layers. And the shape of these cells is also a bit unusual. These cells are not cancer cells, which means they are 'benign'. However, some of their characteristics are similar to cells in a condition called ``DCIS - Ductal Carcinoma In Situ'', which is a very early stage of breast cancer.

This is like a yellow light on the road. It doesn't mean there's an accident, but it means you need to be very careful when moving forward.

ADH and ALH: What is the difference between these two?

You may also hear the term 'Atypical Hyperplasia'. This is the general name for this abnormal cell growth. There are two main types of this. It is important to know the difference between the two.

Both types increase the risk of future cancer. Studies have shown that a woman with either of these conditions may be four times more likely to develop breast cancer than someone without it.

What are the symptoms of ADH?

In most cases, ADH does not cause any specific symptoms. It is often discovered incidentally. ADH is usually diagnosed when a breast abnormality (e.g., microcalcifications) is detected during a mammogram performed for another reason and a biopsy is performed to investigate the abnormality further.

However, very rarely, some people may also experience symptoms like these:

• A lump in the breast is felt in the hand.
• Feeling pain in the breast.
• Abnormal nipple discharge (especially bloody).

If you have symptoms like this, it's not necessarily due to ADH. However, if you notice any unusual changes in your breasts , it's wise to see your doctor right away and get checked out.

Causes and risk factors of ADH

Doctors still don't know exactly why these milk duct cells behave this abnormally. However, it is believed that some factors that increase the risk of breast cancer are also associated with the risk of developing ADH.

What are these risk factors?

• Family history: If a family member (especially a close relative like a mother, sister, or daughter) has had breast cancer.
• Genetic changes: Having genetic mutations like `(BRCA1, BRCA2)` that increase the risk of breast cancer.
• Personal history: If you have had any other cancer before.
• Obesity: Failure to maintain a healthy body weight.
• Lifestyle: Frequent drinking and use of tobacco products.

It is important to remember that even someone without any of these risk factors can develop ADH or breast cancer.

The process of diagnosing and treating ADH

Let's take a look at what your doctor usually does next after diagnosing ADH.

1. Surgical / Excisional Biopsy

ADH is often first diagnosed with a 'needle biopsy', which involves taking a small piece of tissue from the breast with a needle-like instrument and examining it.

Once ADH is confirmed, the next step for doctors is to perform a 'surgical biopsy' or 'excisional biopsy' . This involves surgically removing the entire area of ​​abnormal cells, along with some healthy tissue around them.

Therefore, by removing and examining the entire area, you can be 100% sure that there are no other dangerous cells around it. In about 20% of surgeries performed in this way, cancer cells have been found in addition to ADH. So this surgery is done for your safety.

2. Risk-Reducing Medications

If the tissue is examined after surgery and there are no remaining cancer cells, most often no further treatment is needed. However, if your doctor thinks that your risk of future cancer is very high , based on factors such as your personal and family history, he or she may prescribe medications to help reduce that risk.

These medications work by blocking the action of the hormone estrogen in the body, which is known to contribute to the growth of some types of breast cancer.

• Tamoxifen for pre-menopausal women.
• Medications such as Raloxifene or Anastrozole for post-menopausal women.

These medications are usually recommended for about 5 years. Although they can cause some side effects, serious side effects are rare. Whether this medication is right for you or not is something you should discuss with your doctor.

3. Close Surveillance

Once you've been diagnosed with ADH, the most important thing is to pay close attention to your breasts. Your doctor may recommend the following:

• Annual Mammogram: Never skip this.
• Clinical Breast Exam: Having your breasts examined by a doctor every 6 to 12 months.
• Breast MRI: If your risk is high, an MRI scan may be recommended once a year in addition to a mammogram.
• Self-Breast Exam: Learn how to examine your breasts at home once a month and make it a habit. If you notice any changes, tell your doctor right away.

What is the risk of developing cancer for someone with ADH?

ADH is not cancer, but it does increase the risk in the future. Don't be alarmed by these statistics, they don't mean that everyone with ADH will develop cancer.

• Within 5 years of being diagnosed with ADH, about 7 out of 100 people (7%) will develop breast cancer.
• After 10 years , about 13 out of 100 people (13%) may develop it.
• After 25 years , about 30 out of 100 people (30%) may develop it.

This shows how important regular screening is, as the risk increases over time. Because even if cancer does develop in some way, regular screening in this way can detect it at a very early stage. Then the chances of treatment and complete cure are much higher.

What can I do to reduce the risk?

While there is no surefire way to prevent ADH, there are several things you can do to reduce your risk of future breast cancer. These are also very good for your overall health.

• Maintain a healthy weight: Try to stay at a healthy weight for your height.
• Exercise daily: Engage in at least 30 minutes of vigorous exercise a day.
• Limit alcohol: If you drink alcohol, limit it as much as possible. It is best to stop drinking altogether if possible.
• Avoid smoking: Stop smoking and using tobacco products completely.
• Healthy diet: Eat a diet rich in vegetables, fruits, and herbs, and low in oil, sugar, and salt.

Breast health, ADH, Atypical Ductal Hyperplasia, Breast cancer risk, Biopsy, Mammogram, Women's health, breast health Sinhala, ADH Sinhala