诊断

通常在乳房 X 光检查或临床乳房检查中发现可疑区域并通过活检进行评估后发现乳腺不典型增生。活检时,医生将取出组织样本,并将样本送给经过专门训练的医生(病理学家)分析。组织样本将在显微镜下进行检查,病理学家会识别出存在的乳腺不典型增生。

要进一步评估乳腺不典型增生,医生可能建议通过手术取出较大的组织样本以检查是否有乳腺癌。诊断为乳腺不典型增生后,可能会需要进行手术活组织检查(局部扩大切除术或肿块切除术),以取出所有受累组织。病理学家将观察较大的标本,以寻找原位癌或侵入性癌症的证据。

治疗

治疗非典型增生通常采用手术切除异常细胞,同时确保该区域内不存在原位癌或侵入性癌症。医生通常会建议加强乳腺癌筛查以及通过药物治疗降低患乳腺癌的风险。

旨在监测乳腺癌的随访检查

医生可能建议每年进行检查,以筛查乳腺癌。这可能增加及早发现乳腺癌的机会,而此时治愈的可能性更大。请与医生讨论您的乳腺癌筛查选项。相应选项可能包括:

  • 进行乳房自我检查,提高乳房健康意识,让自己更加熟悉乳房的情况并能够发现任何异常的乳房变化
  • 每年接受医护人员进行的临床乳房检查
  • 每年进行乳房 X 光检查
  • 根据其他风险因素,例如密集乳房、患乳腺癌的家族史或存在乳腺癌的遗传易感性

降低患乳腺癌风险的方法

为了降低您患乳腺癌的风险,医生可能建议您:

  • 服用预防性用药。连续 5 年使用选择性雌激素受体调节剂,例如他莫昔芬或雷洛昔芬(Evista),或许可以降低患乳腺癌的风险。

    这类药物的工作原理是阻断乳腺组织中雌激素与雌激素受体的结合。雌激素被认为会促进某些乳腺癌的生长。

    他莫昔芬是唯一获准用于绝经前女性的药物。

    绝经后女性的另一个选择可能是芳香化酶抑制剂,例如依西美坦(Aromasin)和阿那曲唑(Arimidex),它们可以减少体内雌激素的分泌。

  • 避免采用绝经后激素治疗。研究人员已得出结论,治疗绝经期症状的激素联合疗法(雌激素加孕激素)会增加绝经后女性患乳腺癌的风险。许多乳腺癌的生长都依赖于激素。
  • 参加临床试验。临床试验旨在测试尚未向公众公开的新疗法,这些新疗法可能有助于降低与非典型增生相关的乳腺癌风险。请咨询医生您是否有资格参加任何临床试验。
  • 考虑能够降低风险的(预防性)乳房切除术。对于乳腺癌风险很高的女性,乳房切除术(切除一只或两只乳房的手术)可以降低将来患乳腺癌的风险。

    如果您携有某个发生了基因突变的乳腺癌基因,或者您有很严重的乳腺癌家族史表明您可能出现这种基因突变,您可能会被认为有很高的乳腺癌风险。

    但是这种手术并非适合所有人。根据您的个人情况,与您的医生讨论这种用于降低风险的手术有哪些风险、益处和局限性。

    如果您有严重的乳腺癌家族史,请遗传咨询师评估您携有基因突变的风险以及基因检测对您的作用,可能对您有所帮助。

Follow-up tests to monitor for breast cancer

Your doctor may recommend that you undergo tests to screen for breast cancer. This may increase the chance that breast cancer is detected early, when a cure is more likely. Talk about your breast cancer screening options with your doctor. Your options may include:

  • Self-exams for breast awareness in order to develop breast familiarity and to detect any unusual breast changes
  • Clinical breast exams by your health care provider annually
  • Screening mammograms annually
  • Additional breast cancer screening tests, such as breast MRI or molecular breast imaging, based on your other risk factors for breast cancer

Ways to reduce your risk of breast cancer

To reduce your risk of developing breast cancer, your doctor may recommend that you:

  • Take preventive medications. Treatment with a selective estrogen receptor modulator, such as tamoxifen or raloxifene (Evista), for five years may reduce the risk of breast cancer.

    These drugs work by blocking estrogen from binding to estrogen receptors in breast tissue. Estrogen is thought to fuel the growth of some breast cancers.

    Tamoxifen is the only drug approved for use in premenopausal women.

    Another option for postmenopausal women may be aromatase inhibitors, such as exemestane (Aromasin) and anastrozole (Arimidex), which decrease production of estrogen in the body.

  • Avoid menopausal hormone therapy. Researchers have concluded that combination hormone therapy to treat symptoms of menopause — estrogen plus progestin — increases breast cancer risk after menopause. Many breast cancers depend on hormones for growth.
  • Participate in a clinical trial. Clinical trials test new treatments not yet available to the public at large that may prove helpful in reducing breast cancer risk associated with atypical hyperplasia. Ask your doctor if you're a candidate for any clinical trials.
  • Consider risk-reducing (prophylactic) mastectomy. If you have a very high risk of breast cancer, a risk-reducing mastectomy — surgery to remove one or both breasts — may be an option to reduce the risk of developing breast cancer in the future.

    You might be considered at very high risk of breast cancer if you have a genetic mutation in one of the breast cancer genes or you have a very strong family history of breast cancer that suggests a likelihood of having such a genetic mutation.

    But this surgery isn't right for everyone. Discuss with your doctor the risks, benefits and limitations of this risk-reducing surgery in light of your personal circumstances.

    If you have a strong family history of breast cancer, you might benefit from meeting with a genetic counselor to evaluate your risk of carrying a genetic mutation and the role of genetic testing in your situation.

  • Make healthy lifestyle choices. Make healthy choices in your daily life in order to reduce your risk of breast cancer. For instance, exercise most days of the week, maintain a healthy weight, don't smoke and limit the amount of alcohol you drink, if you choose to drink alcohol.

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临床试验

探索 Mayo Clinic 的研究 测试新的治疗、干预与检查方法,旨在预防、检测、治疗或控制这种疾病。

妥善处理与支持

确诊非典型性增生可能带来压力,因为它会增加患乳腺癌的风险。对结果的未知可能会使您担心自己的健康。

随着时间的推移,每个女性都会形成一套自己的方法以应对非典型性增生和愈增的乳腺癌患病风险。在找到应对方法之前,您不妨尝试:

  • 了解您个人患乳腺癌的风险。乳腺癌的风险统计数据可能令人崩溃而且恐惧。乳腺癌风险统计数据是通过跟踪许多非典型性增生的女性并监测其是否患有乳腺癌得到的。尽管这些统计数据可以使您了解自身的预后情况,但无法告诉您患乳腺癌的风险。

    请医生解释您个人患乳腺癌的风险。了解您个人患乳腺癌的风险后,您就可以更放心做出治疗相关的决定。

  • 去参加所有的随访。如果您确诊非典型性增生,您的医生可能建议您更频繁地进行乳腺癌筛查和检测。在每次检查前,您可能发现自己心神不宁,因为您害怕医生会发现乳腺癌。

    不要因恐惧而拒绝前去就诊。相反,恐惧是一种正常现象,接受恐惧并找到应对方法。放松心情,在日记中写下您的感受,或与一位让您精神振奋的好友共度时光。

  • 保持健康。选择健康的生活方式以保持健康。例如,保持健康的体重,选择富含果蔬的健康饮食,获得充足睡眠以保证醒来时精力充沛,并限制饮酒(如果饮酒的话)。

    您无法控制自己是否会患有乳腺癌,但您可以保持健康,以便在需要时可以接受乳腺癌治疗。

  • 与相同处境的其他女性交谈。与其非典型性增生女性患者交谈。向医生咨询您所在社区的互助团体。

    其他选择包括在线留言板。乳腺癌组织(例如 BreastCancer.org)为乳腺癌高危女性提供了信息交流平台,可供她们互相交流。

准备您的预约

如果乳房 X 光检查显示您的乳房存在可疑区域,医生可能会将您转诊给乳房健康专科医生或专业的乳房中心。

您可以做什么

由于就诊时间可能很短,而且往往会涉及到很多方面,因此最好做好充分准备。为就诊做准备,请尝试:

  • 了解就诊前是否有任何限制规定。当您预约时,一定要询问是否需要提前做好准备,例如限制饮食。
  • 写下您目前出现的所有症状,包括那些看起来与您安排本次预约无关的任何症状。
  • 写下关键的个人信息,包括任何主要压力或近期生活变化。
  • 列出您正在服用的所有药物、维生素或补充剂。
  • 考虑让家人或朋友陪同就诊。有时很难记住就诊期间提供给您的所有信息。陪同者可能会记住您所遗漏或忘记的一些事项。

要问的问题

由于您和医生交谈的时间有限,请提前准备好问题清单。请按照重要性从高到低的顺序列出问题,以免时间不够。关于非典型增生,要向医生咨询的一些基本问题包括:

  • 能请您给我解释一下我的病理报告吗?
  • 我是否需要做更多检查?
  • 我需要做非典型增生手术吗?
  • 是否有药物可以降低我患乳腺癌的风险?
  • 我要怎么做才能降低患乳腺癌的风险?
  • 我应该注意乳腺癌的哪些症状和体征?
  • 我应该多久接受一次乳房 X 光检查来筛查乳腺癌?
  • 我是否还应该做磁共振成像来筛查乳腺癌?
  • 对于和我处于相同状况的朋友或家人,您有什么建议?
  • 我需要遵守哪些限制规定?
  • 我应该去看乳房健康专科医生吗?治疗费用是多少,我的保险能报销吗?
  • 我要考虑基因咨询吗?
  • 是否有我可以带走的手册或其他印刷材料?您建议哪些网站?

除了您准备咨询医生的问题外,就诊期间还可以随时提出您想到的其他问题。

医生可能做些什么

医生可能会问一些问题。请做好回答这些问题的准备,这样有利于更好地安排时间,去详细了解您所关注的任何方面。医生可能会问:

  • 您是否有乳腺癌家族史?
  • 您是否有其他癌症家族史?
  • 您以前做过乳腺活检吗?您知道以前的乳腺活检结果吗?

What you can do

Because appointments can be brief, and because there's a lot of information to discuss, it's a good idea to be prepared. To prepare for your appointment, try to:

  • Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
  • Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Write down key personal information, including any major stresses or recent life changes.
  • Make a list of all medications, vitamins or supplements that you're taking.
  • Consider taking a family member or friend along. Sometimes it can be difficult to absorb all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.

Questions to ask

Your time with your doctor is limited, so prepare a list of questions ahead of time. List your questions from most important to least important in case time runs out. For atypical hyperplasia, some basic questions to ask your doctor include:

  • Can you explain my pathology report to me?
  • Do I need more tests?
  • Will I need surgery for atypical hyperplasia?
  • Are there medications I can take to lower my risk of breast cancer?
  • What can I do to reduce my risk of breast cancer?
  • What signs or symptoms of breast cancer should I watch for?
  • How often should I have a mammogram to screen for breast cancer?
  • Should I also have an MRI to screen for breast cancer?
  • What would you recommend to a friend or family member in my situation?
  • Are there any restrictions that I need to follow?
  • Should I see a breast health specialist? What will that cost, and will my insurance cover it?
  • Should I consider genetic counseling?
  • Are there any brochures or other printed material that I can take with me? What websites do you recommend?

In addition to the questions that you've prepared, don't hesitate to ask other questions that come to mind during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time later to cover other points you want to address. Your doctor may ask:

  • Do you have a family history of breast cancer?
  • Do you have a family history of other types of cancer?
  • Have you had a breast biopsy before? Do you know the results of previous breast biopsies?
June 23, 2022
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  2. AskMayoExpert. Atypical hyperplasia of the breast. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2014.
  3. Degnim AC, et al. Stratification of breast cancer risk in women with atypia: A Mayo cohort study. Journal of Clinical Oncology. 2007;25:2671.
  4. Breast cancer risk reduction. Fort Washington, Pa.: National Comprehensive Cancer Network. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed Aug. 21, 2014.
  5. Breast cancer screening and diagnosis. Fort Washington, Pa.: National Comprehensive Cancer Network. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed Aug. 21, 2014.
  6. Pruthi S (expert opinion). Mayo Clinic, Rochester, Minn. Sept. 6, 2014.
  7. Hartmann LC, et al. Atypical hyperplasia of the breast — Risk assessment and management options. New England Journal of Medicine. 2015;372:78.
  8. Hartmann LC, et al. Understanding the premalignant potential of atypical hyperplasia through its natural history: A longitudinal cohort study. Cancer Prevention Research. 2014;7:211.