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Atypical Ductal Hyperplasia (ADH)

What is atypical ductal hyperplasia?

Atypical ductal hyperplasia (ADH) is not a form of breast cancer. Rather, it is a marker for women who may have a risk factor for developing breast cancer in the future. If you have a biopsy that shows atypical ductal hyperplasia in one of your breasts, your doctor will want to follow your breast health very carefully.

Armed with this knowledge, you will want to choose a comprehensive breast center. At the Johns Hopkins Breast Center, our team of breast cancer specialists is recognized for their expertise in evaluating and treating breast cancer. Further, our team of nurses, navigators and survivor volunteers are passionately committed to preventing, fighting and treating breast cancer.

Women with ADH should never undergo a voluntary preventative/prophylactic mastectomy. Our physicians and staff are specially trained to help women understand ADH and what their risks may be for developing breast cancer.

How is a diagnosis made for atypical ductal hyperplasia?

After a core breast biopsy, an analysis will confirm the presence of atypical ductal hyperplasia cells in the breast tissue. There is no way to determine the presence of ADH by reviewing a mammogram or other breast imaging study. It also cannot be felt on a clinical breast exam. If ADH cells are found on a core biopsy, an excisional open breast biopsy is often recommended so more tissue can be examined to look for an associated breast cancer. 

What can I do if I'm diagnosed with atypical ductal hyperplasia?

First, there is no need to panic. If the pathology findings are limited to atypical ductal hyperplasia, you do not have breast cancer – but you do have an increased risk of developing it in the future. Not all ADH cells need to be removed, but your doctor should be aware of the findings. The most important thing to do now is find a breast center where your breast health can be closely monitored.

Women with a diagnosis of ADH alone should not need to undergo a voluntary mastectomy. The risk of developing breast cancer is higher than it is in the average population, but most women just need to be closely monitored. Some can even take medication, such as Tamoxifen, to reduce the risk of developing breast cancer.

Our physicians and staff are specially trained to help women understand ADH and their risks for developing breast cancer. If a woman has ADH cells found on biopsy, as well as other risk factors for breast cancer, further evaluation can be done to calculate her risk of one day developing breast cancer and the appropriate preventative steps can be recommended. This may include lifestyle changes, medications or surgery.

At the Johns Hopkins Breast Center, many of our patients with ADH benefit by joining our high-risk clinic program, the Johns Hopkins Breast and Ovarian Surveillance Service (BOSS). The program focuses on ways to reduce the risk of developing breast cancer and gives women tools to manage the knowledge that they are at higher risk. A medical oncologist can assess your overall risk and recommend ways to reduce risk in the future, such as hormonal therapy for breast cancer prevention.