Benign breast disease is often diagnosed through biopsy performed as a result of concerning mammographic or palpable findings. More than 1 million US women undergo breast biopsies annually due to these concerns, with >70% of the results revealing benign disease.1 However, not all benign breast biopsies are equal, and certain lesions confer an increased risk for breast cancer. Specifically, lesions with atypical hyperplasia (AH) and lobular carcinoma in situ (LCIS) have been shown to be associated with a higher risk for future breast cancer and to be precursors in breast carcinogenesis.2–5 Recent data have also shown a high cumulative breast cancer incidence of 30% at 25 years of follow-up in women with AH.3
Management of these high-risk lesions is essential in breast cancer prevention. This review discusses the clinical presentation and histologic diagnosis of AH and LCIS, and examines the risk for invasive breast cancer associated with and management of these lesions, including surgical excision, surveillance, and risk-reduction therapy.
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