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Atypical Ductal Hyperplasia
Anilemys Paneca
Florida National University
Advanced Primary Care of Family
Professor: Jorge Brito
November 17, 2022
Biopsies of the breast performed for palpable or mammographic evaluations always reveal findings that are benign in nature. Over one million breast biopsies performed in the United States of America every year always have benign conditions. One of the benign conditions revealed by biopsy findings is a typical hyperplasia. Even though a typical hyperplasia is not a cancerous situation, it is a high-risk factor that predisposes women to the occurrence of cancer in the breast. Atypical hyperplasia falls in the category of a high-risk benign lesion (Danforth, 2018). 10% of the annual biopsies performed in the United States of America have been found to have the condition. The existence of benign lesions is highly linked to the future occurrence of cancer. Both ductal and lobular hyperplasia occur with frequencies that are almost similar and have similar risks of causing cancer of the breast (Kader et al., 2018).
Atypical ductal hyperplasia has features that entail distention and filling of the ducts that form micropapillary due to the formation of complex architectural patterns. With the proliferation of the monotonous cells in patterns that are complex in nature, atypical ductal hyperplasia has the probability of 8 out 10 possibilities of causing cancer in future. 25 years after biopsy 30% of patients have a high chance of attracting breast cancer that can either be regarded as invasive or situ due to the presence of atypical ductal hyperplasia (Tomlinson-Hansen, Khan, & Cassaro, 2022). While the occurrence of atypical ductal hyperplasia has been linked to higher chances of breast occurrence in menopausal stages, the purpose of this study is to explore the effect of hormonal replacement therapies versus the decision not to apply an intervention. Hormonal therapies have been associated with increased cases of breast cancer in post-menopausal women. The situation however, creates a serious debate as to what is best option between hormonal therapy versus no intervention. From the perspective of effects, hormonal replacement therapy is much better as compared to no intervention. Even though there exist studies that link hormonal replacement therapies with cancer, the risk of cancer is very low. Secondly post-menopausal patients require hormonal replacement therapy for crucial medical purposes.
PICOT
Patient: Post-menopausal women with atypical ductal hyperplasia
Intervention: Hormonal replacement therapy
Comparison: No intervention
Outcome: Influencing the morbidity and mortality of breast cancer
Time: Within one year
Atypical ductal hyperplasia has been linked to the occurrence of cancer in post-menopausal women. Even through atypical ductal hyperplasia is not cancerous neither does it cause cancer, it has a high risk that is associated with the occurrence of cancer in the identified population. A critical point of comparison exists between an intervention to the condition with hormonal replacement therapy which may increase chances of cancer occurrence versus no intervention which may influence the morbidity and mortality of cancer in the breast. The position of the current paper is that hormonal replacement therapy is better off than no intervention given a time period of one year of use. The use of hormonal replacement therapy for a period of one year does not increase the chance of cancer occurrence (Tomlinson-Hansen, Khan, & Cassaro, 2022).
The Vulnerable Population
The post-menopausal women who are the vulnerable population require hormonal replacement therapy not primarily for atypical ductal hyperplasia, but critical health conditions. HRT is indicated for use by the vulnerable population for the treatment of vaginal dryness, sleeping disturbances, and hot flashes. HRT serves the purpose of replacing the hormonal activities of estrogen, which declines in levels as women reach the menopause stage. Additionally, hormonal replacement therapy HRT help post-menopausal women maintain the mineral content and strength of body bones.
Post-menopausal women with a family history of breast cancer are likely to develop cancerous conditions in the sections of the breast that have atypical duct hyperplasia. Genetic risk factors for breast cancer account for about of 10% of hereditary cancer cases. The risk of cancer occurrence is estimated to take place between 5 years or more after diagnosis of atypical duct hyperplasia. The condition does not have recognizable symptoms. The risk of the condition, however, increases with the advancement in age. History of cancer in a family or patient cancer history before and after menopause is another condition that affect the vulnerability of the population to breast cancer.
Literature Review
The use of hormonal replacement therapy in post-menopausal women with atypical ductal hyperplasia remain a controversial subject. Saul et al. (2022) in their article explored the risk factors associated with HRT use in breast cancer. The authors assert that the risk of HRT use to breast cancer are reasonably low. The authors in their article underscore the other factors such as duration of use of HRT, diabetes, and metabolic condition of a patient. Even though the article does not address the issue of atypical ductal hyperplasia as factor that influences breast cancer, the authors postulate that HRT has no cancerous effects if used for a period not exceeding one year (Saul et al., 2022).
While Saul et al. (2022) Try to dissociate HRT with the risk of cancer in post-menopausal women with atypical ductal hyperplasia, Perkins, Louw-du Toit and Africander (2018) not only link HRT to increase risk of breast cancer, but also include other conditions such as stroke and heart disease. Despite the fact that Perkins, Louw-du Toit and Africander (2018) tie HRT to risk of cancer in post-menopause women, their study did not take into account the existence of atypical ductal hyperplasia as preexisting condition.
Vinogradova et al. (2020) in their study accommodates the fact that there is some risk of cancer occurrence with use of HRT but brings in a different element of study that entails comparing HRT use in different combinations. The study reveal that long-term use of HRT has a chance of causing cancer when the hormones involved are progestogens, norethisterone, medyprogosterone, and levonorgestrel. The study also indicates that risk of cancer declines with the discontinuation of treatment. The authors claim that their study confirm that there is high risk associated with cancer with the long-term use of estrogen that is administered solely and increased with long term use when both progestogen and estrogen are combined.
Unlike Vinogradova et al. (2020) in their article who advocate the for use of estrogen and other hormonal combinations in reducing the risk of cancer, Crew et al. (2017) does not fully support the use of estrogen in validating the efficacy of HRT in reducing cancer occurrence. Crew et al. (2017) advocate for the use of aromatase and tamoxifen. According to their study, the authors tie aromatase and tamoxifen with a reduced risk of cancer that ranges between 50% to 65%. Their article identifies possible factors that could be blamed for the low uptake of these combinations of medicine that include lack of awareness of breast cancer in the vulnerable population.
Thorat and Cuzick, (2017) emphasize the use of endocrine therapy as a preventive measure to reduce the risk of breast cancer in post-menopausal women. The article compares the efficacy of two approaches based on the results of different studies. In a study in which particular modulators of estrogen were used, the efficacy to reduce the risk of cancer was established at 38%. However, in a study in which aromatase inhibitors were used, the efficacy to reduce the risk of cancer was 53%. The results of the two studies support the position of other previous articles that the use of hormonal replacement therapies reduce the risk of cancer.
Chen et al. (2018) assert that menopausal hormone therapy is safe for women who are younger than 60 years or 10 years after the menopause stage. The authors in their article claim that patients in this stage that do not have contraindications for hormonal therapy such as coronary heart disease, cases of venous thromboembolic, stroke, and history of breast cancer respond well to both menopausal hormonal therapies. The authors in their study also link a combination of estrogen-progestin use with breast cancer after long-term use.
Proposal
The use of hormonal replacement therapy for post-menopausal women with atypical ductal hyperplasia is a critical point of medical concern. While the use of HRT in the vulnerable category of the patients has been linked to occurrence of cancer, it is evident that the risk of cancer is very low. The current study therefore proposes the use of HRT as compared to no intervention. HRT is essential for post-menopausal women in curing hot flush, dryness of the vagina, and maintaining bone strength (Kader et al., 2018). Therefore, despite the existence of some arguments that link HRT and cancer, it is the best option better than no intervention for post-menopausal patients.
The existence of atypical ductal hyperplasia does not imply the automatic occurrence of cancerous conditions in the breast. Additionally, atypical ductal hyperplasia is not cancer. The use of hormonal replacement therapies is therefore recommended for post-menopausal women in reducing the risk of cancer occurrence (Tomlinson-Hansen, Khan, & Cassaro, 2022). However, an advanced nurse should make sure that the patient does not use HRT for a period exceeding one year. Long term use is associated with increased risk of cancer. An advanced nurse should make sure that if HRT is used to replace hormonal roles that are not performed by hormones during the post-menopausal stage, alternative treatments should be prescribed after one year of HRT usage. Advanced nurse should also check for contraindications associated with HRT such as diabetes and coronary heart complication.
References
Danforth, D. N. (2018). Molecular profile of atypical hyperplasia of the breast. Breast Cancer Research and Treatment, 167(1), 9-29.
