A 45-year-old woman is found on routine mammography to have microcalcifications. Biopsy reveals atypical ductal hyperplasia (ADH). Compared to women without ADH, her relative risk of developing invasive breast cancer is approximately:
- A 4-5-fold increase in risk ✓
- B 1.5-fold (same as fibrocystic change without atypia)
- C 10-fold increase, equivalent to DCIS
- D No increased risk as ADH is a reactive process
Correct answer: A. 4-5-fold increase in risk
Explanation
Atypical ductal hyperplasia (ADH) confers a 4-5 fold relative risk of invasive breast carcinoma (both breasts), increased to 8-10 fold if there is also a first-degree family history. ADH shares morphological and molecular features with low-grade DCIS but by definition involves less than 2 duct spaces or is less than 2 mm. Fibrocystic change without atypia carries no increased risk (or <1.5x). DCIS itself carries ~8-10x risk if left untreated.
Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.