Women with atypical ductal hyperplasia, atypical lobular hyperplasia, or lobular carcinoma in situ carry a higher breast cancer risk, and many clinicians aren’t sure how to manage it. Dr. Sabrina Sahni, trained in both women’s health and medical breast medicine, shows how to stratify risk in these patients and what the evidence supports for reducing it. She then takes up conjugated estrogens/bazedoxifene (CEE/BZA) for patients with these lesions who also have menopausal symptoms: where it fits and what is known about its breast effects. She also covers how to lay out the options in a shared decision-making conversation.

Sabrina Sahni, MD, MSCP, is a board-certified family medicine physician and Menopause Society Certified Practitioner with dual fellowship training in Specialized Women's Health and Medical Breast — both completed at the Cleveland Clinic. Her clinical practice focuses on the intersection of menopause management and breast health, with particular expertise in hormone therapy counseling for women at elevated breast cancer risk, breast cancer risk assessment, benign breast disease, and survivorship care. Dr. Sahni has authored peer-reviewed publications on hormone therapy in women with benign breast disease, menopausal hormone therapy in older women, and non-hormonal management of vasomotor symptoms, and is an active member of The Menopause Society, the International Society for the Study of Women's Sexual Health, and the National Consortium of Breast Centers. Her rare combination of menopause and breast medicine subspecialty training positions her as a uniquely qualified voice on one of clinical women's health's most consequential — and most frequently mishandled — counseling challenges.