Lobular Carcinoma (in situ) or LCIS
What is lobular carcinoma in situ?
LCIS or lobular carcinoma in situ describes a situation where abnormal tissue growth is discovered within the milk glands or ‘lobules‘ of the breast. Anatomically speaking, milk is produced deep in the breast lobules, then transported via the breast ducts to the nipple. With LCIS the abnormal cells have not yet infiltrated to the breast ducts.
Lobular carcinoma in situ is not considered a precursor of cancer, but rather a true marker of present cancer. LCIS is not that common, comprising only 1-6% of all breast carcinomas. If and when the carcinoma infiltrates to other areas of the breast or perhaps other areas of the body, it is termed Invasive lobular carcinoma, which accounts for approximately 10-15% of all breast cancers.
I just want to let you know that I have created a newer version of this page with more up-to-date information on LCIS, because well… this page is getting a little bit out-dated. But don’t get me wrong, I would still use it.
How is LCIS discovered?
Lobular carcinoma is often discovered serendipitously, as it usually does not show on screening mammograms. Typically it is discovered through a biopsy done for some other reason, such as an abnormal mammogram or suspicious breast lump. LCIS most commonly occurs in one breast, but it is estimated that approximately 1/3 of patients will develop lobular carcinoma in both breasts.
Unlike DCIS, LCIS is not associated with the development of microcalcifications. Once detected, the physician will likely advise a number of additional tests, including biopsies and MRI scans, but also PET and CT scans. This is because lobular carcinoma is known to spread to other parts of the body such as bone and lung tissue.
The image below shows a proliferation of cancer cells occuring within the terminal duct lobular unit (or TDLU) of a breast lobule. The malignant cells are small and regular, creating distended acini (berry-like bulges) in the terminal lobule. The TDLU is the entity most likely to change when breast cancer evolves from a benign to malignant state.
What is the increased risk of invasive breast cancer?
There is no question that the presense of lobular carcinoma in situ confers a substantially higher risk for developing invasive breast cancer, approximately 7-9 times that of unaffected women. LCIS is thought to carry a 10-20% lifetime risk for developing breast cancer, but is very unlikely to develop during the first five years following diagnosis.
It is estimated that 20%-30% of LCIS will develop into an infiltrating carcinoma, and of these there is an approximate 50/50 split between ductal and lobular presentations. LCIS can spread to either breast, but recent studies suggest that cancer growth on the ipsilateral (same-side) breast is more likely than the contralateral breast, with incidence rates of approximately 30% and 15% respectively. If the cancer has spread to the bones, liver, or lungs, five year survival rates are significantly lower.
Overall, LCIS is thought to confer a annual percentage risk increase of 1% for developing invasive breast cancer. Fortunately, early detection presents many good options for prevention and treatment.
Cause and frequency of lobular carcinoma
Less is known about increased risk factors for lobular carcinoma than for ductal carcinoma. No specific genes such as the BRCA1 and BRCA2 variants have been directly linked to LCIS. Likewise there is no clear association between family history, hormonal exposure, or environmental factors and LCIS. Nonetheless lobular carcinoma is the second most common form of breast cancer, with an incidence rate ranging from 6-15% of all breast cancers.
Treatment and followup options
Once a diagnosis of LCIS is confirmed, a physician will likely recommend a range of scans and biopsies to ascertain the extent and aggressiveness of the carcinoma. Most certainly, a women should have annual breast examinations and mammograms in order to detect the emergence of invasive breast cancer as early as possible.
The discovery of lobular carcinoma in situ marks the beginning of a long term and stressful management plan for the disease. It is important to establish a good support network and open and frequent communication with the primary physician. Depending upon personal high-risk factors, preventive surgery (mastectomy) might be an option. It is best to take time to evaluate all the pros and cons, as there are many treatment options for LCIS.
Below are a bunch of Q&A…
- What is the meaning of lobular carcinoma in situ? LCIS is an uncommon condition in which abnormal cells form in the lobules or milk glands in the breast. LCIS is not cancer, but being diagnosed with LCIS indicates that you have an increased risk of developing breast cancer.
- What are the symptoms associated with lobular carcinoma in situ? LCIS doesn’t cause any signs nor symptoms. Rather, your doctor might discover incidentally that you have LCIS. For example, after a biopsy to asses a breast lump or an abnormal area, such as microcalcifications, found on a mammogram.
- When should I see a doctor? Make an appointment with your doctor if you notice a change in your breast, such as a lump, an area of puckered or otherwise unusual skin, a thickened region underneath the skin, or nipple discharge. Ask your doctor when you should consider breast cancer screening as well as how often should it be repeated. Most groups recommend routine screening beginning in your 40’s. Talk with your doctor about what’s right for you.
- What causes lobular carcinoma in situ? It’s not clear what causes LCIS.
- How does lobular carcinoma in situ start? LCIS begins when cells in a milk-producing gland, known as a lobule, of a breast develop genetic mutations that cause the cells to appear abnormal. The abnormal cells remain in the lobule and don’t extend into, or invade, nearby breast tissue.
- What is the percentage of risk for developing lobular carcinoma in situ? The risk of breast cancer in women diagnosed with LCIS is thought to be approximately 20%. Your individual risk of breast cancer is based on many factors. Talk to your doctor to better understand your personal risk of breast cancer.
- What are the risk factors? You have a family history of breast cancer, you’ve taken hormone replacement therapy for menopause, and if your a women in your early 40’s.
- What can you do to prepare for your appointment? A few simple things you can do to be prepared for your doctor’s appointment would be to write down any symptoms you may be experiencing, write down your medical history, note any family history of breast cancer or any other type of cancer as well, and make a list of your medications.
- What are the tests and diagnoses of lobular carcinoma in situ? LCIS may be present in one or both breasts, but it usually isn’t visible on a mammogram. The condition is most often diagnosed as an incidental finding when you have a biopsy done to evaluate some other area of concern in your breast. Types of breast biopsy that may be used include fine-needle aspiration, core needle, or surgical.
- How is lobular carcinoma in situ treated? There are three main approaches to treatment, these include careful observation, taking a medication to reduce cancer risk (chemoprevention), and/or surgery. If you’ve been diagnosed with LCIS, your doctor may recommend more frequent exams to closely monitor your breasts or signs of cancer, these may include frequent self-exams, clinical breast exams, screening mammograms, or other imaging techniques such as MRI. Two selective estrogen receptor modulator (SERM) drugs are approved to reduce the risk of invasive breast cancer, these medications may be tamoxifen or raloxifene. You could also consider participating in a clinical trial as well, to explore an emerging therapy for preventing breast cancer.
- What are a few lifestyle and home remedies? If your worried about your risk of breast cancer, steps to reduce your risk may be drinking alcohol in moderation (if at all), exercise most days of the week, and maintain a healthy weight.
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