Lobular Neoplasia
The term lobular neoplasia tends to suggest an early breast pre-cancer development, which is more of a ‘serious risk factor‘ that might eventually lead to a more ductal or lobular cancer in both breasts, rather than an imminent cancer threat. There are two typical kinds of lobular neoplasia; LCIS, and ALH, discussed below.
By way of background, milk is produced in the lobules of the breast, then passes through small ducts, ending at the nipple. Lobular Neoplasia indicates that new pre-cancer cell growth has been detected in a breast lobule.
Lobular Neoplasia, then, is a name given to a certain classification of breast abnormality based upon the location of ‘new cell growth‘ (neoplasia) , i.e. originating in the lobules of the breast.
A little bit more about lobular neoplasia is written here.
This page still has some pretty good information, but come check out our new page with more up-to-date information on Lobular Neoplasia.
LCIS
LCIS stands for ‘lobular carcinoma in situ‘. This is a very early diagnosis which indicates cancer is present in the breast lobule but has not yet spread past the epithelial lining. LCIS increases the risk for latent breast cancer development by approximately 7 to 12 times. The majority of breast cancers which develop following a diagnosis of LCIS occur after 15 years, with about 50% of invasive tumors actually originating in the milk ducts.
A woman with LCIS has approximately a 25% chance of breast cancer development later in life.
ALH
ALH stands for ‘atypical lobular hyperplasia‘ , which indicates a finding of unusual and ‘rapid growth‘ of cells within a breast nodule. Estimates are that ALH presents an increased risk of 4-6 times for eventual breast cancer development. However, ALH leads to subsequent carcinoma at a rate of only 10-20%.
Prognosis and treatment
Because of the low incidence rate, the tendency towards bilaterality, and long delay before the onset of invasive breast cancer, it is generally held that there no direct link between a finding of lobular neoplasia and malignant cancer.
Lobular neoplasia occurs in roughly .5% to 8% of breast biopsies. High-risk patients are often treated with chemoprophylactic agents such a tamoxifen or raloxifene. Tamoxifen is thought to reduce the risk of breast cancer development for an LCIS diagnosis by up to 56%.
Here are a few common Q&A…
- How greatly does having LCIS increase breast cancer risk? One estimate is that the lifetime risk of developing an invasive breast cancer is 30-40% for women with LCIS, vs a lifetime risk of 12.5% for the average woman. Another estimate suggests that an LCIS diagnosis increases breast cancer risk to 21% over the next 15 years.
- What are the LCIS risk factors? Depends on your age when lobular neoplasia is diagnosed, the extent of the lobular neoplasia (the risk is greater with LCIS than ALH), and having a significant family history of breast cancer.
- How is lobular neoplasia diagnosed? It can be difficult to diagnose because most women with lobular neoplasia have no symptoms. It is usually diagnosed after a biopsy is done on the breast for some other reason, such as an abnormal finding on a mammogram or a suspicious breast lump. These procedures may include fine need aspiration biopsy, core needle biopsy, incisional biopsy, or excisional biopsy.
- What are the treatment options for lobular neoplasia? Close monitoring (regular clinical exams, regular screening mammography, MRI, and monthly breast self-exams), hormone therapy medicines (such as tamoxifen, raloxifene, exemestane, and anastrozole have been shown to reduce breast cancer risk), and risk-reducing surgery (prophylactic mastectomy). Also, you may want to consider taking part in a clinical trial that is testing a new approach to reducing the risk of breast cancer.
References
- Dershaw DD. Does LCIS or ALH Without Other High-Risk Lesions Diagnosed on Core Biopsy Require Surgical Excision? The Breast Journal, Volume 9, Number 1, 2003 1-3.
- Cohen MA. Cancer Upgrade at Excisional Biopsy after Diagnosis of Atypical Lobular Hyperplasia or Lobular Carcinoma in Situ at Core-Needle Biopsy: Some Reasons Why. Radiology 2004; 231: 617-621.
- Lakhani SE. In Situ Lobular Neoplasia: time for an Awakening. Lancet 2003; 361: 96.
- Elsheikh TM, Silverman JF. Follow-up Surgical Excision is Indicated when Breast Core Needle Biopsies Show Atypical Lobular Hyperplasia or Lobular Carcinoma in Situ. Am. J. Surg. Pathol. Volume 29, Number 4, April 2005.
- Foster MC, Helvie MA, Gregory NE, Rebner M, Nees AV, Paramagul C. Radiology 2004; 231:31: 813-819.
- Page DL, Schuyler PA, Dupont WD et al. Atypical Lobular Hyperplasia as a Unilateral Predictor of Breast Cancer Risk: a Retrospective Cohort Study. Lancet 2003: 361: 125-129.
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