Lobular Carcinoma in situ (LCIS)

What is Lobular Carcinoma in situ?

Lobular Carcinoma in situ (LCIS) describes a situation where abnormal tissue growth occurs within the milk glands or lobules of the breast.

Anatomically speaking, milk is produced deep in the breast lobules, then the breast ducts transport the milk to the nipple. With LCIS, the abnormal cells have not yet infiltrated the breast ducts.

Lobular carcinoma in situ is not a precursor of cancer, but rather a true marker of present cancer. LCIS is not that common, comprising only 1% to 6% of all breast carcinomas.

If and when the carcinoma infiltrates to other areas of the breast, or perhaps other areas of the body, medics then term it, Invasive lobular carcinoma. This accounts for approximately 10% to 15% of all breast cancers.

I just want to let you know that I have a newer version of this page with more up-to-date information on LCIS. This is because, well … this page is getting a little bit old. But don’t get me wrong it is still great and I would still use it.

How is Lobular Carcinoma In Situ discovered?

Lobular carcinoma is often discovered by accident, as it usually does not show on screening mammograms. Typically, physicians discover LCIS 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 research studies estimate that approximately one third of patients will develop lobular carcinoma in both breasts.

Unlike ductal carcinoma in situ (DCIS), LCIS is not associated with the development of microcalcifications. Once doctors detect LCIS they will likely advise a number of additional tests, including:-

biopsies
MRI scans
PET scan
CT scan

This is because lobular carcinoma is known to spread to other parts of the body such as bone and lung tissue.

The image (above right) shows a proliferation of cancer cells occurring 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 increase in the risk of invasive breast cancer?

There is no question that the presence of lobular carcinoma in situ confers a substantially higher risk for developing invasive breast cancer. In fact LCIS increases the risk approximately 7 to 9 times that of a woman without LCIS.

Furthermore, lobular carcinoma in situ carries a 10% to 20% lifetime risk for developing breast cancer. However, LCIS is very unlikely to develop during the first five years following diagnosis.

Research studies estimate that 20% to 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 an 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 in situ

Less is known about the risk factors for lobular carcinoma than for ductal carcinoma. No specific genes, such as the BRCA1 and BRCA2 variants, have direct links 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% to 15% of all breast cancers.

Treatment and follow-up options

After your team confirm a diagnosis of LCIS, 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’s …

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 having a diagnosis of LCIS indicates that you have an increase in the risk of developing breast cancer.

What are the symptoms of lobular carcinoma in situ?

LCIS does not cause any signs or 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, on mammogram.

When should I see a doctor?

Make an appointment with your doctor if you notice any of the following including a:-

change in your breast
lump,
area of puckered or otherwise unusual skin
thickened region underneath the skin
nipple discharge

Ask your doctor how often you should have breast cancer screening and follow up. Most groups recommend routine screening beginning in your 40’s. Talk with your doctor about what is right for you.

What causes lobular carcinoma in situ?

It is not yet 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 do not 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 with a diagnosis of LCIS is approximately 20%. However, 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 for Lobular Carcinoma In-Situ?

Some of the risk factors for LCIS include:-

a family history of breast cancer
hormone replacement therapy (HRT) for menopause
Age: the early 40’s for women is the mean age for LCIS

What can you do to prepare for your appointment?

There are a few simple things you can do to prepare for your doctor’s appointment:-

write down any symptoms you may be experiencing
take your medical history
note your family history of breast cancer or any other type of cancer as well
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 is not visible on a mammogram. Physicians most often discover LCIS as an incidental finding when you have a biopsy done to evaluate some other area of concern in your breast.

Types of breast biopsy possibly necessary include:-

fine-needle aspiration
core needle biopsy
surgical excision

What is the Treatment for Lobular Carcinoma in Situ?

There are three main approaches to treatment, these include:-

careful observation and monitoring
medication to reduce cancer risk (chemoprevention)
breast cancer surgery

If you have a diagnosis of LCIS, your doctor may recommend more frequent exams to closely monitor your breasts for signs of cancer, these may include:-

frequent self-exams
clinical breast exams
screening mammograms
other imaging techniques such as MRI.

In addition, two selective estrogen receptor modulator (SERM) drugs may reduce the risk of invasive breast cancer. These medications are Tamoxifen or Raloxifene. You could also consider participating in a clinical trial as well, to explore any emerging, new 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), exercising most days of the week and maintaining a healthy weight.

References

Kumar V, Abbas AK, Fausto N. Robbins and Cotran Pathologic Basis of Disease. Seventh Edition. Philadephia: Elsevier Saunders, 2005, p. 1123.
Afonso N, Bouwman D (August 2008). “Lobular carcinoma in situ” Eur. J. Cancer Prev. 17 (4): 312–6.
Page DL, Schuyler PA, DuPont WD, Jensen RA, Plummer WD Jr, Simpson JF. Atypical lobular hyperplasia as a unilateral predictor of breast cancer risk: a retrospective cohort study. Lancet 361:125, 2003.
National Breast Cancer Centre. 2001. ‘Clinical practice guidelines for the management of early breast cancer:Second edition’. National Breast Cancer Centre, Camperdown,NSW
Hlawatsch A, Teifke A, Schmidt M, Thelen M. Preoperative Assessment of Breast Cancer: Sonography Versus MR Imaging. AJR 2002; 179:1493-1501
Liberman L, Morris EA, Kim CM, Kaplan JB, Abramson AF, Menell JH, Van Zee KJ, Dershaw DD. MR Imaging Findings in the Contralateral Breast of Women with Recently Diagnosed Breast Cancer. AJR 2003; 180:333-341.