Breast Cancer - Lobular carcinoma in situ (LCIS)

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Breast Cancer - Lobular carcinoma in situ (LCIS)

Definition
Lobular carcinoma in situ (LCIS) occurs within the lobules located at the end of the breast ducts. The term "in situ" means that the abnormal cells remain in place and don't spread beyond the lobule. LCIS is most often diagnosed in premenopausal women and found incidentally as a result of biopsies done for another reason, such as a suspicious breast lump or an abnormal mammogram. LCIS itself often doesn't show up on mammograms.

Most cancer experts don't consider lobular carcinoma in situ to be cancer. Rather, it's considered an area of abnormal tissue growth that signals an increased risk of developing invasive breast cancer later on. Best estimates put this risk at seven times — or more — that of the general population. The increased risk applies not only to the breast the LCIS is found in, but also to the other breast.

Researchers continue to explore whether in some cases lobular carcinoma in situ may actually be a preinvasive cancer, just like ductal carcinoma in situ.

Symptoms
You won't be able to detect anything unusual if you have lobular carcinoma in situ (LCIS). The condition isn't associated with any signs or symptoms. Rather, your doctor might discover that you have LCIS incidentally — for instance, after a biopsy to assess an abnormal area found on a mammogram.

Causes

Lobular carcinoma in situ (LCIS) is most frequently diagnosed in women in their 40s — about a decade earlier than ductal carcinoma in situ (DCIS) — but it can be diagnosed in older women, too. LCIS begins as an abnormal growth of cells in a milk-producing gland of the breast (lobule). The growth remains in place in the lobule and doesn't extend into nearby breast tissue. Having LCIS makes it more likely that you could one day develop invasive breast cancer.

Experts don't know if LCIS results from genetic mutations that occur during the course of your lifetime. Also, it's unclear whether there's an association between LCIS and a family history of breast cancer or environmental or hormonal exposures. So far, no specific genes, such as BRCA1 or BRCA2, have been linked to the development of LCIS.

When to seek medical advice
Since you won't notice any signs or symptoms that could indicate lobular carcinoma in situ, it's important to have regular checkups, including mammograms and clinical breast exams, to monitor your breast health.

And, of course, anytime you do notice a change in your breasts, such as a lump, an area of puckered or otherwise unusual skin, a thickened region under the skin, or a nipple discharge, contact your doctor to have it evaluated. Such breast changes could be indicators of more-serious problems, including breast cancer.

Tests and diagnosis
Lobular carcinoma in situ (LCIS) may be present in one or both breasts. The condition usually is diagnosed as an incidental finding when you have a biopsy done to evaluate some other area of concern in your breast. LCIS can be associated with microcalcifications — tiny deposits of calcium that may indicate the presence of cancer — seen on a mammogram, but often LCIS isn't detectable on mammograms. LCIS may be diagnosed even when there are no microcalcifications seen on a mammogram.

Sometimes, LCIS is discovered when a laboratory-based doctor (pathologist) analyzes a core needle biopsy — a group of small samples of breast tissue collected to test for signs of disease — done on a suspicious area in your breast.

LCIS may also be detected following surgical removal of a breast lump or area of thickening or during the analysis of breast tissue removed in the surgical treatment of invasive breast cancer.

Treatments and drugs
A number of factors, including your personal preferences, come into play when you decide whether to undergo treatment for lobular carcinoma in situ (LCIS). There are three main approaches to treatment: careful observation, taking a medication to reduce cancer risk (chemoprevention) or preventive surgery.

Observation
If you've been diagnosed with LCIS, it's unlikely you'll develop invasive breast cancer during the first five years after your diagnosis. So it may be reasonable to choose not to do anything other than closely monitor your breasts, including:

Frequent breast self-exams to develop breast familiarity and to detect any unusual breast changes
Clinical breast exams at least twice a year
Screening mammograms every year
Other imaging techniques, such as magnetic resonance imaging (MRI), if you have other risk factors and a strong family history of breast cancer
Chemoprevention
Treatment with tamoxifen (Nolvadex) is another option for LCIS. Tamoxifen blocks the action of estrogen — a hormone that fuels breast cancer and promotes tumor growth — to reduce your risk of developing invasive breast cancer. Tamoxifen can be used by both premenopausal and postmenopausal women. You can take tamoxifen for a total of five years, so planning when to take the drug is a key issue for you to discuss with your doctor.

Another chemoprevention agent that your doctor may consider is raloxifene (Evista), a drug approved to prevent and treat osteoporosis in postmenopausal women. Results from a recent study — the Study of Tamoxifen and Raloxifene (STAR) Trial — show raloxifene to be as effective as tamoxifen in reducing risk of invasive breast cancer in postmenopausal women.

Discuss with your doctor the risks and benefits of taking a drug for breast cancer prevention to see if it's the best course of treatment for you.

Preventive surgery
One other option for treating LCIS is preventive (prophylactic) mastectomy. This surgery removes both breasts — not just the breast affected with LCIS — to reduce your risk of developing invasive breast cancer. To obtain the best possible protective benefit from this surgery, both breasts are removed because LCIS increases your risk of developing breast cancer in either breast. Preventive surgery may be an option for you if you're at high risk of breast cancer based on your family history or a personal history of carrying a breast cancer-related genetic mutation. Surgery to treat LCIS isn't urgent, so take time to carefully weigh the pros and cons of preventive mastectomy with your doctor.

Clinical trials
If you have LCIS, you might consider participating in a clinical trial exploring an emerging therapy for preventing breast cancer. Your doctor can help you find out more about clinical trials looking for participants and help determine whether you'd be a candidate.