LCIS - Lobular Carcinoma In Situ

/Home/b. About Breast Cancer/Breast Cancer Types/Non-Invasive Breast Cancer/Lobular Carcinoma In Situ (LCIS)

LCIS - Lobular Carcinoma In Situ

Lobular carcinoma in situ (LCIS) is an area (or areas) of abnormal cell growth that increases a person’s risk of developing invasive breast cancer later on in life. Lobular means that the abnormal cells start growing in the lobules, the milk-producing glands at the end of breast ducts. Carcinoma refers to any cancer that begins in the skin or other tissues that cover internal organs — such as breast tissue. In situ or “in its original place” means that the abnormal growth remains inside the lobule and does not spread to surrounding tissues. People diagnosed with LCIS tend to have more than one lobule affected.

Despite the fact that its name includes the term “carcinoma,” LCIS is not a true breast cancer. Rather, LCIS is an indication that a person is at higher-than-average risk for getting breast cancer at some point in the future. For this reason, some experts prefer the term “lobular neoplasia” instead of “lobular carcinoma.” A neoplasia is a collection of abnormal cells.

LCIS is usually diagnosed before menopause, most often between the ages of 40 and 50. Less than 10% of women diagnosed with LCIS have already gone through menopause. LCIS is extremely uncommon in men.

LCIS is viewed as an uncommon condition, but we don’t know exactly how many people are affected. That’s because LCIS does not cause symptoms and usually does not show up on a mammogram. It tends to be diagnosed as a result of a biopsy performed on the breast for some other reason.

LCIS and Breast Cancer Risk

People with LCIS are considered to be at higher-than-average risk of developing invasive breast cancer over the next few decades of their lives. This is why doctors sometimes say that LCIS is a “marker” for increased breast cancer risk. The cancer can be either an invasive ductal carcinoma (cancer that starts in the duct and spreads beyond it) or an invasive lobular carcinoma (cancer that starts in the lobule and spreads beyond it). The invasive carcinoma may or may not develop from the original areas of LCIS that were found, and it can develop in either breast. Invasive ductal carcinoma is actually more common after LCIS than invasive lobular carcinoma is.

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, versus 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.

If a woman with LCIS develops an invasive breast cancer, it doesn’t typically happen within a few years. Rather, it is more likely to happen over the long-term — in 10, 15, or 20 years or even beyond that. A woman with LCIS is considered to be at elevated risk for developing breast cancer for the rest of her life.

Symptoms and Diagnosis of LCIS

It is difficult to detect LCIS on your own. Doctors usually find LCIS through an abnormal mammogram and a biopsy.

Symptoms of LCIS
LCIS usually does not cause any signs or symptoms, such as a lump or other visible changes to the breast. LCIS may not always show up on a screening mammogram. One reason is that LCIS often lacks microcalcifications, the tiny specks of calcium that form within other types of breast cancer cells. On a mammogram, microcalcifications show up as white specks. It’s believed that many cases of LCIS simply go undiagnosed, and they may never cause any problems.

Diagnosing LCIS
LCIS 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 biopsy procedures may include the following:

Fine needle aspiration biopsy: A very small, hollow needle is inserted into the breast. A sample of cells is removed and examined under the microscope. This method leaves no scars.
Core needle biopsy: A larger needle is inserted to remove several bigger samples of tissue from the area that looks suspicious. In order to get the core needle through the skin, the surgeon must make a tiny incision. This leaves a very tiny scar that is barely visible after a few weeks.
Incisional biopsy: Incisional biopsy removes a small piece of tissue for examination.
Excisional biopsy: Excisional biopsy attempts to remove the entire suspicious lump of tissue from the breast.
To the pathologist looking at the sample under the microscope, LCIS can look very much like ductal carcinoma in situ, or DCIS (cancer that is limited to the breast duct) — especially low-grade, solid DCIS. Unlike LCIS, DCIS is considered to be cancer and does require treatment with surgery and often radiation therapy. So you may want to ask why the pathologist has determined that you have LCIS rather than DCIS. You might also want to seek a second opinion from a pathologist at a different hospital.

In more than half of cases, LCIS is “multifocal,” meaning that multiple lobules have areas of abnormal cell growth inside them. In about one-third of women with LCIS, the other breast is affected as well.

Even though LCIS is not really breast cancer, you may hear your doctor describe it as “Stage 0.” The breast cancer staging system is used to describe how far cancer has spread beyond the site of the original tumor. Both LCIS and DCIS are considered Stage 0, the earliest stage possible.

Treatment for LCIS

LCIS does not require treatment in the way you might normally think of cancer treatment, such as needing to have surgery, radiation therapy, and chemotherapy. You and your doctor may decide that you should undergo careful observation to watch for any signs of invasive breast cancer. You also may decide to use strategies to reduce your risk of breast cancer in the future, such as medications or surgery.

Careful observation means sticking to a schedule of breast exams and screenings agreed upon by you and your doctor. The goal is to watch for signs of invasive breast cancer — and if signs do become evident, to act on them early. Your schedule may include the following:
frequent breast self-exams to become familiar with your breasts and detect any unusual breast changes. Ask your doctor to show you the correct technique and how often you should examine your own breasts.
clinical breast exams (manual exams performed by your doctor) at least twice a year
screening mammograms every year
possibly other imaging techniques, such as magnetic resonance imaging (MRI), if you have other risk factors for breast cancer and/or a strong family history of the disease
Medications such as tamoxifen or Evista (chemical name: raloxifene) have been shown to reduce breast cancer risk. LCIS is usually hormone receptor-positive, meaning that estrogen and/or progesterone fuels the growth of the abnormal cells. If you decide to use medication to manage your risk of breast cancer, you are likely to use tamoxifen or Evista.

If you are premenopausal, your doctor is likely to recommend that you take tamoxifen, a medication that blocks estrogen from attaching to the cells and signaling them to grow. Tamoxifen works to reduce the risk of an invasive breast cancer from developing in the future. A large clinical trial called The Breast Cancer Prevention Trial found that women with LCIS who took tamoxifen for 5 years reduced their risk of invasive breast cancer by 46%.

If you’ve already been through menopause, your doctor may suggest Evista (chemical name: raloxifene), another medication that blocks estrogen’s effects on breast tissue. A large clinical trial known as the Study of Tamoxifen and Raloxifene (or STAR trial) showed that raloxifene was as effective as tamoxifen in reducing the risk of invasive cancer in postmenopausal women with LCIS.
Risk-reducing surgery, also called prophylactic mastectomy, is the removal of both breasts to reduce the risk of breast cancer ever developing. If you have other risk factors for breast cancer besides LCIS, such as a BRCA1 or BRCA2 mutation or a strong family history of the disease, you and your doctor might discuss this option. Prophylactic mastectomy would involve both breasts because LCIS, like these other risk factors, increases the risk of developing cancer in both breasts.

Keep in mind that LCIS is not an immediate threat to your health. You have the time to consult with your doctor and weigh all the pros and cons of risk-reducing surgery.
Yet another option is to take part in a clinical trial that is testing a new approach to reducing the risk of breast cancer. You can talk with your doctor about any clinical trials that may be available in your area.

Follow-up Care for LCIS

You and your doctor will work together to develop a schedule of follow-up visits. Your schedule may include a physical exam with your doctor every 6 to 12 months, as well as a mammogram and/or another imaging study every 12 months.

If you are taking tamoxifen, you should have a physical exam and have your medical history taken by a gynecologist every year, because this medication can increase the risk of cancer of the uterus. Any unusual symptoms, such as abnormal bleeding, should be reported immediately to your doctor. (If you have had your uterus removed, this recommendation does not apply to you.)