Written by : Dr.M.D.Mazumdar, MD
Treatment of Lobular Breast Carcinoma (LCIS) is somewhat controversial.
LCIS is not a carcinoma but a precancerous condition. Presence of LCIS indicates that the woman is at a higher risk of developing invasive lobular breast carcinoma (ILC) in later life. About 25% of women with LCIS will develop ILC.
While some doctors advocate removal of the lump by surgery due to the slight risk of invasive breast cancer, others say that active treatment is not necessary.
How to Manage Lobular Breast Carcinoma in Situ
Tamoxifen reduces the risk of developing breast cancer in both pre- and post-menopausal women who have been diagnosed with LCIS. Raloxifene (Evista) is approved for postmenopausal women.
Although Raloxifene is slightly less effective than Tamoxifen in reducing the risk of breast cancer, it has fewer harmful health effects. Tamoxifen can increase the risk of cataracts and cancer of the uterus as well as the risks of blood clots in the lungs and large veins. This makes Raloxifene a better choice for women who already have familial risks of developing these conditions.
Other drugs like aromatase inhibitors exemestane and anastrozole may also lower the risk of developing breast cancer in postmenopausal women at higher risk of getting LCIS.
Some patient with LCIS will be advised to undergo a preventive (prophylactic) mastectomy. Although drastic, it has been proved to reduce the risk of developing breast cancer in the future. These are generally women with a strong family history of breast cancer or who are positive for BRCA1 or BRCA2 mutation. A prophylactic bilateral mastectomy may also be considered.
Lobular carcinomas in situ (LCIS) represent 1-2% of all breast cancers. Of these, approximately 10-20% of women will develop invasive breast cancer within 15 years after their LCIS diagnosis. Thus, LCIS is considered a biomarker of increased breast cancer risk.
While both breasts are at increased risk of developing invasive cancer, the ipsilateral (same side) breast may be at greater risk.
The invasive cancers may include both invasive ductal carcinoma as well as invasive lobular carcinoma, but the risk of developing invasive ductal cancer is more.
The overall 5-year survival rate of lobular carcinoma in situ has been estimated to be 97%.
The cumulative risk of developing invasive cancer at 5 year intervals varies, with the risk at 10 years being 13 - 15%, the risk at 20 years being 26 - 35%, and the risk at 35 years being between 35% and over 50%.
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