Lobular Carcinoma In Situ
Introduction
Treatment Option Overview
Treatment Options for Patients with LCIS
Current Clinical Trials
Introduction
The term lobular carcinoma in situ (LCIS) is misleading. This lesion is more
appropriately termed lobular neoplasia. Strictly speaking, it is not known
to be a premalignant lesion, but rather a marker that identifies women at an
increased risk for subsequent development of invasive breast cancer. This risk
remains elevated even beyond 2 decades, and most of the subsequent cancers are
ductal rather than lobular. LCIS is usually multicentric and is frequently
bilateral. In a large prospective series from the National Surgical Adjuvant
Breast and Bowel Project with a 5-year follow-up of 182 women with LCIS
managed with excisional biopsy alone, only eight women developed ipsilateral breast
tumors (four of the tumors were invasive).[1] In addition, three women developed contralateral breast
tumors (two of the tumors were invasive).
Treatment Option Overview
Most women with LCIS have disease that can be managed without additional local therapy after
biopsy. No evidence is available that re-excision to obtain clear margins is
required. The use of tamoxifen has decreased the risk of developing breast
cancer in women with LCIS and should be considered in the routine management of
these women.[2] The NSABP-P1 trial of 13,388 high-risk
women comparing tamoxifen to placebo demonstrated an overall 49% decrease in
invasive breast cancer, with a mean follow-up of 47.7 months.[2] Risk was
reduced by 56% in the subset of 826 women with a history of LCIS, and the
average annual hazard rate for invasive cancer fell from 12.99 per 1,000 women
to 5.69 per 1,000 women. In women older than 50 years, this benefit was
accompanied by an annual incidence of 1 to 2 per 1,000 women of endometrial
cancer and thrombotic events. (Refer to the PDQ summary on
Breast Cancer Prevention for more information.)
Bilateral prophylactic mastectomy is sometimes considered an
alternative approach for women at high risk for breast cancer. Many
breast surgeons, however, now consider this to be an overly aggressive approach.
Axillary lymph node dissection is not necessary in the management of LCIS.
Treatment Options for Patients with LCIS
- Observation after diagnostic biopsy.
- Tamoxifen to decrease the incidence of subsequent breast cancers.
- Ongoing breast cancer prevention trials (including the National Cancer Institute of Canada's trial [CAN-NCIC-MAP3], for example).
- Bilateral prophylactic total mastectomy, without axillary node dissection.
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with lobular breast carcinoma in situ. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
References
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Fisher ER, Redmond C, Fisher B, et al.: Pathologic findings from the National Surgical Adjuvant Breast and Bowel Projects (NSABP). Prognostic discriminants for 8-year survival for node-negative invasive breast cancer patients. Cancer 65 (9 Suppl): 2121-8, 1990.
[PUBMED Abstract]
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Fisher B, Costantino JP, Wickerham DL, et al.: Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst 90 (18): 1371-88, 1998.
[PUBMED Abstract]
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