Lobular Carcinoma in Situ – Diagnosis and Treatment
Overview
Lobular carcinoma in situ (LCIS) is a condition where groups of abnormal cells form in the milk-producing glands (lobules) inside the breast. These cells are not considered cancer, but they are a sign that a person has a higher chance of developing breast cancer later.
- Location: Affects the terminal duct lobular units of the breast.
- Cell Changes: Abnormal growth stays inside the lobules and does not break into nearby tissue.
- Diagnosis: Often found by accident during a biopsy for another breast issue.
- Common Features Found with LCIS: Sclerosing adenosis, radial scars, papillomas, cysts, and columnar cell changes may appear in tissue samples.
Tests used to find LCIS include mammography, ultrasound, breast MRI, needle biopsy, and surgical biopsy. Pathologists may check for the loss of a protein called E-cadherin, which is typical in LCIS cells.
Differences Between LCIS and Invasive Breast Cancer
| Feature | LCIS | Invasive Breast Cancer |
|---|---|---|
| Where does it grow? | Stays inside the lobules | Spreads into nearby breast tissue |
| Cancer type | Not cancer, but raises future risk | Is cancer and can metastasize |
| Spread to lymph nodes | No | Yes, possible |
| Treatment approach | Often surveillance and medicines | Surgery, chemo, radiation, more |
Unlike invasive cancers, LCIS does not spread to lymph nodes, peritoneum, or other organs. It does not show symptoms like a lump or pain. LCIS shows up because of abnormal findings on a mammogram or biopsy.
Even though LCIS itself does not invade, it is linked to a greater chance of breast cancer in the future. Some risk factors that increase this risk include family history, certain gene changes like CDH1, hormone replacement therapy, and previous benign breast conditions such as flat epithelial atypia or complex sclerosing lesions.
A person with LCIS should discuss breast cancer screening and monitoring options, such as more frequent mammograms, breast MRIs, or considering medicines like endocrine therapy to lower cancer risk. Surgery is not always needed, but sometimes an excisional biopsy may be done to rule out any nearby invasive cancer.
Diagnosis
Breast Imaging and Screening
Doctors usually start by looking at the breast tissue using tests like mammograms and sometimes ultrasound or MRI. These imaging tests help find changes or unusual spots in the breast that may not cause any symptoms. If something unusual is seen, more testing will be needed.
Tissue Sampling and Lab Review
If an area looks suspicious, a small sample of breast tissue is taken, often through a needle biopsy. A pathologist examines these cells under a microscope to check for signs of lobular carcinoma in situ (LCIS). The lab test can show how the cells look and help decide what steps to take next.
Why a Precise Diagnosis Matters
Finding LCIS early and correctly is important because it increases the risk of breast cancer in the future. Accurate tests help doctors create a plan, which might include regular check-ups, medicine, or other options.
Treatment
Careful Observation and Routine Checks
People diagnosed with LCIS often do not need immediate treatment. Instead, doctors may recommend active surveillance, which means regular breast exams and imaging tests, like mammograms or MRIs, to watch for any changes over time. This allows for early detection if cancer develops.
Hormone-Based Therapies
Some patients are offered medications that block or lower estrogen. These drugs can help reduce the chance of developing invasive breast cancer in the future, especially for those at higher risk. Hormonal therapy is usually taken for several years and is chosen based on individual health factors.
Surgery Choices (Breast Conservation or Removal)
Surgery is not the first choice for most people with LCIS but may be considered in some cases. Options include:
- Lumpectomy: Removal of only the area with abnormal cells.
- Mastectomy: Surgery to remove all breast tissue, usually recommended for patients with a high genetic risk or multiple areas of LCIS.
The decision for surgery depends on several risk factors and personal preferences.
Things That Influence Treatment Decisions
Treatment plans for LCIS are tailored to each person. Key factors that affect decisions include:
- Age and overall health
- Family history of breast cancer
- Personal wishes
- Test results, such as genetic testing for BRCA mutations
- Size and location of the LCIS
Doctors work with patients to choose options that fit best with their health and life situation.
Lowering the Chance of Breast Cancer After LCIS
People diagnosed with lobular carcinoma in situ (LCIS) can take steps to reduce their risk of breast cancer. Regular screenings, such as mammograms or MRI scans, help spot changes early. Health providers often recommend check-ups every year.
Doctors may suggest medicines like selective estrogen receptor modulators (SERMs) or aromatase inhibitors. These medications lower hormone levels or block hormone effects, which can reduce breast cancer risk for some patients.
Lifestyle changes also play a role. Keeping a healthy weight, staying active for at least 150 minutes each week, and avoiding tobacco support overall health. For some, preventive surgery to remove breast tissue may be an option, especially if they have other risk factors.
The following table outlines some common strategies:
| Risk-Reducing Option | Purpose | Who Might Consider It |
|---|---|---|
| Regular Breast Screenings | Early cancer detection | All with LCIS |
| Risk-Reducing Medication | Lower hormone influence | Higher-risk individuals |
| Healthy Lifestyle Changes | Support overall health | All with LCIS |
| Preventive Surgery | Remove risk tissue | Very high-risk individuals |
Emotional and Psychological Effects of Learning You Have LCIS
A diagnosis of lobular carcinoma in situ (LCIS) can bring up many emotions. People may feel confused or worried since LCIS is not cancer, but it does raise the risk of getting breast cancer in the future. This uncertainty can lead to ongoing feelings of anxiety about possible future health problems.
People diagnosed with LCIS may experience:
- Fear or worry about developing breast cancer later on.
- Stress related to frequent medical checkups and tests.
- Confusion about what the diagnosis means and the different treatment choices.
- Concern about how the diagnosis might affect daily life or family.
Emotional reactions can also affect relationships and the ability to plan for the future. Some may feel isolated if they do not know others with the same diagnosis. Support from family, healthcare teams, and patient groups can help people manage these feelings.
| Common Feelings After LCIS Diagnosis | Ways to Cope |
|---|---|
| Anxiety | Talking with a healthcare provider |
| Confusion | Seeking clear information |
| Worry about cancer | Connecting with support groups |
| Stress from follow-up | Practicing stress-management techniques |
Getting Ready for Medical Visits
Being prepared for a healthcare appointment about lobular carcinoma in situ (LCIS) helps make the visit more productive. Patients should bring a list of all current symptoms and note when these started. Keeping track of changes or new symptoms can help the healthcare provider understand the situation better.
It is helpful to write down any personal or family history of breast cancer. This could include family members who have had breast, ovarian, or related cancers. Patients should also bring a list of all medications, vitamins, and supplements they are taking. A table can help organize this information:
| Item to Bring | Details to Note |
|---|---|
| Symptoms | When they started, how often |
| Family cancer history | Who had cancer, what type |
| Medications and supplements | Name, dose, how often taken |
| Previous breast procedures | Biopsies, surgeries, or tests |
Being clear and organized can help make the medical visit more effective and ensure all important information is discussed.
