From the Guidelines
Lobular carcinoma in situ (LCIS) is mostly found in premenopausal women, making option (a) correct. LCIS is typically an incidental finding during breast biopsy performed for other reasons rather than presenting as a palpable breast lump, so option (b) is incorrect. Unlike ductal carcinoma in situ, LCIS does not have characteristic calcification patterns on mammography that would allow for radiographic detection, making option (c) incorrect. LCIS is considered a risk marker rather than a true precancerous lesion, indicating increased risk for future breast cancer development in either breast, so option (d) is incorrect. When women with LCIS do develop invasive breast cancer, it can be either lobular or ductal in type, not exclusively lobular, making option (e) incorrect. Some key points to consider in the management of LCIS include:
- LCIS is most commonly diagnosed in women between 40-50 years of age, is often multifocal and bilateral, and increases the risk of developing invasive breast cancer by approximately 1% per year 1.
- Management typically involves close surveillance rather than immediate surgical intervention, though risk-reducing medications like tamoxifen may be considered 1.
- The use of tamoxifen in premenopausal women, or tamoxifen or raloxifene in postmenopausal women, should be considered as a risk reduction strategy in women with LCIS who are followed up with observation 1.
- Follow-up of patients with LCIS includes interval history and physical examinations every 6 to 12 months, and annual diagnostic mammography is recommended in patients being followed up with clinical observation 1.
From the Research
Characteristics of Lobular Carcinoma in Situ
- Lobular carcinoma in situ (LCIS) is mostly found in premenopausal and postmenopausal women, with a median age at diagnosis of 50 years 2
- LCIS is usually an incidental finding in breast biopsies and does not typically present as a breast lump 3, 4
- There is no characteristic calcification pattern on mammography that is specific to LCIS 3
- LCIS is considered a marker of increased risk for breast cancer, rather than a true precancerous lesion 3, 4, 5
- The associated cancer can be either ductal or lobular in nature, with most subsequent malignancies being ductal 3, 6
Management and Risk Reduction
- The management of LCIS typically involves careful non-operative observation, with regular mammographic surveillance 3, 4, 5
- Chemoprevention with tamoxifen has been shown to reduce the risk of breast cancer in women with LCIS 2, 3
- Bilateral prophylactic mastectomy is considered an overly aggressive treatment option for LCIS, and is not typically recommended 3, 4