From the Guidelines
Lobular carcinoma in situ (LCIS) is typically not surgically removed from the breast, as it is considered a marker for increased breast cancer risk rather than a true cancer or pre-cancer that requires immediate removal. When LCIS is found on a biopsy, the standard approach is usually close monitoring rather than surgery, as recommended by the NCCN Guidelines for Breast Cancer Risk Reduction 1. This monitoring includes regular mammograms, possibly MRIs, and clinical breast exams. However, there are exceptions where surgery might be considered: if the LCIS is pleomorphic (a more aggressive variant), if it's associated with other concerning findings, or based on patient preference due to anxiety or very high risk factors.
For patients with LCIS, risk-reducing medications like tamoxifen, raloxifene, or aromatase inhibitors may be recommended instead of surgery, as they can lower the risk of developing breast cancer 1. The non-surgical approach is preferred because LCIS itself rarely transforms into cancer, and when found incidentally, removing it doesn't significantly change the overall breast cancer risk, which is elevated throughout both breasts. According to the most recent guidelines, patients with classic LCIS or ALH that is concordant with imaging may be suitable for monitoring in lieu of surgical excision, along with risk reduction therapy 1.
Some key points to consider in the management of LCIS include:
- The risk of developing invasive breast cancer is low, approximately 21% over 15 years 1
- Bilateral mastectomy may be considered in special circumstances, such as in women with a BRCA1/2 mutation or a strong family history of breast cancer 1
- Pleomorphic LCIS may have a greater potential to develop into invasive lobular carcinoma, and surgical excision may be recommended in these cases 1
- Risk-reducing medications can lower the risk of developing breast cancer, and may be recommended instead of surgery 1
From the Research
Surgical Removal of LCIS in Breast
- LCIS is not always surgically removed, as it is often considered a marker of increased risk rather than a true precursor to invasive cancer 2, 3.
- Studies have shown that the risk of breast cancer associated with LCIS can be managed with observation, chemoprevention, or bilateral prophylactic mastectomy 4, 3.
- Surgical excision of LCIS is sometimes performed, but it is not always necessary, and the decision to do so should be made on a case-by-case basis 2, 5.
- Factors such as radiologic-pathologic concordance, presence of other high-risk lesions, and patient preference should be taken into account when deciding whether to surgically remove LCIS 2, 6.
Management of LCIS
- Observation with regular follow-up is a common management strategy for LCIS, as it allows for early detection of any subsequent malignancy 2, 3.
- Chemoprevention has been shown to reduce the risk of breast cancer in women with LCIS, and it may be considered as an alternative to surgical excision 4.
- Bilateral prophylactic mastectomy is also an option for women with LCIS, although it is typically reserved for those with a strong family history of breast cancer or other high-risk factors 4, 3.
Outcomes and Risks
- The risk of breast cancer associated with LCIS is significant, with studies showing a 2-10% annual incidence of breast cancer in women with LCIS 4, 5.
- The long-term outcome of LCIS is similar to that of ductal carcinoma in situ (DCIS), with a significant risk of local recurrence and metastasis 5.
- Factors such as volume of disease and presence of other high-risk lesions may be associated with an increased risk of breast cancer in women with LCIS 4, 6.