From the Guidelines
Observation alone is the preferred management option for women diagnosed with pure Lobular Carcinoma In Situ (LCIS), as their risk of developing invasive carcinoma is low, approximately 21% over 15 years 1.
Key Considerations
- Bilateral mastectomy with or without reconstruction may be considered in special circumstances, such as women with a BRCA1/2 mutation or a strong family history of breast cancer 1.
- Risk-reduction mastectomy can be considered as an option for women with LCIS without additional risk factors, but this approach is not recommended for most of these women 1.
- Tamoxifen or raloxifene may be used as a risk reduction strategy in women with LCIS, with tamoxifen associated with an approximately 46% reduction in the risk of developing invasive breast cancer 1.
Follow-up and Monitoring
- Interval history and physical examinations every 6 to 12 months are recommended for women with LCIS 1.
- Annual diagnostic mammography is recommended for patients being followed up with clinical observation 1.
- Pathologic review of all cases is recommended to distinguish LCIS from atypical hyperplasia or carcinomas with early invasion 1.
- Genetic counseling is recommended if the patient is considered to be at high risk for hereditary breast cancer 1.
From the Research
Management of Lobular Carcinoma In Situ (LCIS)
The management of LCIS is largely debated, with various studies suggesting different approaches.
- Surgical management is often conservative, with excisional biopsy or local excision being the most common methods 2.
- Chemoprevention counseling is also commonly provided, with a significant proportion of patients opting for chemoprevention 2.
- The use of tamoxifen has been shown to reduce the risk of subsequent breast cancer in patients with LCIS 3.
- Mastectomy is not typically recommended as a strategy for risk reduction for most patients with LCIS, although some studies have shown an increase in mastectomy rates over time 4.
- There is significant variability in the management of LCIS, with different surgeons and institutions having different approaches 5.
Factors Influencing Management
Several factors can influence the management of LCIS, including:
- Patient characteristics, such as age and family history 2, 5.
- Method of diagnosis, with core biopsy being less likely to result in mastectomy compared to other methods 2.
- Histology, with pleomorphic LCIS being more likely to result in aggressive management compared to classic LCIS 5.
- Geographic region, with mastectomy rates varying significantly depending on location 4.
Outcomes
The outcomes for patients with LCIS are generally favorable, with high disease-free survival and overall survival rates 2.