From the Guidelines
Lobular carcinoma, specifically invasive lobular carcinoma (ILC), is a type of breast cancer that originates in the lobules of the breast and has spread beyond these glands, accounting for approximately 10-15% of all breast cancer cases. According to the study by 1, ultrasound can be considered in the follow-up of lobular invasive carcinomas, highlighting the importance of tailored approaches to managing this specific type of breast cancer.
Key Characteristics of Invasive Lobular Carcinoma
- It often presents as a thickening or hardening in the breast rather than a distinct lump, making it challenging to detect on mammograms.
- Treatment typically involves surgery, possibly followed by radiation therapy, chemotherapy, hormone therapy (if hormone receptor-positive), or targeted therapy, depending on the specific characteristics of the cancer.
- Prognosis varies based on stage at diagnosis, tumor grade, hormone receptor status, and other factors.
Importance of Screening and Follow-Up
- Regular breast cancer screening is crucial for early detection, especially for those with risk factors such as family history or previous LCIS diagnosis.
- Follow-up care, as outlined by 1, should include regular visits, annual mammography with ultrasound for lobular invasive carcinomas, and consideration of lifestyle factors such as regular exercise and nutritional counseling to improve prognosis and quality of life.
Management Considerations
- The use of hormone replacement therapy should be discouraged due to the increased risk of recurrence, as noted in the guidelines 1.
- For patients on tamoxifen, annual gynecological examinations are recommended, and regular bone density evaluations are advised for those on aromatase inhibitors.
- Lifestyle interventions, including regular exercise, can provide functional and psychological benefits and possibly reduce the risk of recurrence, making them a valuable component of follow-up care.
From the Research
Definition and Characteristics of Lobular Carcinoma
- Lobular carcinoma, also known as invasive lobular carcinoma (ILC), is a subtype of breast cancer that accounts for approximately 10% to 15% of all breast cancer cases 2, 3, 4, 5.
- It is characterized by a distinct growth pattern that can make it difficult to detect using standard diagnostic methods such as palpation or X-ray mammography 2.
- ILC is often estrogen receptor (ER)-positive and HER2-negative, which can influence treatment options 4, 5.
Clinical Challenges and Treatment Options
- ILC can be challenging to diagnose and treat due to its multifocality and multicentricity at presentation 4.
- Treatment options for ILC are often based on data from invasive ductal cancers (IDC), despite the unique biology and characteristics of ILC 4.
- Hormone therapy is a common treatment approach for ILC, but novel treatments such as CDK4/6 inhibitors and antibody drug conjugates may also be effective 5.
- The Oncotype recurrence score (RS) can be used to predict the risk of recurrence and identify patients with ILC who may benefit from chemotherapy 3.
Diagnostic Imaging and Staging
- Magnetic resonance imaging (MRI) is the most accurate imaging modality for diagnosing and staging ILC, particularly in detecting multifocal and contralateral tumors 6.
- MRI can aid in improving preoperative staging and treatment planning for ILC, compared to full field digital mammography (FFDM) and ultrasound (US) 6.
- However, current literature on the use of MRI in ILC diagnosis and staging is inconsistent, and further studies are needed to fully understand its role 6.
Molecular Mechanisms and Biomarkers
- ILC has distinct molecular aberrations compared to IDC, including E-cadherin loss, FOXA1 mutations, and GATA3 mutations 4.
- These molecular differences may influence tumorigenesis and therapeutic strategies for ILC 4.
- Further research is needed to fully understand the molecular mechanisms and biomarkers of ILC and to develop targeted treatment approaches 4, 5.