Lobular carcinoma in situ

Definition :

Lobular carcinoma in situ (LCIS) is an uncommon condition in which abnormal cells form in the lobules or milk glands in the breast. LCIS isn't cancer. But being diagnosed with LCIS indicates that you have an increased risk of developing breast cancer. LCIS usually doesn't show up on mammograms. The condition is most often discovered as a result of a biopsy done for another reason, such as a suspicious breast lump or an abnormal mammogram. Women with LCIS have an increased risk of developing invasive breast cancer in either breast. If you're diagnosed with LCIS, your doctor may recommend increased breast cancer screening and may ask you to consider treatments to reduce your risk of invasive breast cancer

Sign and Symptom :

Lobular carcinoma in situ (LCIS) doesn't cause signs or symptoms. Rather, your doctor might discover incidentally that you have LCIS for instance, after a biopsy to assess a breast lump or an abnormal area, such as microcalcifications, found on a mammogram

Causes
Breast anatomy

Lobular carcinoma in situ It's not clear what causes LCIS. LCIS begins when cells in a milk-producing gland (lobule) of a breast develop genetic mutations that cause the cells to appear abnormal. The abnormal cells remain in the lobule and don't extend into, or invade, nearby breast tissue. LCIS isn't cancer and it doesn't develop into cancer. But having LCIS increases risk of breast cancer and makes it more likely that could develop invasive breast cancer. The risk of breast cancer in women diagnosed with LCIS is thought to be 20 percent. Put another way, for every 100 women diagnosed with LCIS, 20 will be diagnosed with breast cancer and 80 won't be diagnosed with breast cancer. The risk for women in general is thought to be 12 percent. Put another way, for every 100 women in the general population, 12 will be diagnosed with breast cancer in their lifetime. Your individual risk of breast cancer is based on many factors. Talk to your doctor to better understand your personal risk of breast cancer.

Tests and diagnosis

Fine-needle aspiration

Lobular carcinoma in situ (LCIS) may be present in one or both breasts, but it usually isn't visible on a mammogram. The condition is most often diagnosed as an incidental finding when you have a biopsy done to evaluate some other area of concern in your breast. Types of breast biopsy that may be used include:

Fine-needle aspiration biopsy. Your doctor directs a very fine needle into the breast. Next, your doctor uses a syringe attached to the needle to collect a sample of cells or fluid for examination. Core needle biopsy. A radiologist or surgeon uses a thin, hollow needle to remove several tiny tissue samples. Imaging techniques, such as mammography, ultrasound or MRI, are often used to help guide the needle used in a core needle biopsy. Surgical biopsy. A surgeon may perform an operation to remove a portion of the breast for examination. Treatments and drugs A number of factors, including your personal preferences, come into play when you decide whether to undergo treatment for lobular carcinoma in situ (LCIS). There are three main approaches to treatment: careful observation, taking a medication to reduce cancer risk (chemoprevention) or preventive surgery. Observation If you've been diagnosed with LCIS, your doctor may recommend more frequent exams to closely monitor your breasts for signs of cancer. This may include:

Frequent breast self-exams to develop breast familiarity and to detect any unusual breast changes Clinical breast exams at least twice a year Screening mammograms every year Other imaging techniques, such as magnetic resonance imaging (MRI), if you have other risk factors and a strong family history of breast cancer Chemoprevention Two selective estrogen receptor modulator (SERM) drugs are approved to reduce the risk of invasive breast cancer. Both drugs work by blocking breast tissue's receptivity to estrogen, which influences the development and growth of many breast tumors.

Tamoxifen. Tamoxifen reduces the risk of developing invasive breast cancer. Tamoxifen can be used by both premenopausal and postmenopausal women. Tamoxifen is typically taken for five years. Tamoxifen slightly increases the risk of serious conditions including uterine cancer, stroke and cataracts, as well as side effects such as hot flashes and vaginal dryness. Tamoxifen also increases the risk of blood clots in postmenopausal women.

Raloxifene (Evista). Raloxifene is also approved to reduce the risk of invasive breast cancer in high-risk postmenopausal women, including those with LCIS. Raloxifene is as effective as tamoxifen in reducing risk of invasive breast cancer in postmenopausal women. Raloxifene is linked to fewer cases of uterine cancer, blood clots and stroke than tamoxifen, but is otherwise associated with similar health risks. Women who have multiple risk factors for heart disease or

have a history of heart disease should not take raloxifene because of an increased risk of a stroke. Discuss with your doctor the risks and benefits of taking a drug for breast cancer prevention to see if it's the best course of treatment for you.

Preventive surgery
One other option for treating LCIS is preventive (prophylactic) mastectomy. This surgery removes both breasts not just the breast affected with LCIS to reduce your risk of developing invasive breast cancer. To obtain the best possible protective benefit from this surgery, both breasts are removed, because LCIS increases your risk of developing breast cancer in either breast. Preventive surgery may be an option for you if you're at high risk of breast cancer based on a strong family history or a BRCA gene mutation. Surgery to treat LCIS isn't urgent, so you have time to carefully weigh the pros and cons of preventive mastectomy with your doctor.

Prognosis
The generally good prognosis after treatment for DCIS requires large patient series and longterm follow-up to evaluate the risk of dying of breast cancer, and hitherto no studies have reported estimates of the breast cancer corrected survival rate. Thus, it is not known how the risk of dying of breast cancer in women who have been treated for DCIS is linked to new invasive cancers. Even less is known about the natural history of LCIS. LCIS is said to be a general risk factor for invasive breast cancer, with similar risks for both breasts (3 , 10 , 20, 21) . The risk of a subsequent invasive cancer is reported to be 711 times higher than the risk of a breast cancer in the general female population (17 , 22, 23, 24) .