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Lobular Carcinoma in Situ (LCIS)

Definition


Disease: Lobular Carcinoma in Situ (LCIS) Lobular Carcinoma in Situ (LCIS)
Category: Gynecological diseases
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Disease Definition:

Lobular carcinoma in situ (LCIS) is an indicator that someone has a higher chance of developing breast cancer in the future. LCIS is an area of abnormal tissue growth that occurs and stays within the lobules or milk glands that are located at the end of the breast ducts.

Mammograms don't show LCIS. Usually, a biopsy that is done for another reason, such as a suspicious breast lump or an abnormal mammogram, is how this condition is discovered.

Women that have LCIS will have a 10 to 20% lifetime risk of developing invasive breast cancer in either breast. However, to reduce the risk of invasive breast cancer in women with LCIS, effective screening and treatment options are available.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

If a woman has LCIS, she won't be able to detect anything unusual because this condition doesn't cause any signs or symptoms. Rather, after a biopsy to asses a breast lump or an abnormal area found on a mammogram, the doctor may discover that the woman has LCIS.

Even though an LCIS could be diagnosed in older women, it's usually diagnosed in women in their 40s. So, women should follow the recommended guidelines for their age group for clinical breast exams and mammography. In case a woman is not sure, she could ask her doctor how often she should be screened for breast cancer.

A woman should also contact her doctor for an evaluation in case she notices a change in her breasts, such as a lump, an area of puckered or otherwise unusually skin, a thickened region under the skin or nipple discharge. These are changes that could indicate more-serious problems, such as breast cancer.

Causes:

If a woman has LCIS, she will have an increased risk of developing invasive breast cancer. LCIS usually begins as an abnormal growth of cells in a milk-producing gland of the breast called the lobule. This growth will remain in place in the lobule and won't extend into or invade nearby breast tissue.

It is still not clear if LCIS has an association with environmental or hormonal exposures, or a family history of breast cancer. Also, no specific genes, such as BRCA1 or BRCA2 have been linked to the development of LCIS, so experts still don't know if LCIS is caused by genetic mutations that occur during the course of lifetime.

Complications

Complications:

None

Treatments:

Treatment for LCIS depends on a number of factors, including the patient’s personal preferences. The three main approaches of treatment involve:

 

  • Careful observation
  • Taking a medication to reduce cancer risk (chemoprevention)
  • Preventive surgery



OBSERVATION:
In case a woman has been diagnosed with LCIS, during the first five years after her diagnosis she’s not likely to develop invasive breast cancer. So, choosing to do nothing other than closely monitoring the breasts could be an appropriate option. This method may include:

 

  • Clinical breast exams at least twice a year
  • Frequent breast self-exams to develop breast familiarity and to detect any unusually breast changes
  • Screening mammograms every year
  • Other imaging techniques, such as MRI (magnetic resonance imaging), in case she has a strong family history of breast cancer and other risk factors.


CHEMOPREVENTION:
To reduce the risk of invasive breast cancer, there are two selective estrogen receptor modulator (SERM) drugs. These medications work by blocking breast tissue`s receptivity to estrogen, which influence the development and growth of many breast tumors.

Tamoxifen:
The risk of developing invasive breast cancer is significantly reduced by using tamoxifen. However, this drug is only effective against cancers that grow in response to hormones (hormone receptor positive cancers), just like all SERMs. Most cases of LCIS are hormone-receptor positive. Both premenopausal and postmenopausal women can use tamoxifen. Planning when to take the drug is a key issue for the woman to discuss with her doctor, because she can take tamoxifen only for a total of five years.
Tamoxifen slightly increases the risk of serious conditions including uterine cancer, stroke and cataracts. Vaginal dryness and hot flashes are some of its side effects. The risk of blood clots in postmenopausal women is also increased by tamoxifen. In case a woman takes tamoxifen, the doctor should monitor her for health problems associated with this drug every 6 to 12 months.

Raloxifene:
This drug was developed to prevent and treat osteoporosis. However, it also reduces the risk of invasive breast cancer in high-risk postmenopausal women, including those with LCIS. In reducing risk of invasive breast cancer in postmenopausal women, results from the Study of Tamoxifen and Raloxifene (STAR) trial has shown that this drug is as effective as tamoxifen. Raloxifene has caused fewer cases of uterine cancer, blood clots and stroke than tamoxifen, however, it has other risks. Raloxifene shouldn't be taken by women who have multiple risk factors for heart disease or have a history of heart disease.
To see if chemoprevention is the best course of treatment, a woman should talk with her doctor to discuss the pros and cons.

PREVENTIVE SURGERY:
Preventive (prophylactic) mastectomy is another option of treating LCIS. To reduce the risk of developing invasive breast cancer, this surgery will remove both breasts, not just the affected breast, because LCIS increases the risk of developing breast cancer in either breast. In case a woman is at high risk of breast cancer based on her family history or a BRCA gene mutation, preventive surgery could be an option for her. She should take her time to carefully weigh the benefits and risks of preventive mastectomy with her doctor, because surgery to treat LCIS isn't urgent.

Prognosis:

Not Available

Expert's opinion

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