Lobular Carcinoma In Situ of Breast

Lobular Carcinoma In Situ of Breast

Article
Women's Health
Diseases & Conditions
+1
Contributed byKrish Tangella MD, MBAMar 20, 2022

What are the other Names for this Condition? (Also known as/Synonyms)

  • LCIS of Breast
  • Mammary LCIS
  • Mammary Lobular Carcinoma In Situ

What is Lobular Carcinoma In Situ of Breast? (Definition/Background Information)

  • Lobular Carcinoma In Situ (LCIS) of Breast is a non-invasive malignant breast tumor. It originates in the terminal duct lobular units of the breast. The terminal duct lobular units form part of the breast duct system. It is suspected that LCIS of Breast is a precursor lesion for invasive breast cancer
  • Based on the histology of the tumor cells when observed under the microscope by a pathologist, Lobular Carcinoma In Situ of Breast is categorized as:
    • Classic LCIS
    • Pleomorphic LCIS
    • Florid LCIS
  • In a majority of cases, the condition is asymptomatic and can remain undetected. A diagnosis of Lobular Carcinoma In Situ of Breast is usually incidental and occurs on breast biopsies undertaken for other health conditions. Occasionally, the lesions may be detected on radiological studies
  • The cause of formation of Lobular Carcinoma In Situ of Breast is not well-established. Several genetic abnormalities have been noted in these tumors. The condition is mostly observed in middle-aged and older women
  • In general, the treatment of Lobular Carcinoma In Situ of Breast may involve a wait and watch approach, hormone therapy, and surgery, based on the healthcare provider’s evaluation of the condition
  • The prognosis of Mammary Lobular Carcinoma In Situ is usually excellent with adequate treatment and regular follow-up. However, in case of a recurrence or transformation to invasive carcinoma of the breast, the prognosis depends on several factors and may vary from one individual to another

Who gets Lobular Carcinoma In Situ of Breast? (Age and Sex Distribution)

  • Lobular Carcinoma In Situ of Breast is seen in young, middle-aged, and older adults
    • Classic LCIS is diagnosed in pre-menopausal women with mean age of 50 years
    • Pleomorphic and florid LCIS are predominantly seen in post-menopausal women having mean age of 60 years
  • Even though males may be affected, a higher number of cases are reported in women than men
  • All racial and ethnic groups are affected, and no specific predilection is seen

What are the Risk Factors for Lobular Carcinoma In Situ of Breast? (Predisposing Factors)

The risk factors for Lobular Carcinoma In Situ (LCIS) of Breast is similar to invasive carcinoma of breast that include:

  • Women have a much greater chance of developing breast cancer than men
  • Advancing age: The risk increases for women over the age of 55 years
  • Family history: Women with a mother, sister, or daughter diagnosed with breast cancer have a higher risk for developing the condition
  • Inherited gene mutations: Mutations in certain genes (BRCA1 or BRCA2) can lead to a much higher risk
  • Radiation therapy: Receiving radiation therapy to the chest or breast area can also increase the risk. It is noted that the risk for developing breast cancer later in life is the greatest for radiation therapy administered during puberty
  • Obesity: Being overweight or obese elevates the risk after menopause
  • Alcohol use: Consuming alcohol more than one drink per day; the more the alcohol consumed, the greater is the risk
  • Menstrual cycle: Women who got their period before the age of 12 years, and those who reached menopause after age 55 have an increased risk
  • Postmenopausal hormone therapy: Women taking hormone replacement therapy medications containing both estrogen and progesterone for menopause have a higher risk for developing LCIS
  • Reproductive history: Having the first child after the age of 35, or never having children
  • Physical inactivity: A lack of physical exercise (leading a sedentary life) can increase the risk
  • Breastfeeding: Not breastfeeding one's child can increase the risk for developing the condition

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Lobular Carcinoma In Situ of Breast? (Etiology)

The exact cause of development of Lobular Carcinoma In Situ (LCIS) of Breast is currently not well understood. Molecular studies have shown certain genetic abnormalities that include:

  • Germline mutations involving CDH1 gene localized at 16q22.1; this results in CDH1 inactivation
  • The involvement of CDH1 gene is observed in over 80% of the cases. The other genes reportedly involved include PIK3CA gene in 41% and CBFB gene in 12% of the cases
  • The classic, pleomorphic, and florid types of LCIS often present loss of chromosome 16q and gain of chromosome 1q
  • Additionally, ERBB2 gene involvement is commonly seen in pleomorphic LCIS

What are the Signs and Symptoms of Lobular Carcinoma In Situ of Breast?

In a vast majority of cases, no specific signs and symptoms of Lobular Carcinoma In Situ (LCIS) of Breast are reported. The condition is often an incidental finding on breast biopsies. Rarely, 2% of the individuals show radiological abnormalities on imaging studies.

  • The tumor is multifocal in almost 80% of the individuals i.e., multicentric LCIS (several areas of breast present LCIS)
  • LCIS may be unilateral (involving one breast) or bilateral (involving both breasts - seen in between 30-67% of the cases)

How is Lobular Carcinoma In Situ of Breast Diagnosed?

Lobular Carcinoma In Situ of Breast may be diagnosed in the following manner:

  • Complete physical examination with comprehensive medical and family history evaluation
  • Breast exam to check for any lumps or unusual signs in the breasts
  • Blood tests including complete blood count (CBC) test
  • Mammogram: A mammogram uses X-rays to provide images of the breast. The tumor can cause radiological abnormalities on a mammogram, even though the presence of a breast lump on self-exam is not noted. Pleomorphic and florid LCIS are more often associated with microcalcifications
  • Galactography: A mammography using a contrast solution, mostly used to analyze the reason behind a nipple discharge
  • Breast ultrasound scan: Using high-frequency sound waves to produce images of the breast
  • Computerized tomography (CT) or magnetic resonance imaging (MRI) scan of the breast
  • Breast biopsy:
    • A biopsy of the tumor is performed and sent to a laboratory for a pathological examination. A pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. Examination of the biopsy under a microscope by a pathologist is considered to be gold standard in arriving at a conclusive diagnosis
    • Biopsy specimens are studied initially using Hematoxylin and Eosin staining. The pathologist then decides on additional studies depending on the clinical situation
    • Sometimes, the pathologist may perform additional studies, which may include immunohistochemical stains and molecular studies to assist in the diagnosis

Biopsies are the only methods used to determine whether an abnormality is benign or cancerous. These are performed by inserting a needle into a breast mass and removing cells or tissues, for further examination. There are different types of biopsies:

  • Fine needle aspiration biopsy (FNAB) of breast mass: In this method, a very thin needle is used to remove a small amount of tissue. FNA has limited diagnostic value for LCIS
  • Core needle biopsy of breast mass: A wider needle is used to withdraw a small cylinder of tissue from an abnormal area of the breast
  • Open tissue biopsy of breast mass: A surgical procedure used less often than needle biopsies, it is used to remove a part or all of a breast lump for analysis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Lobular Carcinoma In Situ of Breast?

The complications of Lobular Carcinoma In Situ (LCIS) of Breast may include:

  • Emotional stress due to the presence of a premalignant condition
  • Increased risk for the development of invasive breast carcinoma:
    • The absolute risk of developing breast cancer in individuals diagnosed with LCIS is 1-2% a year, with a cumulative risk of over 20% in 20 years
    • In general, the risk is about 7-12 times higher when compared to women among the general population (without LCIS)
    • It is estimated that 25-60% of individuals diagnosed with pleomorphic LCIS and florid LCIS on a core biopsy have invasive carcinoma on excisional biopsies/lumpectomies of the breast
  • Recurrences following surgery may be observed; the recurrences may be LCIS or DCIS (ductal carcinoma in situ). In some cases, LCIS may return as invasive lobular/ductal carcinoma
  • Side effects of treatment

How is Lobular Carcinoma In Situ of Breast Treated?

The treatment of Lobular Carcinoma In Situ (LCIS) of Breast may involve the following strategies based on the healthcare provider’s evaluation of the individual:

  • Active surveillance that includes regular examinations and periodic follow-ups
  • Hormone therapy to prevent subsequent development of breast cancer
  • There is an ongoing debate whether surgery is needed to remove LCIS of Breast that is present as a radiological abnormality

All of the above modalities are generally considered for classic LCIS.

However, in case of pleomorphic and florid LCIS, there is limited information on the optimal management of these pre-invasive lesions. Some reports seem to indicate that surgery followed by radiation therapy may be considered. The WHO recommends complete surgical excision and removal of the tumor for both pleomorphic and florid LCIS, when it is diagnosed on a core needle biopsy.

How can Lobular Carcinoma In Situ of Breast be Prevented?

Currently, no specific preventive measures are available for Lobular Carcinoma In Situ of Breast. In general, it is important to be aware of the following:

  • Learning to do regular ‘breast self-exams’ in order to help identify any unusual lumps or signs in the breast
  • Maintain a healthy body weight and exercise regularly
  • Implement and follow a well-balanced diet; a high intake of fiber via fresh fruits and vegetables helps in a healthy lifestyle
  • Avoid or completely stop smoking
  • If taking alcohol, only drink in moderation; limit to one or (maximum) two drinks a day
  • Limit combination hormone therapy used to treat symptoms of menopause. It is advised that individuals be aware of the potential benefits and risks of such hormonal medications
  • Cancer screenings can help detect any breast cancer during the early stages

What is the Prognosis of Lobular Carcinoma In Situ of Breast? (Outcomes/Resolutions)

The prognosis is Lobular Carcinoma In Situ (LCIS) of Breast is generally excellent with early treatment (surgery) in a vast majority of cases, since LCIS in itself is a non-invasive cancer. 

  • In some cases, LCIS may recur and hence it is important to remain vigilant and hold periodic follow-up screenings
  • In case of a late diagnosis of the condition, the risk for progression of LCIS to invasive breast carcinoma is high
  • In case of development of an invasive carcinoma, the overall prognosis depends on the stage of the tumor, among other factors
  • It is estimated that the relative risk for progression in individuals diagnosed with LCIS is 7-12 times than those without LCIS among the general population

Additional and Relevant Useful Information for Lobular Carcinoma In Situ of Breast:

The following DoveMed website links are useful resources for additional information:

https://www.dovemed.com/healthy-living/womens-health/

https://www.dovemed.com/diseases-conditions/cancer/

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Krish Tangella MD, MBA picture
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Krish Tangella MD, MBA

Pathology, Medical Editorial Board, DoveMed Team

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