Reviewers: Kenneth Blank, MD and Leonard Farber, MD
Source: International Journal of Radiation Oncology, Biology and Physics. 15 January 1998, Volume 40 number 2, pg. 353
Lobular carcinoma in situ (LCIS) was first described in 1941 as a noninvasive form of breast cancer. However, after years of clinical study it is now clear that LCIS it is not a cancer but rather a risk factor for the development of breast cancer. As such, most women with LCIS are advised to undergo careful yearly breast cancer screening. LCIS is typically multifocal (occurring in more than one area) and carries a lifetime risk of 25% for subsequently developing breast cancer. Interestingly, if a breast cancer develops it occurs with equal frequency in the breast with and without the LCIS. Therefore, if treatment is desired, the only acceptable form of treatment is bilateral mastectomy.
It is not uncommon for a component of LCIS to be detected in the pathologic specimen of women who undergo surgery (lumpectomy or mastectomy) for invasive breast cancer. Because LCIS increases a woman's risk of developing breast cancer in either breast, physicians questioned whether the presence of LCIS should dictate a mastectomy over a lumpectomy, in which the majority of the breast tissue remains behind? This question is the focus of a recent article in the 15 January 1998 issue of the International Journal of Radiation Oncology, Biology and Physics.
Physicians from Yale University Department of Therapeutic Radiology reviewed the pathology reports of all women who were treated with conservative surgery (lumpectomy) and radiation prior to 1992 to identify women who had a component of LCIS. Fifty-one patients were identified and compared to 1045 patients without evidence of LCIS and who were treated conservatively (lumpectomy and radiation) during the same time interval. The median follow-up was greater than 10 years for both groups. The two groups were similar with respect to age at presentation, clinical stage, nodal status, estrogen receptor status and adjuvant therapy received. The overall survival, distant disease free survival and ipsilateral tumor recurrence was not statistically different between the two groups.
The findings from this study demonstrate that women with a component of LCIS do not have a worse prognosis than women without an LCIS component after treatment with conservative surgery and radiation for breast cancer. The finding of LCIS on a surgical specimen in women undergoing treatment for breast cancer should not influence the treatment decision making process and these women should be eligible for breast conservation therapy.