Management of Lobular Carcinoma In Situ
Primary Management Options
- The National Comprehensive Cancer Network recommends observation as the standard management for most women with LCIS because the risk of developing invasive carcinoma is relatively low, approximately 21% over 15 years 1, 2
- Histologies of subsequent invasive carcinomas tend to be favorable 2
- Deaths from secondary invasive cancers are unusual in appropriately monitored women 1
- Tamoxifen for premenopausal women is associated with approximately 46% reduction in risk of developing invasive breast cancer 2
- Tamoxifen or raloxifene for postmenopausal women are effective in reducing risk of invasive cancer 1, 2
Risk Reduction Strategies
- Bilateral risk-reduction mastectomy may be considered in special circumstances, such as women with BRCA1/2 mutation, and can reduce risk by 90-95% 1, 3
- Women with strong family history of breast cancer may also consider bilateral risk-reduction mastectomy 2, 3
- If mastectomy is chosen, a bilateral procedure is required as risk is equal in both breasts 1, 2
- Women treated with bilateral mastectomy are appropriate candidates for breast reconstruction 2
Follow-up Recommendations
- Interval history and physical examinations every 6 to 12 months are recommended for women with LCIS 1, 2
- Annual diagnostic mammography is recommended for patients being followed with clinical observation 2
- Patients receiving tamoxifen or raloxifene therapy should be monitored according to breast cancer risk reduction guidelines 1
Special Considerations
- Pleomorphic LCIS may behave more aggressively than classic LCIS, but outcome data regarding treatment of this variant are lacking 2, 4
- The American College of Radiology and the National Comprehensive Cancer Network do not provide specific guidelines for the management of pleomorphic LCIS, but recommend a multidisciplinary approach 2
Common Pitfalls to Avoid
- Do not confuse LCIS with invasive lobular carcinoma, which requires different management 4
- Avoid unnecessary excision of biopsy sites to obtain clear margins for LCIS, as recommended by the National Comprehensive Cancer Network 1, 2
- Do not recommend unilateral mastectomy, as risk is equal in both breasts 1, 2