Lobular Carcinoma in Situ

1 What is Lobular Carcinoma in Situ (LCIS)?

Lobular carcinoma in situ (LCIS) is a rare condition which leads to the development of abnormal cells in the lobules or milk glands of the breast. Although it is not a form of cancer, LCIS increases the risk of developing breast cancer. It is usually discovered as a suspicious lump during biopsy. If one is diagnosed with LCIS, the doctor may recommend screening for breast cancer. The doctor may also ask the patient to consider the treatment options which reduce the risk of cancer development.

2 Symptoms

There are no evident signs or symptoms of lobular carcinoma in situ (LCIS), rather, it might be discovered accidentally during a biopsy to assess a breast lump or an abnormal area, such as micro-calcifications, found on a mammogram.

When to see a doctor?

Consult a doctor if you experience any abnormality in your breasts, such as a lump, an area of unusual growth of skin, a thickening under the skin, or discharge from nipples. Ask your doctor when you should go for a breast cancer screening and how often it should be repeated. It is recommended to undergo a routine breast cancer screening in the beginning of your 40s. 

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3 Causes

Lobular carcinoma in situ (LCIS) is caused by the abnormal cells production in the breast. Although the exact mechanism of its development is not well understood, it is considered to develop due to certain genetic mutations in the milk producing glands (lobules).

LCIS affected cells are non invasive in nature to the nearby tissues and does not lead to cancer but increases the risk of invasive breast cancer up to 20%, though the normal ratio of occurrence of breast cancer in women is 12 out of 100.

4 Making a Diagnosis

 is most often diagnosed as an accidental discovery while conducting a biopsy to evaluate some other area of concern in your breast. 

Seek medical attention, if you experience any lump or any other abnormal change in your breasts and if any of the family members has been diagnosed with cancer. If you have experienced abnormalities in the past, carry your reports, biopsy details and list of medications. 

LCIS may affect one or both breasts, but it usually undetectable on a mammogram. 

Types of breast biopsy that may be used include: 

  • Fine-needle aspiration biopsy: The doctor inserts a very fine needle into the breast and uses a syringe attached to the needle to collect a sample of cells or fluid for examination.
  • Core needle biopsy: A thin, hollow needle is used to remove several tiny tissue samples. Imaging techniques, such as mammography, ultrasound or MRI, are used at times to help guide the needle used in a core needle biopsy.
  • Surgical biopsy: A proportion of the breast is removed by the surgeon and is examined under the microscope.

5 Treatment

The treatment of lobular carcinoma in situ (LCIS) depends upon a number of factors even your personal preferences. On the basis of careful observation the doctor may recommend following measures:

  • Frequent self breast examinations to diagnose any abnormality and changes.
  • Clinical breast tests which should be done at least twice a year.
  • Annual screening mammograms and other imaging techniques, like MRI
  • In case of a strong family history related to breast cancer, the doctor may suggest medication for chemoprevention. There are two FDA approved selective estrogen receptor modulator (SERM) drugs which have been potent in case of invasive breast cancer. These drugs work by blocking breast tissue's reception towards estrogen, which controls the propagation of many breast tumors. These are:
  1. Tamoxifen: It is a drug used to reduce the risk of invasive breast cancer development. Tamoxifen is safe to be used by both premenopausal and postmenopausal women. It has a dosage period of five years. The drug may slightly increase the risk of serious conditions like uterine cancer, strokes, cataracts, and other side effects such as hot flashes, vaginal dryness and blood clot development in case of postmenopausal women. 
  2. Raloxifene (Evista): Raloxifene has an equal efficacy as that of tamoxifen, but only in case of postmenopausal women. Raloxifene has had comparatively less cases of uterine cancer, blood clots and stroke in comparison to tamoxifen, but is otherwise associated with similar health risks. 

In general, these medications can reduce the risk of breast cancer by half. Women who have a history of heart related diseases are suggested not to take any of these drugs. Drugs like Exemestane (Aromasin) can be taken to decrease the production of estrogen in the body. 

  • Surgery is another option apart from chemotherapy drugs, which involves removal of the areas affected by LCIS. This might be done at the time of biopsy but sometimes removal of more tissues is needed. After the removal of LCIS, it is recommended to attend constant follow-up examinations, since there is a high risk of redevelopment of cancer.  
  • Preventive (prophylactic) mastectomy is another option for treating LCIS. This includes removal of both the breasts in order to eliminate the probability of invasive breast cancer. This kind of surgery might be an option if the patient is at high risk of breast cancer based on a very strong family history or a BRCA gene mutation. However, surgery to treat LCIS isn't urgent, so you have time to carefully weigh your options wisely by consulting your doctor.

6 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with lobular carcinoma in situ (LCIS).

The following steps can be taken to avoid the chances of breast cancer:

  1. The daily alcohol consumption should be limited to one drink a day, if you could not quit drinking. 
  2. Exercise regularly, for at least 30 minutes. 
  3. Maintain a healthy weight.
  4. Eat wisely, in order to limit the number of calories per day.
  5. Reduce your anxiety levels and find ways to cope with stress in your life.

7 Risks and Complications

The risk of lobular carcinoma in situ (LCIS) increases if:

  • There is a family history of breast cancer or if any of your close relatives have been diagnosed with breast cancer, you may have an increased risk of LCIS. 
  • You've taken hormone replacement therapy for menopause
  • If you're a woman in early 40s.
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