Overview
Cancer of the breast is the most frequently diagnosed cancer in U.S. women. If you have been diagnosed with one of the noninvasive breast diseases called lobular carcinoma in situ (LCIS), you probably have many questions and concerns about treatment. This patient summary, which is based on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines™) for breast cancer, will help you understand the best available treatments for LCIS. Talk with your doctor about these therapies so that together you can decide on a treatment plan that is right for you.
Breast cancer is the most common cancer in women. Breast cancer usually occurs in the lobules (which make milk) or the ducts (which drain milk from the breast). In the United States, it occurs most frequently in women after menopause; however it can occur at any age.
Background
LCIS is not technically a cancer at all, but rather can be thought of as a precancerous condition in which abnormal cells are found in the lobules of the breast. However, studies have shown that women with LCIS have an increased risk for developing breast cancer in the future.
LCIS is typically found when a biopsy has been done for another reason, such as when a suspicious area was seen on a mammogram.
Treatment
When LCIS is found after a needle biopsy, surgery is done to remove the tissue in the area of the breast where the abnormal cells were found. This is done to be sure there is no invasive cancer. If no cancer is found in the removed tissue, no other surgery or treatment is needed. No radiation therapy or chemotherapy is used for LCIS. The preferred approach recommended in the NCCN Guidelines
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for Breast Cancer is close monitoring with annual mammography, consideration of annual breast MRI, and periodic breast examinations.
Women who have had LCIS have an increased risk for developing an invasive cancer within their lifetime than women who have not had LCIS. Therefore, you may be offered hormone therapy to reduce your risk of getting breast cancer in either breast. See Hormone Therapy for Breast Cancer Risk Reduction.
Prophylactic Mastectomy
The risk of developing breast cancer in the future may be increased further in women with LCIS who also have other risk factors for breast cancer (such as a strong family history of breast cancer). A few of these women may want to consider the option of prophylactic (preventive) mastectomy to greatly reduce the risk of future cancer. Because both breasts are at equal risk for developing cancer after LCIS is found, this preventive mastectomy must include both breasts.
If you are considering this surgery, you should carefully review the risks and options, recognizing that this is not an emergency and that there is no need to rush to proceed. You are encouraged to meet with professionals in several fields, including genetics professionals, who can help you understand your risks for future breast cancer and other health problems and determine which course of action is best for you.
Breast Reconstruction After Mastectomy for LCIS
If you have chosen preventive mastectomy to treat LCIS, you may have surgery to reconstruct the breasts immediately after the mastectomy or in a separate operation at a later time. Reconstruction may be done with tissue removed from the abdomen or another part of the body, using an artificial implant, or using a combination of the two methods.
Breast reconstruction surgery has potential risks and complications. Doctors usually recommend it only for otherwise healthy women who have certain conditions (such as diabetes) and who do not smoke because women with these conditions have an increased risk of complications from the surgery.
If you think reconstruction may be right for you, ask your doctor to refer you to a plastic surgeon before you schedule the mastectomy.
Hormone Therapy for Breast Cancer Risk Reduction
The hormone estrogen can stimulate the growth of certain breast cancers that have receptors for estrogen, or are estrogen receptor–positive. Hormone therapy blocks the hormonal stimulation of breast cancer tumor growth.
If you have been diagnosed with LCIS, two drugs are available, tamoxifen and raloxifene, that may reduce your risk of developing cancer in either breast in the future, depending on your health and past medical conditions. Tamoxifen can be taken by premenopausal and postmenopausal women. Raloxifene should only be taken by postmenopausal women because it has not been studied well in younger women.
Ask your doctor about the benefits and side effects of these hormone therapies and whether one or the other is an option for you. It is important to let your doctor know if you are taking any other medications because they might interact with your hormone therapy.
Side effects associated with hormone therapy include hot flashes and a slightly increased risk for blood clots and developing cancer of the uterus. If you are taking these drugs, you should call your doctor if you experience abnormal uterine bleeding and symptoms/signs of a blood clot, such as swelling and pain in a leg or arm.
Hormone therapies are usually taken as pills and are generally given for about 5 years. It is important that you do not stop taking the medicine without consulting with your doctor because these drugs are more effective when taken for long periods of time.
Life After Treatment
After completion of your treatment, you will begin a period called follow-up. During this period, you will visit your doctor every 6 to 12 months to ensure your continued good health. These visits to your doctor will give you a chance to ask questions and share your concerns. You will need an annual mammogram and possibly an MRI to ensure that if you develop a new breast cancer, it can be found and treated at an early stage.
If you are taking tamoxifen or raloxifene, you will also need to see your gynecologist for an annual exam. If you experience any abnormal vaginal bleeding or plan to have surgery at any time for any other reason, let your doctor know so that proper precautions can be taken.