Lobular Carcinoma in Situ - Causes, Symptoms, Diagnosis, and Treatment

What Is Lobular Carcinoma in Situ?

Lobular carcinoma in situ, or LCIS, is a condition where some cells inside the milk-producing glands of the breast start to change in an abnormal way. Even though the word “carcinoma” might sound scary, LCIS is not breast cancer. It is best thought of as a warning sign that a woman has a higher chance of developing breast cancer later in life.

The term “in situ” means "in its original place." This means the abnormal cells stay where they started and do not spread to other parts of the body as true cancer does. However, having LCIS does increase the risk of future recurrence.

About three out of every 10 women with LCIS may develop breast cancer at some point in their lifetime. LCIS is quite uncommon; it affects roughly four to 11 women out of every 100,000.

What Are the Causes of Lobular Carcinoma in Situ?

The exact cause of lobular carcinoma in situ remains unknown. Doctors know that it happens when cells in the milk-producing glands of the breast begin to change and form an abnormal group of cells, but what actually starts these changes is not yet clear. The important thing to remember is that these abnormal cells remain inside the lobules and do not spread into the breast tissue.

Certain factors pose the risk of developing LCIS. Using hormone replacement therapy for more than five years after menopause is one of them. Having a family history of LCIS or breast cancer and being over 40 years of age also raises the chances.

What Are the Symptoms of Lobular Carcinoma in Situ?

Most women with LCIS do not see any symptoms at all. There is usually no pain, skin change, or obvious warning sign.

In a few cases, you may feel a small lump in the breast, but this is uncommon. LCIS is seen more often in women who are still in their premenstrual years. Because LCIS does not usually cause symptoms, it is often found by accident. The doctor will discover it during a routine breast check, mammogram, or biopsy performed for another reason.

What Is the Diagnosis of Lobular Carcinoma in Situ?

The main method of diagnosing lobular carcinoma in situ is biopsy. Here, a small piece of tissue is removed from your breast and examined under a microscope for cells. Different types of biopsies are used in the diagnosis of lobular carcinoma in situ, such as:

• Needle Biopsy - Under local anesthesia, a small amount of tissue from the breast is removed using a needle and examined. Usually, a needle biopsy is enough to diagnose lobular carcinoma in situ.

• Excisional Biopsy - If a needle biopsy is not sufficient for diagnosis, an excisional biopsy is performed. A slightly larger piece of tissue is removed from the affected site and examined. It is usually done under general anesthesia.

What Are the Complications of LCIS?

LCIS itself is not cancerous, but it can sometimes turn into ductal carcinoma in situ (DCIS) or lobular breast cancer. This does not happen often or in everyone with LCIS. But various studies have shown that about one in every 10 women with LCIS may go on to develop one of these breast cancers later in their lives.

What Are the Different Types of Lobular Carcinoma in Situ?

Types of LCIS are classified based on how the cells look under the microscope. There are three main types of LCIS.

They are:

1. Classic LCIS: This is the most common type. The abnormal cells are small and fairly uniform in size, and they stay within the milk-producing lobules.

2. Pleomorphic LCIS: In this type, the cells look larger and more irregular than normal cells. Because of their unusual appearance, doctors watch this type more closely.

3. Florid LCIS: Here, the abnormal cells grow into a large mass inside the lobules. Sometimes, dead cells are present in the center of this mass, making it more aggressive than classic LCIS.

How is Lobular Carcinoma in Situ Treated?

Treatment for LCIS mainly focuses on carefully watching the breast and reducing the future risk of cancer.

The treatment involves:

1. Observation: Watchful monitoring is the most common and preferred approach. A breast examination every six to 12 months is advised. Once a year, a mammogram is recommended to check for changes in LCIS.

And if there is a strong family history of breast cancer, your doctor will advise you MRI or molecular breast imaging.

2. Surgery: Surgery is usually advised for a special type called pleomorphic LCIS because it has a higher chance of turning into cancer. Surgery involves:

• Lumpectomy: Only the affected area of the breast is removed.

• Mastectomy: The entire breast is removed.

• For people with strong risk factors, a doctor may suggest a preventive mastectomy where both breasts are removed to greatly reduce the risk of future breast cancer.

• Radiation Therapy: Is also recommended after surgery sometimes.

3. Preventive Medications: Some medications are used to lower the chance of LCIS becoming breast cancer. They are:

• Tamoxifen - a drug that blocks estrogen and reduces breast cancer risk.

• Aromatase inhibitors like Anastrozole and Exemestane - these reduce estrogen levels in the body, which helps stop cancer cells from growing.

What Are the Steps to Reduce the Risk of Getting Breast Cancer?

You can reduce your chances of developing breast cancer by making a few healthy lifestyle choices.

A few steps to reduce the risk of breast cancer are:

• Use hormone therapy after menopause only when really needed, and always at the lowest dose for the shortest possible time.

• Try to maintain a healthy body weight.

• Stay active with regular physical exercise.

• Limit alcohol intake.

• Quit smoking.

• Do regular breast self-examinations to check for any new lumps or changes.

Conclusion:

Lobular carcinoma in situ (LCIS) is not breast cancer, but it is an early warning sign. It happens when the cells in the milk-producing glands of the breast change in an abnormal way. Women with LCIS have about a 30% chance of developing breast cancer later in life. LCIS stays where it starts and does not spread unless it turns into cancer. Treatment may include medication, surgery, or close monitoring depending on the risk level.

If you notice any lump or have a risk of breast cancer and want to learn your chances, talk to a doctor who will explain your risk and the examination of breast cancer.

Key Takeaways:

1. LCIS is a benign breast condition that signals a higher chance of developing breast cancer in the future.

2. Women diagnosed with LCIS have about a 25 to 30 % lifetime risk of developing breast cancer, which is nearly double that of the general population.

3. Studies show that around one in 10 people with LCIS may develop DCIS or invasive lobular carcinoma later in life.