Lobular carcinoma in situ (LCIS)
Lobular carcinoma in situ (LCIS) is an area of abnormal cell growth within the milk glands (known as lobules) of the breast. These cells grow within the lining of the lobules, but do not invade into other parts of the breast. LCIS is most commonly identified following a breast biopsy after the patient or doctor finds a suspicious lump or after an abnormal mammogram
The fact that the cancer is contained within the milk lobules means that lobular carcinoma in situ may be referred to as stage 0 cancer, or pre cancer. This is similar to ductal carcinoma in situ (DCIS), with the difference being that the abnormalities have developed in the milk ducts, rather than the lobules. LCIS is different to invasive lobular carcinoma (ILC), which is the term given to cancer cells and which have originated in the milk lobules and spread to other parts of the breast.
Whilst LCIS is not referred to as cancer, people with LCIS are at a greater risk of developing breast cancer at a later stage in their lives than those who have never had LCIS. The most common type of breast cancer is invasive ductal carcinoma and invasive lobular carcinoma is less common, accounting for around 10-15% of cases of invasive breast cancer.
Symptoms of Lobular Carcinoma in situ
LCIS generally does not cause any noticeable signs or symptoms to the breast, and most women are not aware of any symptoms when they are diagnosed.
Diagnosis for Lobular Carcinoma in situ
LCIS is most commonly found as a result of a biopsy. This involves taking a small sample of cells or tissue from the area of concern in the breast, which is then examined by a pathologist.
As mentioned, there are several subtypes of LCIS and the subtype/s found during a biopsy may affect how your doctor proceeds, with both further testing and management.
- Classical LCIS
In classic LCIS, abnormal cells are seen in the lobules of the breast in a characteristic ‘cloverleaf’ pattern. In the absence of markers for any of the other subtypes of LCIS, it is classified as classic LCIS.
- Pleomorphic LCIS
A diagnosis of pleomorphic LCIS is made when the cells look more irregular in shape than classical LCIS, with the presence of ‘high grade’ nuclei (more abnormal than normal breast nuclei and likely more aggressive) when examined under the microscope. PLCIS is rare but may carry a higher risk of developing into invasive cancer than other types of LCIS.
- Classic LCIS with comedo-type necrosis
In this rare subtype, some of the LCIS cells seen during the biopsy are dead. ‘Comedo’ or ‘comedo necrosis’. refers to the presence of dead (necrotic) cancer cells that build up inside the tumour. In these cases, LCIS may be faster growing and more likely to spread and lead to a higher risk of invasive cancer.
- Florid/bulky (mass forming) LCIS
In this LCIS subtype, the affected lobules are distended, forming a mass-like appearance. Can look similar to pleomorphic LCIS but nuclei are usually low/Intermediate grade.
Treatment for Lobular Carcinoma In Situ
Lobular carcinoma in situ is not a life-threatening condition. However, due to the increased risk of developing breast cancer later in life, women diagnosed with LCIS are advised to have regular check-ups, including:
- a physical examination of both breasts by a doctor once a year
- a mammogram or ultrasound of both breasts once a year
Some hormone therapies have been proven to reduce the risk of developing breast cancer, and this may be recommended for women with LCIS. In addition, depending on the outcome of a biopsy breast surgery may be recommended. It’s important to speak to your doctor about your options.
Lobular carcinoma in situ generally doesn’t cause any symptoms, cannot be felt or causes any changes to the breast.
LCIS is not a dangerous condition. However, having LCIS may increase your chances of developing breast cancer later in life, so it’s important to monitor any changes in the breasts and attend regular check-ups as recommended by your doctor.
LCIS typically does not spread beyond the milk ducts in the breast and becomes invasive cancer. However, having LCIS does increase the risk of developing breast cancer later in life.
In Australia, the 5-year survival rate for women aged 40 and over with invasive lobular carcinoma is 91.5%. Younger women have a slightly lower survival rate of 84%.