Implications and Management of Lobular Carcinoma in situ of the Breast (LCIS)

Abstract: Lobular carcinoma in situ (LCIS) has gone from a rare form of mammary cancer to a marker of increased risk. Treatment options have undergone a corresponding change from ipsilateral mastectomy with axillary node dissection to observation once it became clear that the majority of patients did not progress to invasive cancer. However, recent events suggest a re-evaluation of LCIS management options. It is clear that even meticulous observation may fail to detect invasive cancer before systemic spread has taken place. This fact plus the identification of breast cancer genes have brought a renewed interest in prophylactic mastectomy. At the same time pathologists feel that it is possible to identify microscopic features of LCIS pointing to an increased likelihood of developing invasive cancer. As a result physicians are being asked to better quantitate risks for individual patients. Most patients with LCIS do not need bilateral mastectomies, but we are coming closer to identifying the minority that would be better served by prophylactic surgery.