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Lobular Carcinoma in Situ (LCIS)/Lobular
Neoplasia |
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Though
categorized as a stage
0
breast cancer (the earliest stage), LCIS is not considered a cancer. Rather, it
is �marker� (a signal) that breast cancer may develop. In fact, LCIS has
recently been renamed lobular neoplasia to signify this belief.� Neoplasia is
defined as an abnormal growth in the number of cells. Though LCIS is not
considered a cancer, women who are diagnosed with LCIS (also called lobular
neoplasia) are at a higher risk of developing breast cancer later in
life. According
to the National Cancer Institute, a woman with LCIS has a 25% chance of
developing some form of invasive cancer (either lobular, or more commonly,
infiltrating ductal
carcinoma)
within her lifetime. The
number of women diagnosed with LCIS has increased in recent years, most likely
due to more rigorous breast cancer screening
and advances in mammography
techniques.� Often, LCIS is encountered serendipitously (by chance) while a
pathologist is examining tissue from a breast biopsy that was performed for
another reason (for example, to examine an area of concern found by physical
examination
or with mammography). Treating LCIS
Currently,
the majority of women who have been diagnosed with LCIS do not receive treatment
after biopsy.� Instead, they are closely monitored by physicians with frequent
clinical
breast exams
and mammograms.� It is essential that women with LCIS examine their breasts
carefully, once a month, and see a physician immediately if they notice any
changes
or abnormalities.�
Prophylactic
Mastectomy Some
women with LCIS who are very concerned with developing breast cancer (such as
those who also have a strong family history of breast cancer and/or a proven
genetic mutation) opt for the preventive removal of both breasts, a procedure
called a prophylactic mastectomy.�
Research
shows that prophylactic mastectomy markedly reduces a woman�s risk of developing
breast cancer for those at high risk.� Prophylactic mastectomy may be followed
by immediate or delayed breast reconstruction. While
a bilateral prophylactic mastectomy removes the majority of breast tissue and
reduces the risk of developing breast cancer, it is impossible to remove every
breast cell. Thus, it is still possible to develop breast cancer even if both
breasts are removed. According to Lynn C. Hartman, MD of the Mayo Clinic in
Rochester, Minnesota, if only three cells are left after a mastectomy, cancer
could develop from those three cells.� In a study
conducted by the Mayo Clinic, three of 214 women who had prophylactic bilateral
mastectomies between 1960 to 1993 developed breast cancer and two of the women
later died.� Tamoxifen The
option of taking medication to reduce breast cancer risk is also available to
women with LCIS.� In a large clinical
trial
conducted by researchers with the National Surgical
Adjuvant Breast and Bowel Project
(NSABP), 13,388 women who were at high risk of developing breast cancer were
given either the drug tamoxifen
or a placebo (sugar pill) to determine whether tamoxifen could lower the risk of
breast cancer.� All of the women in the study had a history of LCIS and/or other
risk factors for breast cancer (such as a family history or atypical
hyperplasia, an abnormal increase in the number of breast cells, diagnosed by a
previous breast biopsy).� The trial revealed a 49% decrease in the incidence of
invasive breast cancer in women who were given tamoxifen in the study compared
with women who took the placebo (sugar pill).� As
a result of the NSABP trial, the U.S. Food and Drug Administration (FDA)
approved the use of tamoxifen for women at high risk of breast cancer.� Many
women with LCIS take tamoxifen to help prevent breast cancer.� Women with LCIS
are encouraged to discuss the possibility of taking tamoxifen with their
physicians. A
second clinical trial by the NSABP called the STAR
trial
is currently underway.� The STAR is intended to compare the effectiveness of
tamoxifen with raloxifene, a promising new drug that may help prevent breast
cancer in women over age 35 who are at high risk for breast cancer.� The STAR
trial is still recruiting participants across the United States and Canada.�
Many women with LCIS are eligible to participate in the STAR trial.� Several
centers across the United States are participating in this trial.� Click
here
for more information on eligibility requirements and how to enroll in the STAR
clinical trial. Additional Resources and References
Updated:
July 12, 2000 |