Nov 6, 2007 11:29AM - edited Nov 9, 2007 06:37AM by leafI have not learned anything new.
The 'biggest' database (the SEER database) of LCIS and nothing worse patients was the 1988-2001, had about 4500 patients, and in that time period they did not follow such relevant factors as family history, hormone use. I think mastectomy patients, whether unilateral or bilateral, were excluded.
There is not *one* new study that suggests in some cases LCIS may, in some number of circumstances, be a precursor for bc, there are *several*, from different lines of evidence.
Since there are so very few cases of LCIS (without anything worse), there are no web sites specific to LCIS (that I know of), only papers / research.
Thi largest database of studies (that I know of) is Pubmed. www.ncbi.nlm.nih.gov/sites/ent... . Your search results can be *VERY* dependent on your exact search terms. But this site usually only provides abstracts of papers, not the original papers themselves. Sometimes they do: check out the icon next to the reference.
Sometimes, after a big Google search, I have been able to find the complete original paper, but it often does not let me access the paper again.
This was a 2006 survey of almost all (?~95%) of the DCIS and LCIS (and nothing worse) cases (ie using the SEER database) in the US from 1988-2001. There were only about 4500 cases of LCIS in the SEER database during this 13 year period. CONCLUSIONS: Screening young DCIS patients more frequently and improving the follow-up care of blacks and Hispanic whites with DCIS may reduce their risk of advanced-stage breast cancer. In addition, LCIS may be a precursor rather than just an ambiguous risk factor for invasive breast cancer, and, therefore, localized treatment for LCIS may be warranted. http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=16604564&ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
Note: I would not be surprised if the 'codename' for 'local treatment' may be local excision, which I think is commonly done after LCIS is found on core biopsy. However, I do not know this for sure.
There are also other papers that suggest LCIS can SOMETIMES be a precursor - based on chromosome studies, such as
Out of a consecutive series of 88 LCIS, nine patients developed IBC (5 ILC and 4 invasive ductal carcinomas) between 2 and 10 years after initial biopsy. For each case, mitochondrial DNA heteroplasmy was analyzed in normal mammary gland epithelia, LCIS and IBC by PCR, direct DNA sequencing and phylogenetic tree clustering. Two cases of LCIS and ILC showed identical patterns of heteroplasmy. In one further case, additional mtDNA mutations were present in the ILC following LCIS. The remaining two cases of ILC and all 4 IDC were clonally unrelated to the previously diagnosed LCIS. While the overall risk for the development of invasive breast cancer following LCIS is relatively low and the majority of cases are clonally unrelated, our data clearly show that some LCIS eventually do progress to ILC. Thus, LCIS represents both an indicator lesion for an increased risk of subsequent invasive breast cancer and in some cases a precursor of ILC. www.ncbi.nlm.nih.gov/sites/ent...
Over the decades, there has been a LOT of controversy about LCIS. Up until about 1990, I think most LCIS was treated by bilat mast. This went out of favor when it was found that early invasive breast cancer could often be treated by lumpectomy + rads.
Thus, lobular neoplasia is a risk factor for invasive breast cancer and may be a precursor lesion in unusual circumstances. The management of ALH and LCIS depends on the setting in which they are encountered. When ALH and LCIS are diagnosed after core needle breast biopsy, wire localization for surgical excision is required for definitive diagnosis because rates of histologic underestimation approach those of atypical ductal hyperplasia (ADH). When diagnosed on surgical biopsy, ALH and LCIS generally do not require further intervention, even when present at a surgical margin. However, bilateral breast cancer risk must be considered, especially when patients have a family history of breast cancer. In selected situations, bilateral prophylactic mastectomy with or without reconstruction may be considered when atypical hyperplasia or LCIS is diagnosed. Although this reduces risk for developing subsequent breast carcinoma by 90%, patients selected for prophylactic mastectomy represent a small subgroup of lobular neoplasia patients and generally have other risk factors, such as strong family history or evidence of genetic predisposition. www.ncbi.nlm.nih.gov/sites/ent...
For example, this 1994 paper thinks LCIS should be treated with observation alone. CONCLUSIONS: Four of 51 women treated with observation alone after diagnosis of LCIS developed breast cancer. All were detected by screening at an early stage. LCIS appeared to be an incidental finding on biopsy of mammographic abnormalities. The policy of observation alone for the finding of LCIS spares women mastectomy. Furthermore, cancers that develop in follow-up are likely to be detected at an early stage and be amenable to curative therapy. Observation alone is appropriate treatment for women with LCIS. www.ncbi.nlm.nih.gov/sites/ent...
I think they have not been ANYWHERE as aggressive about LCIS treatment as DCIS. I think that is because the DEATH rate from LCIS (if it progresses to invasive bc)is low. In this 5 year study of 180 LCIS patients,
Only 2 patients in the cohort (1.1%) succumbed to breast carcinoma; 1 patient had a prior invasive IBTR, and the other patient had an invasive CBTR....CONCLUSIONS: LCIS is a more indolent form of in situ breast carcinoma than DCIS, with which it shares other features of its natural history, particularly very low mortality rates. There is no compelling reason to surgically treat LCIS other than conservatively. The values of other adjuvant modalities in the management of LCIS are discussed. The authors acknowledge that their findings are based on relatively few events and, even at 12 years, may be regarded as "preliminary". Nonetheless, their findings may reflect the true biologic nature of LCIS. Copyright 2003 American Cancer Society. www.ncbi.nlm.nih.gov/sites/ent...
In this earlier study of LCIS from the SEER database 1973-1998 (when PBMs were much more common), RESULTS: The incidence of IBC increased over time from diagnosis of LCIS, with 7.1% +/- 0.5% incidence of IBC at 10 years. IBCs detected after partial mastectomy occurred in either breast (46% ipsilateral and 54% contralateral); however, after mastectomy, most IBCs were contralateral (94.7%). www.ncbi.nlm.nih.gov/sites/ent...
I think some of the hesitations people have of using radiation for LCIS include: a) LCIS is usually multifocal, and often bilateral. Does that mean you'd want bilateral radiation? b) If you gave a person bilateral radiation for LCIS, then *if* they later got DCIS or worse, I don't think you would have the option of using radiation again. I thought (and please correct me if I am wrong) that you can use radiation once.
But note, almost all of the studies I've seen give numbers where the *majority* of women with LCIS and nothing worse, at least if they do not have a bad family history, do *NOT* get bc during their lifetime.
That said, am I terrified of getting breast cancer because of my LCIS (and weak family history)? You bet I am. Women vary a lot. Some of us opt to keep their breasts and go on the 'roller coaster ride' (ie close screening), or take tamoxifen/AI and the 'roller coaster' ride, or some of is choose PBMs. I don't handle the screening well at ALL.
We are all different, and I think YOU should have total control over YOUR choices. It is YOUR body and YOUR life.
I will post more later if I can, but I have several other projects I need to do.