I found this 2017 blog post by Dr. Alan Hollingsworth that I thought was interesting food for thought and thought I would share it, in case others haven't seen it. There's more in his post, if this sample piques your interest.
In 2017, apparently the American Joint Committee on Cancer (AJCC) came out with a new 8th edition of the AJCC Cancer Staging Manual, and LCIS has been downgraded to a benign lesion. The author of this blog questions that decision:
"But is there really that much difference between LCIS and low/moderate grade DCIS? Both have approximately the same future risk for invasive breast cancer, with perhaps the only difference being the unpredictable location of that event for LCIS patients. But in terms of threat to a patient's life? Not much difference."
"Under the new system, a 1.0cm low grade DCIS will still be called Stage 0 "cancer," but a 5.0cm area of pleomorphic LCIS, far more threatening to the patient, will be nothing more than a pitiful Pluto trying to sweep clean its orbit in order to get reinstated. The breast cancer expert panel that took the most revolutionary steps ever in the new 8th edition of AJCC staging gave a nod to pleomorphic LCIS as a distinct entity in the text of their opinion, but one gets the impression that the broad array of LCIS presentations was simply too much to handle, especially when these more ominous sub-types of LCIS are relatively rare."
"It may be an oversimplification to designate all non-classical LCIS as "pleomorphic." Of course, many sites on the internet don't even bother with this basic distinction, calling all LCIS a mere "tissue risk" with a 15% chance for future breast cancer (true, if we're only talking about the next 10-15 years). But I think the pendulum swung too far, largely because so many cases of LCIS would be called ALH on review. With ALH, the "tissue risk" moniker applies, with implications indistinguishable from ADH when considering long-term estimates for developing invasive breast cancer."
"Anyway, many years ago, Dr. David Page attempted to define what made certain instances of LCIS more of a threat for invasion, and his most consistent finding was in the qualitative aspect (not so much in the amount of LCIS). That is, when acinar units are so bloated with cells that they appear to be on the verge of exploding (my description), the risk of future invasive cancer is higher, even if the finding is only present on a single slide, single focus."
"Indeed, modern reviews of natural history, such as the recent landmark effort recently by Tari King, et al ( J Clin Oncol 2015; 33:3945-3952) are more restrictive to clear-cut cases of LCIS. In Dr. King's analysis of 1,004 patients opting for surveillance after a diagnosis of LCIS at Memorial Sloan-Kettering, the calculated future risk (including development of DCIS ) was a 2% annual incidence, much higher than the 1% per year commonly quoted. In addition, the future cancer occurred on the same side as the LCIS in 63%, plus an additional 12% were bilateral. Invasive lobular cancer was the culprit in 27% of patients, disproportionate to the 5-10% of lobulars in the general population. All of this points to non-obligated precursor behavior, not simple "tissue risk" as one sees with ALH, ADH and, to a lesser extent, other proliferative pathologies."
7/28/2017, LCIS, Right
7/28/2017 Lumpectomy: Right
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