Patient characteristics associated with the decision to undergo bilateral prophylactic mastectomy for lobular carcinoma in situ.

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 148-148 ◽  
Author(s):  
S. Muhsen ◽  
M. J. Junqueira ◽  
A. Park ◽  
J. S. Sung ◽  
S. Patil ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
High Risk ◽  
Carcinoma In Situ ◽  
Prophylactic Mastectomy ◽  
Lobular Carcinoma ◽  
Lobular Carcinoma In Situ ◽  
Bilateral Prophylactic Mastectomy ◽  
Increased Risk

148 Background: Women at increased risk for breast cancer due to a diagnosis of lobular carcinoma in situ (LCIS) have three management options: high risk surveillance +/- chemoprevention (CP) or bilateral prophylactic mastectomy (BPM). Among a large cohort of women with LCIS, we previously reported there were no differences between women choosing CP compared to those choosing surveillance alone. The purpose of this study was to identify patient factors associated with the decision to pursue BPM for LCIS. Methods: We reviewed our prospectively maintained LCIS database to identify women choosing BPM (1995-2009). Comparisons were made between patients who chose BPM versus those who chose high risk surveillance +/- CP. Results: Among 995 pts with LCIS, 795 (80%) chose surveillance alone, 149 (15%) chose CP and 51 (5%) chose BPM. Compared to patients electing surveillance +/- CP patients who pursued BPM were younger at age of LCIS diagnosis (48 vs. 52 yrs, p < 0.001), more likely to have bilateral biopsies with LCIS (14% vs. 3%, p = 0.002) and more likely to be premenopausal (82% vs. 57%, p < 0.001). Patients choosing BPM were also more likely to have additional risk factors for breast cancer including: stronger family histories and extremely dense breasts (Table). Occult breast cancer was found in 4 (8%) BPM patients. At a median follow-up of 54 months (range 0-190 mos), 120/944 (13%) patients in the surveillance +/- CP group developed breast cancer. Conclusions: High-risk surveillance alone is the preferred management option for women with LCIS at our institution. Patients electing BPM are younger and more likely to have other associated risk factors for developing breast cancer. Further research to define how the increased risk imparted by LCIS is augmented by these factors may allow for better risk stratification and more informed discussions with patients. [Table: see text]

scholarly journals Current Concepts in Diagnosis, Molecular Features, and Management of Lobular Carcinoma In Situ of the Breast With a Discussion of Morphologic Variants

2017 ◽  
Vol 141 (12) ◽  
pp. 1668-1678 ◽  
Author(s):  
Paula S. Ginter ◽  
Timothy M. D'Alfonso
Keyword(s):  
Breast Cancer ◽  
Carcinoma In Situ ◽  
Invasive Carcinoma ◽  
Lobular Carcinoma ◽  
Lobular Carcinoma In Situ ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Molecular Features ◽  
Increased Risk

Context.—Lobular carcinoma in situ (LCIS) refers to a neoplastic proliferation of cells that characteristically shows loss of E-cadherin expression and has long been regarded as a risk factor for invasive breast cancer. Long-term outcome studies and molecular data have also implicated LCIS as a nonobligate precursor to invasive carcinoma. In the past few decades, pleomorphic and florid LCIS have been recognized as morphologic variants of LCIS with more-aggressive histopathologic features, less-favorable biomarker profiles, and more-complex molecular features compared with classic LCIS. There is still a lack of consensus regarding certain aspects of managing patients with LCIS.Objectives.—To review recently published literature on LCIS and to provide an overview of the current morphologic classification of LCIS, recent molecular advances, and trends in patient management.Data Sources.—Sources included peer-reviewed, published journal articles in PubMed (US National Library of Medicine, Bethesda, Maryland) and published guidelines from the National Comprehensive Cancer Network (Fort Washington, Pennsylvania).Conclusions.—Lobular carcinoma in situ represents a marker for increased risk of breast cancer, as well as a nonobligate precursor to invasive carcinoma. Morphologic variants of LCIS—florid and pleomorphic LCIS—are genetically more-complex lesions and are more likely to be associated with invasive carcinoma. Further investigation into which molecular alterations in LCIS are associated with progression to invasive carcinoma is needed to help guide medical and surgical management.

Bilateral Risk for Subsequent Breast Cancer After Lobular Carcinoma-In-Situ: Analysis of Surveillance, Epidemiology, and End Results Data

2005 ◽  
Vol 23 (24) ◽  
pp. 5534-5541 ◽  
Author(s):  
Paul J. Chuba ◽  
Merlin R. Hamre ◽  
Johnny Yap ◽  
Richard K. Severson ◽  
David Lucas ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Carcinoma In Situ ◽  
Lobular Carcinoma ◽  
Incidence Rates ◽  
Partial Mastectomy ◽  
Lobular Carcinoma In Situ ◽  
Time Period ◽  
Increased Risk ◽  
End Results

Purpose Noninvasive lesions involving the lobules of the breast are increasingly diagnosed as incidental microscopic findings at the time of lumpectomy or core-needle biopsy. We investigated the incidence rates of invasive breast cancer (IBC) after a diagnosis of lobular carcinoma-in-situ (LCIS) by using Surveillance, Epidemiology, and End Results (SEER) data. Patients and Methods Patients (N = 4,853) having a diagnosis of primary LCIS in the time period of 1973 to 1998 were identified using the SEER Public Use CD-ROM data. The database was then searched for patients with subsequent primary IBC occurrences (n = 350). The clinical and pathologic characteristics of patients with subsequent primary IBCs were compared with the characteristics of patients with primary IBCs attained during the same time period (N = 255,114). 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%). IBCs occurring after LCIS more often represented invasive lobular histology (23.1%) compared with primary IBCs (6.5%). The standardized incidence ratio (the ratio of observed to expected cases) for developing IBC was 2.4 (95% CI, 2.1 to 2.6) adjusted for age and year of diagnosis. Conclusion LCIS is associated with increased risk of subsequent invasive disease, with equal predisposition in either breast. The minimum risk of developing IBC after LCIS is 7.1% at 10 years.

Outcomes of Tamoxifen Chemoprevention for Breast Cancer in Very High-Risk Women: A Cost-Effectiveness Analysis

2002 ◽  
Vol 20 (1) ◽  
pp. 9-16 ◽  
Author(s):  
Dawn Hershman ◽  
Vijaya Sundararajan ◽  
Judith S. Jacobson ◽  
Daniel F. Heitjan ◽  
Alfred I. Neugut ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Carcinoma In Situ ◽  
Lobular Carcinoma ◽  
Cost Effective ◽  
Risk Groups ◽  
Atypical Hyperplasia ◽  
Lobular Carcinoma In Situ ◽  
Very High

PURPOSE: To estimate the effects on survival, quality-adjusted survival, and health care costs of using tamoxifen for primary prevention in subgroups of women at very high risk for breast cancer. PATIENTS AND METHODS: A decision analysis was performed using a hypothetical cohort of women that included subgroups with atypical hyperplasia, Gail risk greater than 5, lobular carcinoma-in-situ, or two or more first-degree relatives with breast cancer. Data sources were the Breast Cancer Prevention Trial, the Surveillance, Epidemiology, and End-Results program, time trade-off preference ratings, the Group Health Cooperative of Puget Sound, and the United States Health Care Financing Administration. RESULTS: Our model predicted that tamoxifen would prolong the average survival of cohort members initiating use at ages 35, 50, and 60 years by 70, 42, and 27 days, respectively. It would prolong survival even more for those in the higher-risk groups, especially those with atypical hyperplasia (202, 89, and 45 days). Tamoxifen use was also projected to extend quality-adjusted survival by 158, 80, and 50 days in the atypical hyperplasia group. For younger women in the highest risk groups, chemoprevention with tamoxifen was estimated to have cost savings or be cost-effective, both with and without quality adjustments. CONCLUSION: Chemoprevention with tamoxifen may be particularly beneficial to women with atypical hyperplasia, 5-year Gail model risk greater than 5%, lobular carcinoma-in-situ, or two or more first-degree relatives with breast cancer. The benefits may be greater if tamoxifen is initiated before age 50 years rather than after and if the breast cancer risk reduction conferred by tamoxifen lasts longer than 5 years. For women with a very high risk of invasive breast cancer, chemoprevention with tamoxifen seems to be cost-effective.

The Pathologic Finding of Combined Lobular Carcinoma in Situ and Invasive Lobular Cancer May Indicate more than Just a High-Risk Marker Role of Lobular Carcinoma in Situ

2017 ◽  
Vol 83 (5) ◽  
pp. 482-485
Author(s):  
Christopher J. Jean-Louis ◽  
Joshua Masdon ◽  
Betsy Smith ◽  
Oscar Battles ◽  
Paul Dale
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Tumor Size ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Lobular Carcinoma ◽  
Risk Marker ◽  
Mixed Group ◽  
Lobular Carcinoma In Situ

For years, lobular carcinoma in situ (LCIS) has been considered a high-risk marker for developing breast cancer. It is well known that ductal carcinoma in situ is a precursor for the development of invasive ductal carcinoma, and ductal carcinoma in situ is reported to be present in invasive ductal carcinoma in at least 40 per cent of cases. A similar relationship between LCIS and invasive lobular carcinoma (ILC) remains in question. This study evaluates the incidence of synchronous LCIS and ILC at our institution. This is a retrospective review of our tumor registry database of women diagnosed with LCIS or ILC from 2000 to 2014. Pathology reports were evaluated to determine the incidence of pure ILC and mixed ILC/LCIS. Those with both LCIS/ILC (mixed group) and those with pure ILC (pure group) were compared for age, surgical intervention, lymph node involvement, tumor size, nuclear grade, and margins between these two groups. A total of 182 women were identified with LCIS, ILC, or mixed LCIS and ILC. There were76 subjects with pure ILC and 90 with mixed LCIS and ILC. The median and age range for each group were 63.6 (range: 40–97) for the mixed and 64.1 (range: 40–86) for pure groups. Tumor size was evaluated for each group and the median tumor size was 2.5 cm (range: 0.1–7.0cm) for the mixed group and 3.0 cm (range: 0.5–12.5 cm) for the pure group. Nodal involvement was present in 35.23 per cent of the mixed group and 46.3 per cent in the pure group. Surgical treatment for each group was similar, with mastectomy being the preferred surgical option over breast conservation therapy in the mixed and pure groups, 67.07 and 64.71 per cent, respectively. Presently, LCIS is considered a marker, or risk factor, for development of future breast cancer. This retrospective study does identify a strong relationship, 54 per cent, between LCIS and ILC at diagnosis. This high percentage of concurrent LCIS and ILC in surgical/ pathological specimens supports the notion that LCIS may in fact have a precursory role in development of invasive lobular carcinoma of the breast. Additional studies to further investigate this relationship between LCIS and ILC, including genomic analysis, are presently underway.

scholarly journals Breast cancer prevention strategies in lobular carcinoma in situ: A decision analysis

Cancer ◽  
2017 ◽  
Vol 123 (14) ◽  
pp. 2609-2617 ◽  
Author(s):  
Stephanie M. Wong ◽  
Natasha K. Stout ◽  
Rinaa S. Punglia ◽  
Ipshita Prakash ◽  
Yasuaki Sagara ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Analysis ◽  
Cancer Prevention ◽  
Carcinoma In Situ ◽  
Lobular Carcinoma ◽  
Breast Cancer Prevention ◽  
Prevention Strategies ◽  
Lobular Carcinoma In Situ

scholarly journals Breast cancer risk associated with atypical hyperplasia and lobular carcinoma in situ initially diagnosed on core-needle biopsy

Cancer ◽  
2017 ◽  
Vol 124 (3) ◽  
pp. 459-465 ◽  
Author(s):  
Alana R. Donaldson ◽  
Caitlin McCarthy ◽  
Shazia Goraya ◽  
Holly J. Pederson ◽  
Charles D. Sturgis ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Cancer Risk ◽  
Cancer Risk ◽  
Needle Biopsy ◽  
Carcinoma In Situ ◽  
Lobular Carcinoma ◽  
Atypical Hyperplasia ◽  
Lobular Carcinoma In Situ ◽  
Core Needle
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