Lobular carcinoma in situ (LCIS)

LCIS Back to top

Lobular carcinoma in situ is not a cancer, but women who have LCIS have an increased risk of developing breast cancer| in the future. Even so, most women with LCIS don't develop breast cancer.

LCIS may be in one or both breasts|. The risk of developing cancer is the same for both breasts, regardless of which breast LCIS is found in.

Each breast contains hundreds of tiny lobules where milk is produced (see diagram below). With LCIS, there are changes in the cells lining the lobules (or lobes) of the breast. It's often present in both breasts. LCIS is more common in women who have not reached their menopause (the time in a woman’s life when she stops having periods).

 

How it's diagnosed Back to top

LCIS doesn't show up on a mammogram| (breast x-ray). It's usually discovered by chance , when a sample of breast tissue is taken and examined under a microscope (biopsy|) or when a breast lump is removed.

If you've had a fine needle aspiration| or a core needle biopsy| (when the doctor used a needle to take a small piece of tissue from the abnormal area), you may need an operation to remove a larger area of tissue. This is called an excision biopsy|. It may be done to make sure that there are no other changes within the breast tissue, such as precancerous changes (called DCIS|) or an invasive cancer.

Excision biopsy

The abnormal area is removed under a general or local anaesthetic and sent to a laboratory for examination under a microscope. This may mean an overnight stay in hospital, but in some hospitals it's done as day surgery.

If a lump is too small to be felt but has shown up on an ultrasound, the radiologist may need to mark the area for the surgeon before the excision biopsy. This is done by inserting a very small wire (a guide wire) under local anaesthetic, using x-ray or ultrasound guidance. The procedure is known as wire localisation.  

Treatment Back to top

Women don't usually need any treatment when LCIS is diagnosed. And, because the majority of women with LCIS don't develop breast cancer, most will never need treatment. 

Breast screening

Doctors recommend that women with LCIS have breast examinations every 6–12 months and mammograms every 1–2 years. This is so that if there are any changes in the breast|, they can be detected at the earliest stage and treated if appropriate. How often you are seen or have a mammogram varies. Your doctors will tell you what to expect.

Hormonal therapy

A recent research study found that the hormonal therapy tamoxifen| can reduce the risk of breast cancer developing in women with LCIS. But it's still not clear whether the benefits of taking it outweigh the possible risks and side effects it can cause.

A second research trial is being carried out, known as IBIS2. This will look at whether another type of hormonal therapy, called anastrozole| (Arimidex®), can also reduce the risk of breast cancer developing in post-menopausal women who have an increased risk. This trial includes women with LCIS. You can ask your doctor if your local breast unit is involved in this trial. 

Surgery

Rarely, a woman with LCIS may decide to have both breasts removed (bilateral mastectomy|). This tends to happen where there is a strong family history| of breast cancer or the woman is extremely anxious about her risk of developing breast cancer.

Research trials Back to top

Research into treatments for LCIS is ongoing, and advances are being made. Cancer doctors use clinical trials| to assess new treatments. Before any trial is allowed to take place, an ethics committee must approve it and agree that the trial is in the interest of patients.

You may be asked to take part in a clinical trial. Your doctor must discuss the treatment with you so that you have a full understanding of the trial and what it involves. You may decide not to take part, or to withdraw from a trial at any stage.

Your feelings Back to top

You may experience many different emotions|, including anger, resentment, guilt, anxiety and fear. These are all normal reactions and are part of the process many people go through in trying to come to terms with their illness.

References Back to top

This section has been compiled using information from a number of reliable sources, including:

• UpToDate. Lobular carcinoma in situ. (accessed 4 July 2010).
• Improving Outcomes in Breast Cancer – The Research Evidence. 2002. National Institute for Health and Clinical Excellence (NICE).