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Breast anatomy

Although it sounds like cancer, lobular carcinoma in situ (LCIS) is actually an indicator that you have a higher chance of developing breast cancer in the future. LCIS is an area of abnormal tissue growth that occurs within — and stays within — the lobules or milk glands located at the end of the breast ducts.

LCIS usually doesn't show up on mammograms. The condition is most often discovered as a result of a biopsy done for another reason, such as a suspicious breast lump or an abnormal mammogram.

Women with LCIS have a 10 to 20 percent lifetime risk of developing invasive breast cancer in either breast. Fortunately, effective screening and treatment options are available to reduce the risk of invasive breast cancer in women with LCIS.

You won't be able to detect anything unusual if you have lobular carcinoma in situ (LCIS). The condition isn't associated with any signs or symptoms. Rather, your doctor might discover that you have LCIS incidentally — for instance, after a biopsy to assess a breast lump or an abnormal area found on a mammogram.

When to see a doctor
Lobular carcinoma in situ (LCIS) is diagnosed most often in women in their 40s, but it can also be diagnosed in older women. Follow recommended guidelines for your age group for clinical breast exams and mammography. If you're not sure, ask your doctor how often you should be screened for breast cancer.

And, of course, anytime you notice a change in your breasts, such as a lump, an area of puckered or otherwise unusual skin, a thickened region under the skin, or nipple discharge, contact your doctor to have it evaluated. Such breast changes could be indicators of more-serious problems, including breast cancer.

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Breast anatomy

LCIS begins as an abnormal growth of cells in a milk-producing gland of the breast (lobule). The growth remains in place in the lobule and doesn't extend into, or invade, nearby breast tissue. However, having LCIS puts you at increased risk and makes it more likely that you could develop invasive breast cancer.

Experts don't know if LCIS results from genetic mutations that occur during the course of your lifetime. Also, it's unclear whether there's an association between LCIS and a family history of breast cancer or environmental or hormonal exposures. So far, no specific genes, such as BRCA1 or BRCA2, have been linked to the development of LCIS.

If you notice a lump or any other unusual changes in your breasts, make an appointment with your doctor.

If you have already had a breast abnormality evaluated by one doctor and are making an appointment for a second opinion, bring your original diagnostic images and biopsy results to your new appointment. These should include your mammography films, ultrasound CD and glass slides from your breast biopsy. Hand-carry these results to your new appointment or request that the office where your first evaluation was performed send the results to your second-opinion doctor.

Here's some information to help you get ready for your appointment, and what to expect from the doctor.

What you can do

• Write down any symptoms you're experiencing, and for how long. If you have a lump, your doctor will want to know when you first noticed it and whether it seems to have grown.
• Write down your medical history, including details about prior breast biopsies or benign breast conditions with which you've been diagnosed. Also mention any radiation therapy you may have received, even years ago.
• Note any family history of breast cancer, especially in a first-degree relative, such as your mother or sister. Your doctor will want to know how old your relative was when she was diagnosed, as well as the type of breast cancer she had.
• Make a list of your medications. Include any prescription or over-the-counter medications you're taking, as well as all vitamins, supplements or herbal remedies. If you're currently taking or have previously taken hormone replacement therapy, share this with your doctor.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to talk about in depth. Your doctor may ask:

• Do you have a breast lump that you can feel?
• When did you first notice this lump?
• Has the lump grown or changed over time?
• Have you noticed any other unusual changes in your breast, such as discharge, swelling or pain?
• Have you gone through menopause?
• Are you using or have you used any medications or supplements to relieve the symptoms of menopause?
• Have you been diagnosed with any previous breast conditions, including noncancerous conditions?
• Have you been diagnosed with any other medical conditions?
• Do you have any family history of breast cancer?
• Have you or your close female relatives ever been tested for the BRCA gene mutations?
• Have you ever had radiation therapy?
• What is your typical daily diet, including alcohol intake?
• Are you physically active?

If your biopsy reveals LCIS, you'll likely have a follow-up appointment with your doctor. Below are some basic questions to ask your doctor about LCIS. If any additional questions occur to you during your visit, don't hesitate to ask.

• How much does LCIS increase my risk of breast cancer?
• Do I have any additional risk factors for breast cancer?
• How often should I be screened for breast cancer?
• What types of screening technology will be most effective in my case?
• Am I a candidate for medications that reduce the risk of breast cancer?
• What are the possible side effects or complications of these medications?
• Which drug do you recommend for me, and why?
• How will you monitor me for treatment side effects?
• Am I a candidate for preventive surgery?
• In general, how effective is the treatment you're recommending in women with a diagnosis similar to mine?
• What lifestyle changes can help reduce my risk of a cancer recurrence?
• Do I need a second opinion?
• Should I see a genetic counselor?

Lobular carcinoma in situ (LCIS) may be present in one or both breasts, but usually isn't visible on a mammogram. The condition is most often diagnosed as an incidental finding when you have a biopsy done to evaluate some other area of concern in your breast.

Types of breast biopsy that may be used include:

• Fine-needle aspiration biopsy. Your doctor directs a very fine needle into the breast lump. Next, your doctor uses a syringe attached to the needle to collect a sample of cells or fluid for examination.
• Core needle biopsy. A radiologist or surgeon uses a thin, hollow needle to remove several tiny tissue samples from the breast mass. Imaging techniques, such as mammography, ultrasound or MRI, are often used to help guide the needle used in a core needle biopsy.
• Surgical biopsy. A surgeon removes either a portion of the breast lump (incisional biopsy) or the entire breast lump (excisional biopsy, wide local excision or lumpectomy) for examination.

A number of factors, including your personal preferences, come into play when you decide whether to undergo treatment for lobular carcinoma in situ (LCIS). There are three main approaches to treatment: careful observation, taking a medication to reduce cancer risk (chemoprevention) or preventive surgery.

Observation
If you've been diagnosed with LCIS, it's unlikely you'll develop invasive breast cancer during the first five years after your diagnosis. So it may be reasonable to choose to do nothing other than closely monitor your breasts, including:

• Frequent breast self-exams to develop breast familiarity and to detect any unusual breast changes
• Clinical breast exams at least twice a year
• Screening mammograms every year
• Other imaging techniques, such as magnetic resonance imaging (MRI), if you have other risk factors and a strong family history of breast cancer

Chemoprevention
Two selective estrogen receptor modulator (SERM) drugs are approved to reduce the risk of invasive breast cancer. Both drugs work by blocking breast tissue's receptivity to estrogen, which influences the development and growth of many breast tumors.

• Tamoxifen (Nolvadex). Tamoxifen has been shown to significantly reduce the risk of developing invasive breast cancer. Like all SERMs, the drug is effective only against cancers that grow in response to hormones (hormone receptor positive cancers). Most cases of LCIS are hormone-receptor positive. Tamoxifen can be used by both premenopausal and postmenopausal women. You can take tamoxifen for a total of five years, so planning when to take the drug is a key issue for you to discuss with your doctor.

  Tamoxifen slightly increases the risk of serious conditions including uterine cancer, stroke and cataracts, as well as side effects such as hot flashes and vaginal dryness. Tamoxifen also increases the risk of blood clots in postmenopausal women. If you take tamoxifen, your doctor will need to see you every six to 12 months to monitor for health problems associated with this drug.

• Raloxifene (Evista). Originally developed to prevent and treat osteoporosis, raloxifene is also approved to reduce the risk of invasive breast cancer in high-risk postmenopausal women, including those with LCIS. Results from the Study of Tamoxifen and Raloxifene (STAR) trial show raloxifene to be as effective as tamoxifen in reducing risk of invasive breast cancer in postmenopausal women. Raloxifene is linked to fewer cases of uterine cancer, blood clots and stroke than tamoxifen, but is otherwise associated with similar health risks. Women who have multiple risk factors for heart disease or have a history of heart disease should not take raloxifene.

Discuss with your doctor the risks and benefits of taking a drug for breast cancer prevention to see if it's the best course of treatment for you.

Preventive surgery
One other option for treating LCIS is preventive (prophylactic) mastectomy. This surgery removes both breasts — not just the breast affected with LCIS — to reduce your risk of developing invasive breast cancer. To obtain the best possible protective benefit from this surgery, both breasts are removed because LCIS increases your risk of developing breast cancer in either breast. Preventive surgery may be an option for you if you're at high risk of breast cancer based on your family history or a BRCA gene mutation. Surgery to treat LCIS isn't urgent, so take time to carefully weigh the pros and cons of preventive mastectomy with your doctor.

Clinical trials
If you have LCIS, you might consider participating in a clinical trial exploring an emerging therapy for preventing breast cancer. Your doctor can help you find out more about clinical trials and help determine whether you'd be a candidate.

Although LCIS is not cancer, it can be difficult to cope with a diagnosis that signals you are at increased risk of a future breast cancer. Because most cases of invasive breast cancer that follow LCIS don't develop for 10 or more years, you'll need a long-term way to manage your fear and uncertainty.

These suggestions may help you cope with a diagnosis of LCIS:

• Make a plan for prevention. Try to think of your diagnosis as a benefit to your health. Because you know you are at increased risk of breast cancer, you can take action to prevent this disease or catch it in its earliest, most treatable stages. Work with your doctor to plan a more frequent breast cancer screening schedule, and stick with your appointments. Talk with your doctor about the benefits and risks of the drugs tamoxifen and raloxifene, which are proven to reduce the risk of invasive breast cancer. Stay current about the latest medical options for preventing LCIS-related breast cancer. There are excellent books on breast cancer and many reputable resources on the Internet.
• Continue with follow-up and screening. LCIS is a marker for increased risk of breast cancer later in your life, so close follow-up and screening is important. However, you do have time to sort through your emotions and treatment options.