Treatments for Early Breast Cancer
I am going to briefly go through the general management of three types of breast cancer because they are all unique in how to be managed. The first is lobular carcinoma in situ, then ductal carcinoma in situ and then invasive cancer. Lobular carcinoma in situ is classically defined as abnormal cells in the lobules and someone argued that this is really not a cancer at all. We would consider this to be sort of a risky breast. It makes up about one-third of all in situ lesions, it classically is more common in premenopausal women, it is an incidental finding, the mammogram is normal, and lobular carcinoma in situ is found when a biopsy is done for another reason, 40 to 80% of LCIS is multicentric, meaning if you biopsied the rest of the breast, you would find LCIS in about 40 to 80% of women, and 20 to 70% of patient’s it’s bilateral. In the old days they used to do a mirror biopsy, about 70% of the time they would find LCIS in the other breast and this is very important when you are considering appropriate management, 10 to 40% of women if followed long enough will eventually develop an infiltrating ductal carcinoma, not an infiltrating lobular carcinoma. The actual risk of developing an infiltrating cancer is about 1% per year. This is a classic histological photograph of a lobular carcinoma in situ and you can see that the lobule remains very well defined. The membrane is intact but it’s full of these atypical cells. Treatment options for lobular carcinoma in situ are basically two. After a bilateral mammogram which is usually done, and something else is found and a biopsy is performed, you find the diagnosis of lobular carcinoma in situ. If that is your only histologic finding, the patient has two choices, one is observation, nothing more needs to be done, with or without discussion about tamoxifen as we will discuss in the chemo prevention trial.
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Bilateral mastectomy, not unilateral but bilateral mastectomy used to be a very common procedure for LCIS because it treats both breasts, but this is an extreme procedure for a noninvasive, non life threatening condition of the breast, so bilateral mastectomy is usually reserved for women with either very high levels of anxiety or a very strong family risk.