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November 21, 2011

UPDATE: LCIS from Dr. Susan Love...

Note:  If you haven't read my 5-part series posting on the subject of LCIS go to 'Archives' dated:
Part 1:  Jan 8, 2011
Part 2:  Jan 30
Part 3:  Feb 14
Part 4:  Mar 23
Part 5:  Aug 16

Dr Susan Love's website:
Under the microscope, LCIS appears as a bunch of small, round cells stuffing the lobules, which normally don't contain any cells. (See diagram.)


If there are only a few cells and they're not too odd-looking, you have lobular hyperplasia. if they fill the whole lobule and look very atypical (odd), you have LCIS. We thought we understood the natural history of LCIS, but new information has challenged our previous ideas.

The old theory was that LCIS doesn't grow into cancer but signals a possible danger—the way, for example, an overcast day warns you it may rain. Because of this, many experts believed that LCIS wasn't, in fact, a true precancer but more of a risk factor. Recent studies, however, suggest that this may not be the case. 

The first piece of evidence that LCIS can actually progress to invasive lobular cancer came from a 2004 analysis of 180 women who had participated in a study of the National Surgical Breast and Bowel Project. After 12 years of follow-up, this study showed that nine (5 percent) women developed invasive breast cancers in the same breast as the LCIS, and that eight of the nine (89 percent) were invasive lobular cancers—in the same area as the original LCIS.

A second piece of evidence was a study of women who had both LCIS and invasive lobular cancer in the same breast. The pattern of mutations in the involved cells was very similar, suggesting that one had indeed evolved from the other. More recently, molecular studies have shown that both LCIS and infiltrating lobular cancers are estrogen-receptor positive (ER+), HER2-negative, and lack expression of a protein called E- cadherin. (The E-cadherin protein helps cells stick together, and its absence may help explain why lobular cancers don't cling together in a nice lump but march cell by cell through the stroma in single file lines forming a diffuse pattern that is often difficult to detect.) 

The presence of LCIS increases the risk of breast cancer over that of the average woman by about 1 percent per year for the next 30 years. Even so, the vast majority of women diagnosed with LCIS will never get breast cancer. For this reason, the standard treatment for LCIS is close follow-up. However, there are treatment options a woman can consider. You can learn more about treatment options for LCIS here.

The Last Word:  If you want the whole story on LCIS, go to Dr. Love's official site. I've only included the relevant information here, from the updated study that also appears in the 5th edition of Dr. Susan Love's Breast Book.  
Chapters:  (Look Inside Feature)


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