A rare breast condition that causes abnormal cells to appear in the lobules (the glands that produce milk) is called lobular carcinoma in situ (LCIS). While LCIS is not cancer, it significantly increases the risk of developing it. Physicians usually treat this condition with medicines and surgery (sometimes).
In other words, LCIS is a benign (noncancerous) condition that negatively affects the lobules. Furthermore, this condition increases the risk of breast cancer from 7 to 10 times. Usually, the increased risk applies to both breasts. Typically, the breast cancer risk is about 1% to 2% each year.
Most people with LCIS do not develop breast cancer, but they often need regular cancer screenings to find it in the early stages.
Types of LCIS
Physicians have divided this disorder into 3 categories based on how abnormal cells appear under a microscope. These include:
- Classic LCIS – This type causes abnormal cells that fill and expand some lobules but do not spread to nearby tissues.
- Pleomorphic LCIS – In this case, the affected cells are irregular and abnormally large, but still stay in the place where they appeared.
- Florid LCIS – The last type of this condition causes abnormal cells to form a mass in the lobules.
What Are The Symptoms of LCIS?
Sometimes, people with LCIS do not have any symptoms. In the most advanced stages, people with this condition may experience the following symptoms, which usually require immediate medical attention. Examples include:
- New or persistent breast lump, thickening, or hardened area
- Skin changes (these include dimpling, puckering, redness, or an orange-peel texture)
- A nipple that pulls to one side
- Spontaneous, clear, or bloody discharge from the nipple
If you have symptoms that resemble LCIS or breast cancer, immediately contact your healthcare professional. Detecting either LCIS or breast cancer in the early stages increases the cure chances.
Causes and Risk Factors
While most people with LCIS have some genetic changes that cause abnormal cells in their lobules, doctors do not fully understand what exactly triggers these changes. In any case, they have identified some factors that could increase the risk of developing LCIS. Examples include:
- Menstrual history – When menstruation starts early, or menopause begins late, it may increase the risk of LCIS.
- Pregnancy and childbirth – never having been pregnant or having the first child after 30 years old.
- Menopausal hormone therapy (HRT) – Women who use combined Estrogen and progestin therapy for more than 3 years are also at increased risk for LCIS.
- Family history – If you have a family history of breast cancer (including parents, siblings, or children), the risk significantly increases.
- Gene mutations – According to some research, a mutation in the CDH1 gene or BRCA2 gene significantly increases the risk of developing LCIS.
- Dense breast tissue – Women who have dense breast tissue that can be seen on a mammogram are also at increased risk.
- Poor lifestyle habits – These include smoking, misuse of alcoholic drinks, poor diet, and others.
Complications
People who develop LCIS are at increased risk of developing breast cancer, especially if the condition is left untreated. However, doctors may recommend some options to reduce the risk in those who develop LCIS. For example, medicines (such as Tamoxifen or Raloxifene) that help block the effects of Estrogen and reduce cancer risk, and preventive surgery used in people with a family history of breast cancer. Unfortunately, surgery may cause some adverse reactions. Examples include chronic (long-term) pain, infections, bleeding, and others.
Diagnosis
Most of the time, LCIS is found accidentally during tests used for other purposes. For instance, doctors may diagnose this condition during a breast biopsy. It means they find abnormal cells in the lobules while testing you for another condition. Once the condition is diagnosed, doctors may perform additional imaging tests and recommend surgery to remove these abnormal cells, especially if the biopsy and imaging studies do not fully match or you have pleomorphic or florid LCIS.
What Can I Expect if I Have LCIS?
Typically, the prognosis of this condition varies among people because it depends on several factors. These include whether you have a family history of breast cancer, the type of LCIS, age, and your response to treatment. Furthermore, a recent study has suggested that LCIS increases the risk of breast cancer over time. For example, after 5 years of LCIS, the risk of developing breast cancer increases by 7%.
Treatment
Commonly, doctors prescribe different treatment options for people with LCIS. Check below some options often recommended by doctors for people with LCIS:
Active Surveillance
This option involves regular checkups and breast examinations. Doctors often perform them every 6 months and a mammogram once per year. Sometimes, they may also perform a breast MRI (magnetic resonance imaging) scan to get detailed images of breast tissue.
Preventive Therapy
The following treatment options are used to reduce the risk of developing breast cancer. Check some examples below:
- Aromatase inhibitors
- Selective estrogen receptor modulators (SERMs) – Healthcare professionals recommend this treatment for people with an increased risk of ER-positive breast cancer.
Surgery
Doctors often prescribe this treatment if you have pleomorphic or florid LCIS. These types often grow more quickly compared to the classic type. That’s why the removal of abnormal cells is required. They often recommend:
- Lumpectomy – This type of surgery helps remove abnormal cells. During this procedure, surgeons will also remove a small amount of healthy tissue to make sure there are no remaining abnormal cells.
- Bilateral mastectomy – It is used to remove both breasts. While it is rarely used in people with LCIS, doctors recommend it when a person has a strong family history of breast cancer.
Frequently Asked Questions
Is LCIS considered breast cancer?
No. LCIS (lobular carcinoma in situ) is not breast cancer. It is a noncancerous condition in which abnormal cells develop inside the milk-producing lobules of the breast. However, it is considered a marker of increased breast cancer risk because people with LCIS are more likely to develop breast cancer in the future.
What is the difference between LCIS and ductal carcinoma in situ (DCIS)?
LCIS begins in the lobules of the breast and is generally viewed as a risk indicator rather than a true cancer. DCIS begins in the milk ducts and is considered a noninvasive breast cancer that may progress if untreated. Because of this difference, treatment and follow-up recommendations often vary between LCIS and DCIS.
Can LCIS turn into invasive breast cancer?
LCIS itself usually stays confined to the lobules, but it is associated with a higher chance of developing invasive breast cancer later. The future cancer may occur in either breast and may be either lobular or ductal in type.
How is LCIS usually discovered?
Most people do not notice symptoms. LCIS is often found incidentally during a breast biopsy performed for another reason, such as a mammogram or a breast lump that needs evaluation.
Will I need surgery if I have LCIS?
Not always. Many people with classic LCIS are managed with active surveillance and regular screening. Surgery is more commonly recommended for pleomorphic LCIS or florid LCIS, or when biopsy findings and imaging results do not match.
How often should I be screened after an LCIS diagnosis?
Screening plans vary, but many healthcare providers recommend clinical breast examinations every 6 to 12 months and a mammogram once a year. Some people at higher risk may also need breast MRI scans for additional monitoring.
Can lifestyle changes help reduce my breast cancer risk?
Yes. While lifestyle changes cannot eliminate the risk completely, they may help lower it. Helpful steps include:
- Maintaining a healthy weight
- Exercising regularly
- Limiting alcohol intake
- Avoiding smoking
- Eating a balanced diet rich in fruits, vegetables, and whole grains
Are medications available to reduce breast cancer risk in people with LCIS?
Yes. Doctors may prescribe risk-reducing medications such as Tamoxifen, Raloxifene, or aromatase inhibitors for certain people. These medicines can lower the risk of developing hormone receptor-positive breast cancer.
Does having LCIS mean my family members will also develop it?
Not necessarily. Although a family history of breast cancer can increase the likelihood of LCIS and breast cancer, most family members of someone with LCIS will not automatically develop the condition. Genetic counseling may be recommended if there is a strong family history or a known gene mutation.
What symptoms require prompt medical attention?
Contact your healthcare provider promptly if you notice any of the following symptoms. For example:
- A new breast lump
- Persistent thickening or hardening
- Skin dimpling or redness
- Changes in the nipple, including pulling inward
- Clear or bloody nipple discharge
- Any new breast change that does not go away
These symptoms do not always mean cancer is present, but they should be evaluated as soon as possible. Ask your healthcare provider if you have any other questions.
