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Treatments and drugs
By Mayo Clinic staffA 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.
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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.
- Sabel MS. Lobular carcinoma in situ. http://www.uptodate.com/home/index.html. Accessed May 9, 2009.
- Ableoff MD, et al. Cancer of the breast. In: Abeloff MD, et al. Abeloff's Clinical Oncology. 4th ed. Philadelphia, Pa.: Churchill Livingstone; 2008. http://www.mdconsult.com/das/book/body/136909859-11/840302961/1709/129.html#4-u1.0-B978-0-443-06694-8..50099-3_4050. Accessed May 9, 2009.
- LCIS — lobular carcinoma in situ. Breastcancer.org. http://www.breastcancer.org/symptoms/types/lcis/index.jsp. Accessed May 9, 2009.
- Can breast cancer be found early? American Cancer Society. Accessed May 8, 2009.
- Symptoms and diagnosis of LCIS. Breastcancer.org. http://www.breastcancer.org/symptoms/types/lcis/symptoms_diagnosis.jsp. Accessed May 9, 2009.
- LCIS and breast cancer risk. Breastcancer.org. http://www.breastcancer.org/symptoms/types/lcis/cancer_risk.jsp. Accessed May 9, 2009.
- Treatment for LCIS. Breastcancer.org. http://www.breastcancer.org/symptoms/types/lcis/treatment.jsp. Accessed May 9, 2009.
- Meisner ALW, et al. Breast disease: Benign and malignant. Medical Clinics of North America. 2008;92:1115.
- Arpino G, et al. Premalignant and in situ breast disease: Biology and clinical implications. Annals of Internal Medicine. 2005;143:446.
