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.
If you've been diagnosed with LCIS, your doctor may recommend more frequent exams to closely monitor your breasts for signs of cancer. This may include:
- 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
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. Tamoxifen reduces the risk of developing invasive breast cancer. Tamoxifen can be used by both premenopausal and postmenopausal women. Tamoxifen is typically taken for five years.
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.
- Raloxifene (Evista). Raloxifene is also approved to reduce the risk of invasive breast cancer in high-risk postmenopausal women, including those with LCIS. Raloxifene is 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 because of an increased risk of a stroke.
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.
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 a strong family history or a BRCA gene mutation. Surgery to treat LCIS isn't urgent, so you have time to carefully weigh the pros and cons of preventive mastectomy with your doctor.
If you have LCIS, you might consider participating in a clinical trial exploring an emerging therapy for preventing breast cancer. Ask your doctor whether you might be a candidate for current clinical trials.
Jun. 24, 2011
- Abeloff MD, et al. Cancer of the breast. In: Abeloff MD, et al. Abeloff's Clinical Oncology. 4th ed. Philadelphia, Pa.: Churchill Livingstone Elsevier; 2008:1875.
- Breast cancer. Fort Washington, Pa.: National Comprehensive Cancer Network. http://www.nccn.org/professionals/physician_gls/PDF/breast.pdf. Accessed April 15, 2011.
- Sabel MS. Lobular carcinoma in situ of the breast. http://www.uptodate.com/home/index.html. Accessed April 26, 2011.
- Venkitaraman R. Lobular neoplasia of the breast. The Breast Journal. 2010;16:519.
- Arpino G ,et al. Premalignant and in situ breast disease: Biology and clinical implications. Annals of Internal Medicine. 2005;143:446.
- SEER stat fact sheet: Breast. National Cancer Institute. http://seer.cancer.gov/statfacts/html/breast.html. Accessed May 4, 2011.
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