LCIS - mastectomy or radiotherapy?

[putneygirl]

I recently had an 8mm invasive lobular carcinoma removed. The pathology report showed that I had a total 18mm span of ILC and LCIS (extensive intermediate nuclear grade), and "the adjacent breast tissue show a very florid active benign breast disease including fibrocystic disease, duct ectasia, ductal epithelial hperplasia, a benign intraductal papilloma and columnar cell change".



After a re-excision, they were not able to leave me with a clear margin free of LCIS, though multiple biopsies showed that I didn't have LCIS scattered throughout both breasts, so it appears to be localised.



The consultants are now steering me towards a mastectomy & reconstruction as the lowest risk option, on the basis that a) the LCIS has already generated an ILC and b) lobular cancer is so difficult to find at an early stage, even with best efforts (it was found almost incidentally this time). The LCIS may never generate an ILC again, but then again it might, and 2nd time round it may not be caught so fast.



The consultants will back me if I choose to go the radiotherapy route, which seems to be the norm (with close monitoring) for LCIS that has not been found with ILC, on the basis that mastectomy is now seen as "excessive" for this condition.



This is such a difficult decision to make - which option to choose?

Is there an information source or clinical study that has generated numerical likelihoods for my situation?

If I go the mastectomy route, should I be exploring the necessity for removal of both breasts given LCIS being a marker for equal risk of an ILC in either breast?

[CCF-RN,MSN-rf]

Dear putneygirl:  LCIS (lobular carcinoma in situ) is a different problem than the more familiar DCIS (ductal carcinoma in situ).  From at least one benchmark trial, it is thought that LCIS is more of a marker of increased risk of developing breast cancer in either breast rather than a true cancer that needs to be removed.   In general, if LCIS is found without any invasive cancer, radiation therapy is not necessary.  Management may include close follow-up, chemoprevention with tamoxifen or, occasionally, bilateral mastectomy for the purposes of risk reduction for patients who are particularly concerned about their risk.  If invasive cancer is found as well, as in your situation, it is important to try to acheive surgical margins that are negative for the invasive component and radiation therapy is usually recommended following breast conserving surgery.  As with any invasive cancer, a mastectomy is another surgical option but may not be necessary.  A variety of factors will help with that decision including the anticipated cosmetic outcome, consideration of how difficult it will be to examine the breast for new problems in the future and personal preferences.  If the tumor is hormone receptor postive, as lobular carcinomas tend to be, adjuvant hormonal therapy may not only reduce the risk of recurrence of this cancer, but may also reduce the risk of new breast cancers in either breast.  All of these options should be discussed with your physicians.