LCIS does not develop into cancer itself, however, there is a ~25% risk of developing breast cancer in either breast over 30 years. Most of the cancers that do develop are ductal carcinoma (not invasive lobular carcinoma) and it can occur in any area of the breast. This means that there is no reason to try and remove all of it surgically. Therefore, the approach to LCIS is the same as for any woman who is at high risk – prevention of breast cancer.
- Close follow up with or without Tamoxifen
- Bilateral prophylactic mastectomies +/- reconstruction
Prophylactic mastectomy is a viable option and will reduce the risk of developing breast cancer by at least 90%. Tamoxifen or raloxifene has been shown in a large study to reduce the chance of getting breast cancer by ~50%. The prevention study was not without side effects, however, and anyone considering this approach should weigh the risks and benefits for her age. Close follow up means having breast exams every six months and annual mammograms. There is no urgency to your decision regarding treatment of LCIS, as the risk stretches out over thirty years and does not begin immediately. Which path you choose will depend on your age, health, and values.
The latest oncoplastic mastectomy techniques are used to ensure the optimum cosmetic outcome for each patient. Smaller breasted women (A & B cups) can often undergo nipple-sparing mastectomy with implant reconstruction.
While larger breasted women and those with ptosis (sagging) can undergo a mastopexy/reduction mastectomy – correcting the sagging while maintaining size.