The challenges of treating lobular carcinoma in situ.

Oppong and King present a clear and concise review of the current data regarding lobular carcinoma in situ (LCIS) and discuss the rationale behind the current management recommendations for this disease. It is interesting to note that in 2011 we are still debating the clinical management of LCIS despite these lesions having first been recognized in the early 1900s.[1] Recent advances in genomic profiling have demonstrated that in some cases LCIS is no longer simply a risk factor for all types of breast cancer but also a precursor for invasive lobular cancer. It is the molecular characterization of these lesions that may potentially define those women with LCIS who are more likely to develop invasive cancer, and that can help identify targets for therapeutic interventions. However, it is still extremely difficult to determine the true incidence of LCIS in any population due to the fact that LCIS continues to be an incidental finding on biopsy or at surgery. The pleomorphic variant is an exception, since it can present with microcalcifications on mammography.[2] As stated by the authors, the proportion of LCIS in sample sets of benign breast disease is low, ranging between 0.5% and 4%, but the majority of these lesions are multicentric, suggesting a more widespread process. Further, although the risk per year of invasive cancer is 1%, the risk accumulates over time for at least 20 years.[3-7] Bilateral disease can also occur in up to 35% of cases, leading some women to opt for bilateral prophylactic mastectomy.