When It's Not Breast Cancer

Lobular hyperplasia and LCIS may not require surgery

(RxWiki News) When cells in the breast start to grow abnormally, it often means cancer — but not always. Some abnormal growths just increase breast cancer risks. But increased risks don't mean cancer is a given, and treatment may not be needed.

Findings from a recent study suggest that surgery may not always be needed to remove abnormal breast tissue that could turn into cancer down the road.

Instead, careful watching — with regular imaging studies and exams — may be the best option because these growths generally do not turn out to be cancer, according to this study.

"Discuss all treatment options with your doctor."

Michael A. Cohen, MD, FACR, professor of radiology at the Emory University School of Medicine in Atlanta, led this study that looked at the course of two abnormal breast conditions.

A woman’s breasts contain ducts that milk flows through when she nurses her babies. These ducts end in little sacs known as lobules. Cancer and other diseases can form in the ducts and in the lobules.

Atypical lobular hyperplasia (ALH) is an unusual but benign (non-cancerous) growth that appears in the lobules. Lobular carcinoma in situ (LCIS) is a pre-cancerous condition that also develops in the lobules.

According to Dr. Cohen, these two conditions increase a woman’s risks of developing breast cancer four- to ten-fold. Both conditions are detected during a biopsy that removes breast tissue to look for cancer.

Dr. Cohen teamed with Kristen Atkins, MD, a pathologist and associate professor at the University of Virginia in Charlottesville, VA, and other colleagues to see how often these “very tiny lesions” actually developed into cancer.

These researchers examined 10 years of data to determine the number of ALH and LCIS lesions that actually became cancerous following surgery.

The researchers identified 50 cases from 49 women during that 10-year review. Forty-three women had surgical excision of the lesion, and seven underwent two years of follow up. Both the radiologist and the pathologist, who examined the tissue under a microscope to detect disease, agreed on the diagnosis in 43 of the 50 cases. This agreement is called “concordant," meaning there were 43 concordant cases.

The researchers found that none of the concordant cases developed into cancer, while two of the discordant cases developed into ductal carcinoma in situ, a pre-cancer that appears in the ducts.

"These findings show that some women can avoid surgery, and that yearly mammograms along with MRI or ultrasound as second-line screening tools may suffice," Dr. Cohen said in a press release.

"This study demonstrates that some cases of ALH and LCIS may not require localized surgery since the presence of nearby cancer is extremely low or non-existent,” Cary Kaufman, MD, a breast surgeon and specialist at Bellingham Regional Breast Center in Washington state, told dailyRx News.

“This [research] is consistent with the discussions regarding ‘over-diagnosis’ where patients are told they have cancer or pre-cancer which may never develop into a lethal problem during their lifetime," he said.

Dr. Kaufman, who was not involved in this study, continued, “In our excitement to find patients who may avoid a surgical excision, we should not expand the results of this study to those patients who clearly benefit from surgical excision. Specifically, this report doesn’t change our approach to atypical ductal hyperplasia (ADH) or ductal carcinoma in-situ (DCIS) which are more commonly found disorders."

Findings from this research were published July 29 in the journal Radiology.

No outside funding was reported, nor were any conflicts of interest disclosed.


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Review Date: 
July 29, 2013