Management of in situ and minimally invasive breast carcinoma

Abstract

In situ breast carcinoma represents an early localized stage in the transition to invasive breast carcinoma and has an especially favorable prognosis with appropriate management. The widespread use of mammography has contributed to its increased rate of diagnosis. The two histologic forms of this entity have distinct pathologic and biologic characteristics, with different therapeutic implications. Lobular carcinoma in situ is considered a marker of increased risk for subsequent invasive carcinoma and is most commonly managed by nonoperative surveillance. Ductal carcinoma in situ behaves more as a true anatomic precursor of invasive disease and has the same therapeutic options as invasive breast carcinoma. Minimally invasive breast carcinoma should be considered a fundamentally different entity, primarily because of its potential for systemic metastasis that in situ lesions do not theoretically have. There are still many outstanding issues and dilemmas to be resolved by scientific investigation before the intriguing potential of these early forms of breast malignancy are fully understood.

Surgeon perspectives about local therapy for breast carcinoma

“…Six prospective randomized trials have demonstrated that mastectomy does not provide a survival advantage over BCS in invasive carcinoma. [32][33][34][35][36][37][38] The findings of the current study suggest that some surgeons still endorse the concept that a larger operation (mastectomy) is more likely to result in the cure of invasive carcinoma in spite of a substantial body of data that indicates that this is not the case.…”

Essentials of chemical biology: Structure and dynamics of biological macromolecules by Andrew Miller and Julian Tanner

“…Among breast carcinomas of ductal histology, there is consensus that DCIS is likely to be a direct precursor of invasive disease; however, the role of LCIS remains poorly characterized. Early studies suggested that LCIS was unlikely to lead to invasive carcinoma, given that it appeared to increase breast carcinoma risk bilaterally 2–5. Furthermore, it was observed that patients with LCIS commonly developed invasive ductal carcinoma rather than ILC 2, 4.…”

“…Our clinical understanding of lobular carcinoma in situ (LCIS) of the breast has undergone a gradual evolution since the term was coined by Foote and Stewart in 1941 1. Although, histologically a neoplastic lesion, LCIS has long been considered a marker for increased breast carcinoma risk rather than a precursor for invasive carcinoma, because it appears to confer an equally increased risk of breast carcinoma in both the contralateral and ipsilateral breasts 2–5. Furthermore, over half of invasive carcinomas that develop after a diagnosis of LCIS develop > 10 years subsequent to the index lesion, with most of these invasive carcinomas exhibiting ductal histology 2–4…”

Lobular Neoplasia: Morphology and Management

“…6 Although some studies have shown that the combination of LCIS and a family history of breast cancer carries a higher relative risk for younger women, 33 other studies have failed to find that same association. 6 Because the risk is in both breasts, unilateral approaches-such as lumpectomy and radiation, or unilateral mastectomy-play no role.…”