2011 Breast Cancer Symposium
SAN FRANCISCO - Patients with lobular carcinoma in situ were more likely
to select bilateral prophylactic mastectomy over surveillance, with or without
chemoprevention, if they were younger and premenopausal, according to a study
presented here at the 2011 ASCO Breast Cancer Symposium.
Patients with lobular carcinoma in situ (LCIS) have three management
options, according to Shirin Muhsen, MD, research fellow at Memorial
Sloan-Kettering Cancer Center. They are: high-risk surveillance alone,
high-risk surveillance with chemoprevention, and bilateral prophylactic
mastectomy (BPM). Muhsen and colleagues studied patient characteristics and
clinical factors associated with the decision to pursue BPM.
The researchers prospectively included women who presented to
Sloan-Kettering with LCIS from 1995 to 2009. Patients with previous or
concurrent diagnosis of breast cancer were excluded. Comparisons were made
between women who elected BPM and those who elected high-risk surveillance with
or without chemoprevention.
The study included 995 patients who presented during the study period
with LCIS: 80% of these patients chose surveillance alone, 15% chose
surveillance with chemoprevention and 5% chose BPM.
Patients who underwent BPM were younger, with a mean age of 48 years
compared with 52 years (P<.001), and more likely to be premenopausal: 82% vs.
57% (P<.001). They were also more likely to present with bilateral LCIS and
more likely to have one first-degree relative with breast cancer or two
second-degree relatives with breast cancer. In addition, they were also more
likely to have extremely dense breasts according to Breast Imaging Reporting
and Data System density staging.
"Bilateral prophylactic mastectomy is the preferred management option
for a minority of LCIS patients at Sloan-Kettering," Muhsen said. "Further
research to define how the increased risk imparted by LCIS is augmented by
these clinical risk factors may allow for improved methods of risk
stratification and more informed discussions with patients."
For more information:
- Muhsen S. #148. Presented at: 2011 Breast Cancer Symposium; Sept. 8-10; San Francisco.
Disclosure: Dr. Muhsen reports no relevant financial disclosures.
Debu Tripathy, MD
This study, while it involves a very large registry, is really not that informative. It reveals that patients with LCIS mostly choose surveillance, with or without tamoxifen or raloxifene, and those who choose mastectomy have additional risk factors. This is not very surprising. It does not shed light on whether such decisions are worthwhile - there is not a measurable effect on the risk of getting breast cancer or dying of breast cancer.
– Debu Tripathy, MD
HemOnc Today Editorial Board member
Disclosure: Dr. Tripathy reports no relevant financial disclosures.
Earn CME this spring at the HemOnc Today Breast Cancer Review & Perspective meeting to be held March 23-24, 2012 at the Hilton San Diego Bayfront. See details at HemOncTodayBreastCancer.com.