Bilateral risk for subsequent breast cancer after lobular carcinoma-in-situ: analysis of surveillance, epidemiology, and end results data.

PURPOSE Noninvasive lesions involving the lobules of the breast are increasingly diagnosed as incidental microscopic findings at the time of lumpectomy or core-needle biopsy. We investigated the incidence rates of invasive breast cancer (IBC) after a diagnosis of lobular carcinoma-in-situ (LCIS) by using Surveillance, Epidemiology, and End Results (SEER) data. PATIENTS AND METHODS Patients (N = 4,853) having a diagnosis of primary LCIS in the time period of 1973 to 1998 were identified using the SEER Public Use CD-ROM data. The database was then searched for patients with subsequent primary IBC occurrences (n = 350). The clinical and pathologic characteristics of patients with subsequent primary IBCs were compared with the characteristics of patients with primary IBCs attained during the same time period (N = 255,114). RESULTS The incidence of IBC increased over time from diagnosis of LCIS, with 7.1% +/- 0.5% incidence of IBC at 10 years. IBCs detected after partial mastectomy occurred in either breast (46% ipsilateral and 54% contralateral); however, after mastectomy, most IBCs were contralateral (94.7%). IBCs occurring after LCIS more often represented invasive lobular histology (23.1%) compared with primary IBCs (6.5%). The standardized incidence ratio (the ratio of observed to expected cases) for developing IBC was 2.4 (95% CI, 2.1 to 2.6) adjusted for age and year of diagnosis. CONCLUSION LCIS is associated with increased risk of subsequent invasive disease, with equal predisposition in either breast. The minimum risk of developing IBC after LCIS is 7.1% at 10 years.

[1]  G. W. Snedecor.  STATISTICAL METHODS , 1967 .

[2]  S. Devries,et al.  Loss of chromosome 16q in lobular carcinoma in situ. , 2001, Human pathology.

[3]  G. Colditz,et al.  Risk of breast cancer associated with atypical hyperplasia of lobular and ductal types. , 1997, Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology.

[4]  J. Urban,et al.  Lobular carcinoma in situ of the breast: Preliminary results of treatment by ipsilateral mastectomy and contralateral breast biopsy , 1981, Cancer.

[5]  L. Fielding,et al.  American Joint Committee on Cancer Prognostic Factors Consensus Conference , 1999, Cancer.

[6]  K. Rieger-Christ,et al.  Disparate E-cadherin mutations in LCIS and associated invasive breast carcinomas , 2001, Molecular pathology : MP.

[7]  J. Wheeler,et al.  Lobular carcinoma in situ of the breast(Long‐term followup , 1974, Cancer.

[8]  A. Patchefsky,et al.  Lobular carcinoma in situ increases the risk of local recurrence in selected patients with stages I and II breast carcinoma treated with conservative surgery and radiation , 2001 .

[9]  F. Vicini,et al.  Clinicopathologic implications of E‐cadherin reactivity in patients with lobular carcinoma in situ of the breast , 2001, Cancer.

[10]  I. Christensen,et al.  Carcinoma in situ of the female breast. 10 year follow-up results of a prospective nationwide study , 2000, Breast Cancer Research and Treatment.

[11]  W. Dupont,et al.  Lobular neoplasia of the breast: higher risk for subsequent invasive cancer predicted by more extensive disease. , 1991, Human pathology.

[12]  R. Goldschmidt,et al.  Lobular carcinoma in situ of the breast. , 1996, Seminars in surgical oncology.

[13]  B. Hankey,et al.  Completeness of hospital cancer case reporting from the SEER program of the national cancer institute , 1995 .

[14]  Yong-jie Lu,et al.  Comparative genomic hybridization analysis of lobular carcinoma in situ and atypical lobular hyperplasia and potential roles for gains and losses of genetic material in breast neoplasia. , 1998, Cancer research.

[15]  E. Kaplan,et al.  Nonparametric Estimation from Incomplete Observations , 1958 .

[16]  C. Bodian,et al.  Lobular neoplasia (so‐called lobular carcinoma in situ) of the breast , 1978, Cancer.

[17]  K. Zedeler,et al.  Lobular carcinoma in situ of the female breast. Short-term results of a prospective nationwide study. The Danish Breast Cancer Cooperative Group. , 1992, The American journal of surgical pathology.

[18]  C K Redmond,et al.  Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. , 1999, Journal of the National Cancer Institute.

[19]  R. Elledge,et al.  Lobular neoplasia on core‐needle biopsy—Clinical significance , 2004, Cancer.

[20]  G. Swanson,et al.  The continuing dilemma of lobular carcinoma in situ. , 1992, Archives of surgery.

[21]  C A Bodian,et al.  Lobular neoplasia: Long term risk of breast cancer and relation to other factors , 1996, Cancer.

[22]  J. Andersen.  Lobular carcinoma in Situ of the breast: An approach to rational treatment , 1977, Cancer.

[23]  David R Lucas,et al.  Osteosarcoma as a second malignant neoplasm. , 2002, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[24]  S. Paik,et al.  Pathologic findings from the National Surgical Adjuvant Breast Project (NSABP) protocol B‐17: Five‐year observations concerning lobular carcinoma in situ , 1996, Cancer.

[25]  R. Severson,et al.  Second Malignant Neoplasms After Primary Central Nervous System Malignancies of Childhood and Adolescence , 2003, Pediatric hematology and oncology.

[26]  S. Schnitt,et al.  The relation between the presence and extent of lobular carcinoma in situ and the risk of local recurrence for patients with infiltrating carcinoma of the breast treated with conservative surgery and radiation therapy , 2000, Cancer.

[27]  G. Colditz,et al.  Cumulative risk of breast cancer to age 70 years according to risk factor status: data from the Nurses' Health Study. , 2000, American journal of epidemiology.

[28]  C. la Vecchia,et al.  Second cancers following in situ carcinoma of the breast , 1998, International journal of cancer.

[29]  W. Dupont,et al.  Atypical lobular hyperplasia as a unilateral predictor of breast cancer risk: a retrospective cohort study , 2003, The Lancet.

[30]  H. Tsuda,et al.  Treatment of noninvasive carcinoma: Fifteen-Year results at the National Cancer Center Hospital in Tokyo , 2000, Breast cancer.

[31]  M. Stratton,et al.  Contribution of germline MLH1 and MSH2 mutations to lobular carcinoma in situ of the breast. , 2001, Cancer letters.

[32]  R. Severson,et al.  Sarcoma as a second malignancy after treatment for breast cancer. , 2002, International journal of radiation oncology, biology, physics.

[33]  K. Zedeler,et al.  Lobular Carcinoma In Situ of the Female Breast , 1992 .

[34]  Norman Wolmark,et al.  Pathologic findings from the National Surgical Adjuvant Breast and Bowel Project , 2004, Cancer.

[35]  F. W. Foote,et al.  Classics in oncology: Lobular carcinoma in situ: A rare form of mammary cancer , 1982 .

[36]  B. Anderson,et al.  Changing Incidence of Lobular Carcinoma in situ of the Breast , 2002, Breast Cancer Research and Treatment.

[37]  C. la Vecchia,et al.  Trends of in situ carcinoma of the breast in Vaud, Switzerland. , 1997, European journal of cancer.

[38]  C. Bartoli,et al.  Risk of invasive cancer in women with lobular carcinoma in situ of the breast. , 1991, European journal of cancer.

[39]  C. Kosloff,et al.  Lobular carcinoma in situ of the breast Detailed analysis of 99 patients with average follow‐up of 24 years , 1978, The American journal of surgical pathology.