The continuing dilemma of lobular carcinoma in situ
A. J. Walt, M. Simon and G. M. Swanson
Department of Surgery, Wayne State University, Detroit, Mich.
We reviewed the courses of 250 consecutive women with lobular carcinoma in
situ of the breast entered into the Surveillance, Epidemiology, and End
Results program of the Michigan Cancer Foundation, Detroit, Mich, between
1973 and 1986. No patient had known invasive cancer at the time of initial
entry. The average follow-up was 93.1 months; 212 patients had mastectomy
for the initial lesion and 65 patients had less than mastectomy, of whom
one developed a new lesion in the ipsilateral breast. Thirty-seven patients
(14.8%) were later found to have lesions in the contralateral breast, 25
within the first year. Thirteen of the 38 lesions (5.2% of the total
series) were invasive, and 11 were primarily ductal. Seventeen patients
died, two of breast cancer, two of unknown causes, and 13 of
non-breast-related causes. The maximum mortality from breast cancer is 1.6%
to this point. The frequency of mastectomy fell from 78.1% in the years
1973 through 1983 to 52% in 1984 through 1986, reflecting a change in
surgical philosophy. Although no guarantees can be given to any individual
patient, the great majority of patients with LCIS unassociated with a
proved invasive cancer can be safely treated with less than mastectomy.
