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Bilateral Risk for Subsequent Breast Cancer After Lobular Carcinoma-In-Situ: Analysis of Surveillance, Epidemiology, and End Results Data

From the Department of Radiation Oncology, St John Hospital Van Elslander Cancer Center and Webber Cancer Center, Grosse Pointe; Department of Pediatrics, Children's Hospital of Michigan; Department of Family Practice, Wayne State University School of Medicine, Detroit; Department of Pathology, University of Michigan, Ann Arbor, MI; Department of Radiation Oncology, and Cedars-Sinai Comprehensive Cancer Center, Los Angeles, CA

Address reprint requests to Paul J. Chuba, MD, PhD, Department of Radiation Oncology, St John Health Systems, 11800 E 12 Mile Rd, Warren, MI 48093; e-mail: paul.chuba{at}stjohn.org

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.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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