anyone heard of this?

Mary,

Sorry for your stressful experience.  I'm sure you're anxious waiting to hear about your latest imaging- sending you calm thoughts.  LCIS is so confusing- this you well know.  I've heard it described as many things: a marker for increased risk, a stage 0 bc, "almost" cancer.....the medical community seems all over the board on it.  I'd really like to know where the LCIS conference was so if you find out, please share as I'm always interested in what's being said about it.  I believe somewhere in the literature it was implied that, though certainly not always, sometimes LCIS can morph into invasive disease. (Leaf, do I have that right?).  Please let us know how things are going.  I'll be thinking of you.

Kelly

Yes. LCIS has been thought to be a 'nonobligate precursor' for ILC for many years.  One of the first papers I saw it in was this 2006 Li et al paper, using SEER data.

  These results are also consistent with a previous report indicating that LCIS is often followed by ILC,29 and suggest that LCIS may be a precursor of ILC specifically, as one might expect based on its histopathologic characteristics. There is laboratory evidence to support this. E-cadherin is a cell adhesion molecule that is not expressed by almost all ILCs, but this molecule is expressed by almost all IDCs. Acs et al.30 found that 96 of 100 (96%) IDCs expressed e-cadherin, whereas 41 of 42 (98%) ILCs showed complete loss of e-cadherin expression.....With respect to LCIS, our data indicate that LCIS may be a precursor lesion of ILC rather than just an ambiguous risk factor for invasive breast cancer and that localized treatment for LCIS may be warranted given that these women have much higher rates of ipsilateral invasive breast cancer, but much more similar rates of contralateral breast cancer, compared with DCIS patients. http://onlinelibrary.wiley.com/doi/10.1002/cncr.21864/full

The operative word here is **may**  (not will).   Many papers I've seen opine that LCIS 'may in a small number of cases' be a precursor.  The studies are much too small to define 'small'.  

Note that **IF** an LCIS woman does go on to get invasive breast cancer, in the majority of cases, she will get IDC, not ILC, and in those cases where the woman gets IDC, LCIS is NOT acting as a precursor.  Most studies I've seen show that **IF** an LCIS woman gets invasive breast cancer, these LCIS women get MORE ILC than the average woman who was not previously diagnosed with LCIS.

In this more recent 2008 study, they found about 2 out of 8 metasynchronous invasive breast cancers showed similar clonality between their LCIS and IBC.  (if I'm reading this right.) http://www.ncbi.nlm.nih.gov/pubmed/17380381

This earlier 2004 study found clonality in 'a majority of cases' in synchronous LCIS and ILC. http://www.ncbi.nlm.nih.gov/pubmed/15197797

However, as in all things LCIS, there is controversy.  In the http://www.ncbi.nlm.nih.gov/pubmed/21287281 that you cite, they seem to think that classic LCIS isn't a precursor, in opposition to the papers I cited above.

This 2010 abstract states Lobular neoplasia has been traditionally recognized as a marker of increased risk for subsequent breast carcinoma development; however, molecular studies suggest that it also behaves in a non-obligate precursor manner. We do not know, as yet, how to identify the subgroup of cases that is most likely to progress, but the epidemiological data would indicate that this progression occurs after a long period of time.  http://www.ncbi.nlm.nih.gov/pubmed/20436498

Some people are confused what 'nonobligate' means.  It means the LCIS cells are NOT obligated to become invasive.  They MAY become invasive, but not all of them become invasive (in the lifetime of the person with LCIS of course.)   In the Chuba study, they found roughly up to 20-25% of the women with LCIS went on to get breast cancer. 

Different pathologists do not always agree on the definition of classic and pleomorphic LCIS.  Even if 2 pathologists agree on the criteria for classic or pleomorphic LCIS, they do not always categorize any particular sample as LCIS or PLCIS.  So there is that difficulty in these studies too; some of these women may be 'misclassified'.  (In some of the NSABP studies that show LCIS data, many (all?) of these LCIS women were originally classified as having DCIS.)

I do think this 'may be a precursor' theme in the last 5 or 10 years gives more support that classic or florid LCIS patients should get the area excised.  However, there is, as in all things LCIS, continuous controversy about whether the area should get excised.

I chose to get excised, and I think most (not all) women with LCIS (and nothing worse) do.  But some do not. This paper opines there are circumstances where re-excision is not ALWAYS necessary after LCIS is found on core biopsy. http://www.ncbi.nlm.nih.gov/pubmed/17214794  But again, this, as in all things LCIS, is controversial.

Thinking of you as you go through this.

Mary------ before I let myself get too worried about this, I would really like to read a transcript from that conference---any way we can get a link to it? 

From that one article, it sounds like florid LCIS (FLCIS) is yet another kind of LCIS in addition to classic and pleomorphic (PLCIS). 

Babycakes----- I would also be very interested in how many of the 40% had any invasive bc show up in the pathology from their PBMs. (they probably don't keep any long term studies on the 60% that don't do PBMs, but both excellent questions for the doctor).

anne