Question about the word Malignancy

There is controversy about just about everything to do with LCIS.



The NCI states that the name LCIS is misleading, and more properly termed lobular neoplasia. and that most oncologists consider it benign. http://www.cancer.gov/cancertopics/pdq/treatment/breast/HealthProfessional/page6



I have read papers that have also stated it should NOT be called lobular neoplasia, and should be called LCIS.



There are controversies on the definition of 'cancer' and 'malignancy'. It is not a sharp, demarcated line.



Atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS) – lesions that are also referred to under the umbrella heading of 'lobular neoplasia' (LN) – occur relatively infrequently in the breast. However, problems and controversies surrounding the most appropriate terminology and classification for these lesions, and the best course of long-term management after diagnosis, are far from infrequent.



Foote and Stewart first coined the term LCIS in 1941 [1], choosing the name to highlight the morphological similarities between the cells of LCIS and those of frankly invasive lobular carcinoma. They recognised parallels with ductal carcinoma in situ (DCIS), namely foci of neoplastic cells that were still contained within a basement membrane. In anticipating that LCIS, like DCIS, was a step along the pathway to invasive cancer, they recommended mastectomy as the standard form of treatment; this management plan was adopted for many years. The term ALH was subsequently introduced to describe morphologically similar but less well developed lesions. LN was a term introduced by Haagensen in 1978 [2] to cover the full range of proliferation, including both ALH and LCIS within the spectrum.



ALH and LCIS have since become well-established histopathological entities in the classification of breast neoplasia, but it has become clear over the past 60 years that they are not precursor lesions for invasive carcinoma in the same way as high-grade DCIS of comedo type [3-6]. A diagnosis of ALH/LCIS today is often seen as a 'risk indicator' for subsequent carcinoma rather than a true precursor. Radical surgical treatment has fallen out of favour but there is a lack of consensus on what the most appropriate management of patients diagnosed with ALH/LCIS should be. Recommendations for treatment vary from follow-up with regular mammography, to follow-up alone or simply 'no action' [2,7,8]. However, recent work is once again suggesting that LCIS is indeed a non-obligate precursor lesion for carcinoma, a finding that might have significant implications for the management of patients diagnosed with this disease.http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=314428 (This paper was written in 2003.)



When they ask on a questionaire whether or not I have been diagnosed with cancer Yes No, I usually circle both.



It is difficult to determine how many women with LCIS go on to develop invasive breast cancer or DCIS, in part because we don't know how many women have LCIS.



However, in the Port study at Sloan Kettering, the raw incidence was about 1% per year. http://www.ncbi.nlm.nih.gov/pubmed/17206485?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

I thought this study was valuable, because theoretically they would more likely be diagnosing LCIS more consistently, and have a more homogeneous population.

liveit56,

I don't see any harm in your going on Evista. You can always stop. It has been used for years for osteoporosis, so it's not really experimental. The side effects are mild. In my case, it really amounts to increased hot flashes, and even those seem to come and go. I am concerned a little about the increased risk of stroke and would not have even begun it if there had been a history in my family. What I did was go with the close monitoring and Evista at first, while I considered my options. After about 6 months, I began seriously thinking about PBMs. I talked to my various doctors about it. They are all supportive of this action. If you start taking Evista, you are doing something to lower your risk, which may make you feel less uncomfortable about having LCIS. In my case, the emotional and physical toll of the tests and biopsies, with the move to a six month monitoring schedule, has made me reconsider staying on the close monitoring path. I realize that I want to avoid getting "real" cancer altogether. If I do this now, I can stop having mammograms, stop worrying about biopsies, and avoid having to have chemo. That's my choice. But if I were you, I wouldn't hesitate to start Evista.

Anne