INTRODUCTION: There is no national standard treatment for patients with breast lobular carcinoma in situ (LCIS). Association of Breast Surgery guidelines for the management of breast cancer suggest that lesions containing LCIS should be excised for definitive diagnosis and recommend close surveillance after excision biopsy. The aim of this study was to form a picture of the current management of LCIS by UK breast surgeons. METHODS: A questionnaire about the management of LCIS was sent to 490 UK breast surgeons. RESULTS: Of 490 questionnaires sent out, 173 (35%) were returned. When LCIS is present in a core biopsy, 61% of breast surgeons perform surgical excision, 22% would not excise but would continue follow-up and the remainder perform neither or set no clear management plan. Over half (54%) follow patients up with five years of annual mammography. If classic LCIS were found at the margins of wide local excision, 92% would not re-excise. Conversely, if pleomorphic LCIS were found, 71% would achieve clear margins. Respondents were split evenly regarding management of classic LCIS with a family history as 54% would not alter management whereas 43% would treat the disease more aggressively. CONCLUSIONS: Our survey has shown that in cases where LCIS is found at core biopsy, most surgeons follow Association of Breast Surgery guidance, obtaining further histological samples to exclude pleomorphic LCIS, ductal carcinoma in situ or invasive cancer, whereas others opt for annual surveillance and some discharge the patient. This study highlighted the huge variability in LCIS management, and the need for randomised controlled trials and input into national audits such as the Sloane Project to establish evidence-based national standard guidelines.
INTRODUCTION: There is no national standard treatment for patients with breast lobular carcinoma in situ (LCIS). Association of Breast Surgery guidelines for the management of breast cancer suggest that lesions containing LCIS should be excised for definitive diagnosis and recommend close surveillance after excision biopsy. The aim of this study was to form a picture of the current management of LCIS by UK breast surgeons. METHODS: A questionnaire about the management of LCIS was sent to 490 UK breast surgeons. RESULTS: Of 490 questionnaires sent out, 173 (35%) were returned. When LCIS is present in a core biopsy, 61% of breast surgeons perform surgical excision, 22% would not excise but would continue follow-up and the remainder perform neither or set no clear management plan. Over half (54%) follow patients up with five years of annual mammography. If classic LCIS were found at the margins of wide local excision, 92% would not re-excise. Conversely, if pleomorphic LCIS were found, 71% would achieve clear margins. Respondents were split evenly regarding management of classic LCIS with a family history as 54% would not alter management whereas 43% would treat the disease more aggressively. CONCLUSIONS: Our survey has shown that in cases where LCIS is found at core biopsy, most surgeons follow Association of Breast Surgery guidance, obtaining further histological samples to exclude pleomorphic LCIS, ductal carcinoma in situ or invasive cancer, whereas others opt for annual surveillance and some discharge the patient. This study highlighted the huge variability in LCIS management, and the need for randomised controlled trials and input into national audits such as the Sloane Project to establish evidence-based national standard guidelines.
Entities:
Keywords:
Breast; Lobular carcinoma in situ; Lobular neoplasia
Authors: Elisa Rush Port; Anna Park; Patrick I Borgen; Elizabeth Morris; Leslie L Montgomery Journal: Ann Surg Oncol Date: 2007-01-07 Impact factor: 5.344
Authors: Therese B Bevers; Benjamin O Anderson; Ermelinda Bonaccio; Saundra Buys; Sandra Buys; Mary B Daly; Peter J Dempsey; William B Farrar; Irving Fleming; Judy E Garber; Randall E Harris; Alexandra S Heerdt; Mark Helvie; John G Huff; Nazanin Khakpour; Seema A Khan; Helen Krontiras; Gary Lyman; Elizabeth Rafferty; Sara Shaw; Mary Lou Smith; Theodore N Tsangaris; Cheryl Williams; Thomas Yankeelov; Thomas Yaneeklov Journal: J Natl Compr Canc Netw Date: 2009-11 Impact factor: 11.908