The management of patients with lobular carcinoma in situ of the breast.

The management of patients with lobular carcinoma in situ (LCIS) has been an enigma for almost as long as the entity has been known. Continued follow-up of these patients has documented that about a quarter to a third will subsequently develop carcinoma in either breast after diagnostic excision, but no further therapy. Lobular carcinoma in situ has a 60% to 90% rate of multicentricity, and about 4% to 6% of mastectomy specimens from patients with LCIS have an invasive cancer elsewhere in the breast. Furthermore, 20% to 45% of women with LCIS have synchronous, or develop metachronous, contralateral breast cancer. The management programs range from clinical follow-up to bilateral mastectomy with reconstruction. These and various other choices are discussed. Since there is no conclusive evidence to justify the selection of any single program to the exclusion of all others, the informed patient must select from among the choices that program which will best satisfy her medical as well as psychosocial needs.