Lobular neoplasia

Breasts are made up of lobules (milk-producing glands) and ducts (tubes that carry milk to the nipple) which are surrounded by glandular, fibrous and fatty tissue. Milk is made and stored within the lobules and carried through to the nipple via the ducts during breastfeeding. When lobular neoplasia occurs, there is an increase in the number of cells contained in the lobules, together with a change in their appearance and behaviour.

The term ‘lobular neoplasia’ describes a range of changes within the breast lobules including atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS). ‘In situ’ means the changes only occur in the breast lobules and do not affect the surrounding tissue.

Both ALH and LCIS are conditions where cells in the lobules of the breast look different and multiply differently from normal cells. Their appearance under the microscope can be very similar to each other. Any diagnosis made will depend on the degree of change that the cells have undergone and how extensive the affected area is.

Very rarely, LCIS may be made up of larger, more abnormal cells, and this is known as pleomorphic LCIS. This behaves differently to other conditions, including lobular neoplasia. Pleomorphic LCIS is usually removed with a margin (border) of normal breast tissue around it. It is treated in a similar way to ductal carcinoma in situ; if you have pleomorphic LCIS you may find our Ductal carcinoma in situ (DCIS) factsheet helpful.

Men can also develop lobular neoplasia but this is extremely rare.

Is lobular neoplasia cancer?

Healthcare professionals do not regard the range of conditions included in lobular neoplasia as cancer. It is considered to be a ‘marker’ (a signal) of an increased risk of developing breast cancer in the future in both breasts. However, there is some recent evidence to suggest that there is a greater risk in the area of the breast in which lobular neoplasia was found, and in some cases it may be a precursor of an invasive breast cancer.

The extent of the risk depends on several factors, including:

• your age when lobular neoplasia is diagnosed
• the extent of the lobular neoplasia (greater with LCIS than ALH)
• whether there is a significant family history of breast cancer (you can find out more about this in our Breast cancer in families booklet).

Although the word ‘carcinoma’ is included in the term LCIS, this is misleading as LCIS is not breast cancer. This is why some experts prefer the term lobular neoplasia.

The vast majority of women diagnosed with ALH or LCIS will never get breast cancer. However, people diagnosed with either condition do have a slightly higher risk than the general population of developing breast cancer at some point in their lives.

Diagnosis

Lobular neoplasia can be difficult to diagnose because most women will have no symptoms. It is usually discovered by chance, either as calcifications (small spots of calcium salts) on a mammogram (breast x-ray), or when a breast biopsy is taken for some other reason, such as a breast lump. It is believed that many cases of lobular neoplasia go undiagnosed and never cause any symptoms.

Treatment and follow up

There is no recommended standard treatment for lobular neoplasia. It is important that you are able to discuss treatment options with your consultant or breast care nurse, based on your particular situation

If your lobular neoplasia is diagnosed by a core biopsy, your doctor may recommend a small operation called an excision biopsy to remove further tissue from the area where the lobular neoplasia was found. This is to confirm that there aren’t any cancer cells in the area.

Although most women who are diagnosed with lobular neoplasia do not develop breast cancer, regular follow-up appointments are often recommended (even after surgery) with the aim of finding any further changes as early as possible. This may include a yearly breast examination and mammograms every one to two years. Sometimes further scans may be recommended such as an MRI (magnetic resonance imaging) scan, if you have other risk factors for breast cancer such as a significant family history of breast cancer.

Rarely, a patient may choose to have risk-reducing bilateral mastectomy if they have extreme feelings of anxiety, or if they also have a strong family history of breast cancer.

Hormone therapy is sometimes used to reduce the risk of breast cancer developing in women with LCIS. There are trials looking at the effectiveness of hormone therapy for this using drugs usually used to treat breast cancer.

Coping with lobular neoplasia

Although lobular neoplasia is not breast cancer, you may experience a number of different emotions, such as fear, shock and anger. There may be times when you feel anxious or negative or concerned about your future risk.

Remember that there are people who can support you, so don’t be afraid to ask for help. By letting other people know how you are feeling, particularly your family and friends, they can be more supportive. It can also help to discuss your feelings or worries with your specialist.

If you want to talk through your feelings in more depth over a period of time, a professional counsellor might be more appropriate. Your specialist, GP or breast care nurse will usually be able to arrange this.