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Lobular Neoplasia (Atypical Lobular Hyperplasia and Lobular Carcinoma in Situ)

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Atypical lobular hyperplasia (ALH) means that there is an overgrowth of abnormal-looking cells in one or more lobules, the breast’s milk-producing sacs. However, there aren’t enough of them for the condition to qualify as lobular carcinoma in situ (LCIS). Both ALH and LCIS are considered benign breast conditions linked to a moderate increase in breast cancer risk.

Some doctors use the term “lobular neoplasia” to describe both ALH and LCIS. This is because there is some gray area between the two categories. If your doctor uses this term, you can ask for more information about the amount of abnormal cells and what they look like. If you have a core needle biopsy that discovers atypical cells, your doctor likely will go on to remove more of the tissue in that area.

Atypical lobular hyperplasia

Since ALH is not a true cancer, there can be some variation in how doctors approach it. Some doctors feel there is no need for additional surgery after the initial biopsy. ALH does not spread outside the lobules where it is found. Decisions about removal have to be made on a case-by-case basis. You and your doctor can work together to make the best choice for you.

With ALH, you may wish to seek a second opinion, asking another pathologist to review the tissue samples. This might reassure you that this is atypical hyperplasia and not an early form of breast cancer.

Whatever your situation, it makes sense to be followed by a doctor with expertise in breast health. Generally, a follow-up physical exam is done at 6 months and a mammogram may be recommended. After that, most women can resume yearly mammograms; in selected cases, doctors may add breast MRI.

For some women, doctors may suggest a hormonal therapy such as tamoxifen, raloxifene, or an aromatase inhibitor to reduce their risk of breast cancer. Studies have found that most ALH cells test positive for estrogen and progesterone receptors. These treatments have side effects, though, so your individual situation will determine whether their benefits outweigh their risks.

For more information, see Follow-up Care for Benign Breast Conditions

Lobular carcinoma in situ

Even though it has the word “carcinoma” in its name, LCIS is not a true breast cancer. LCIS rarely develops into cancer, but it does raise the lifetime risk of breast cancer.

LCIS occurs when cells that look like cancer cells grow inside the milk-producing lobules of the breast. Unlike ductal carcinoma in situ (DCIS), which can become an invasive cancer if left untreated, LCIS more typically remains within the lobules and does not invade nearby healthy tissue. That’s why it is not considered to be cancer. However, there is a rare form of LCIS called pleomorphic LCIS (PLCIS) or high-grade LCIS that may carry a higher risk of becoming invasive, and may therefore be treated similarly to DCIS.

LCIS is sometimes called lobular neoplasia, a category that includes atypical lobular hyperplasia. (ALH is considered to be a milder form of LCIS, and doctors sometimes disagree on where to draw the line.)

With LCIS, it’s important to pay attention to your breast health: do regular self-exams, have clinical breast exams by your doctor, and get annual mammograms. Your doctor may recommend a stepped-up screening plan, possibly adding MRI to mammography. Your doctor also may suggest a hormonal therapy such as tamoxifen, raloxifene, or an aromatase inhibitor to reduce your risk of breast cancer.

Another option for women at very high risk is prophylactic (or preventive) mastectomy to remove both breasts. In most cases, LCIS alone would not be reason enough to have the breasts surgically removed. You and your doctor can discuss whether your LCIS diagnosis combined with any other risk factors puts you at high enough risk to consider surgery.

Prophylactic mastectomy may be able to reduce a woman's risk of developing breast cancer by as much as 97%. The surgery removes nearly all of the breast tissue, so there are very few breast cells left behind that could develop into a cancer. This is an aggressive, irreversible procedure, though, so it generally is only recommended in the highest-risk cases.

Learn more about lobular carcinoma in situ, including symptoms and diagnosis, treatment, and follow-up care.

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