Cancer is a non-transmissable disease characterised by the rapid and uncontrollable division of cells. Cancerous growths can occur anywhere in the body. A thickening in of breast tissue or a change in the size or shape of the breast can act as warning signs of a specific cancer type called lobular breast cancer. Lobular breast cancer (also referred to as invasive lobular carcinoma) is a result of uncontrolled cell division in the milk-producing glands of the breasts, which are known as lobules. However, at later stages of the cancer, cancerous cells can also invade into surrounding breast tissues. This article will outline the causes of lobular breast cancer, describe the signs and symptoms that are used to diagnose the cancer and discuss how it can be managed.
Causes of lobular breast cancer
The exact cause of lobular breast cancer is not clear. It occurs when the cells in milk-producing glands of the breast develop mutations in their DNA, leading to uncontrolled and rapid cell growth.
There are certain risk factors that predispose individuals to invasive lobular carcinoma:
- Sex: people assigned female at birth (AFAB) are more likely to develop lobular breast cancer than people assigned male at birth (AMAB)
- Age: older people are more likely to develop lobular breast cancer than those who are younger
- Genetics: People with inherited genetic cancer syndromes have an increased risk of suffering from breast cancer. A study indicated that people AFAB who had a larger number of affected first-degree relatives were more likely to develop invasive lobular breast cancer than those who had no family history of breast cancers1
- Hormones: increased exposure to oestrogen hormone, which is produced by the ovaries, can act as a factor that makes a person more susceptible to lobular breast cancer. Oestrogen levels can fluctuate during late menopause, in people who experience their first period at a younger age, those with low parity (who have given birth to up to two children) and in people who were older when first giving birth2
- Hormone replacement therapy (HRT): Postmenopausal use of oestrogen and progesterone hormones during and after menopause increases the risk of developing of invasive lobular carcinoma2
- Lobular carcinoma in situ (LCIS): Presence of lobular carcinoma in situ (abnormal cells within breast lobules) increases the risk of developing invasive lobular carcinoma
- Alcohol: consuming alcoholic substances can heighten the chance that a person will acquire spontaneous mutations in lobular cells, which can lead to the development of cancer
Signs and symptoms of lobular breast cancer
The most common symptoms of lobular breast cancer are:
- Thickened and hard area in the breast
- Swelling in the breast
- A lump under the armpit
- Changed shape or size of the breast
- Changes to the nipple
- Change to the texture of the skin in regions where dimpling and puckering occurs on the breast
- Skin irritation
- Nipple discharge other than breast milk
- Breast or nipple pain
Lobular breast cancer can also metastasise (spread) to distant sites of the body, such as into the bones, lungs, brain, liver, ovaries, gastrointestinal tissues and peritoneum (the tissue surrounding the abdomen). Loubular breast cancer tends to progress slowly so, metastasis can be observed many years after a diagnosis has been made. Yet, once metastasis occurs, cancer can become refractory to treatment, worsening a patient’s prognosis. Hence, it is important to be aware of symptoms that suggest that the cancer has began to spread.3
Symptoms of metastatic lobular breast cancer include::
- Pelvic bleeding
- Abdominal pain and bloating
- Painful breathing and shortness
- Unexplained weight loss
- Persistent bone pain
- Difficulty eating
- Visual impairment
- Impaired cognitive function
- Frequent headaches
- Change in skin color and the formation of firm nodules on the skin
- Swelling in the chest, neck, and armpit
Management and treatment for lobular breast cancer
Early detection is very important for better treatment outcomes. When detected and treated early, patients affected by lobular breast cancer have a 100% five-year survival rate. . If cancer spreads to nearby tissues, the likelihood that the person will survive for five years decreases to 93%, with metastatic cases having survival rates of only 22%.
Treatment options for invasive lobular carcinoma include:
- Surgery: the doctor will determine the type of surgery according to the size, location, characteristics of the cancer, medical history and your preferences. Lumpectomy (removing cancer and abnormal tissues from the breast) or mastectomy ( removal of all breast tissues) is uaully performed
- Chemotherapy:an adjuvant therapy given before or after surgery. It helps decrease the risk of cancer recurrence elsewhere in the body
- Radiation therapy:adjuvant therapy that targets cancer cells which may be left after surgery. It is always recommended after lumpectomy and may be used after mastectomy to avoid a resurgence of the cancer
- Endocrine therapy (hormonal blockade): this therapy option either attempts to inhibit the action of oestrogen hormone on receptors or lowers the level of the hormone in the body
- Immunotherapy: this treatment harnesses your own body’s immune system to attack cancer cells
- Targeted therapy: this treatment targets specific characteristics of cancer cells, such as the proteins that allow cancer cells to grow rapidly. Antibodies are designed to direct the immune system towards attacking the features of cancerous cells
How is lobular breast cancer diagnosed?
Lobular breast cancer diagnosis is challenging due to its diffuse growth pattern. Lobular breast cancer can be multi-foca,l meaning it can occur in more than one location or be bilateral, occurring in both breasts. This makes screening, detection, and treatment more complicated. A physical breast examination is first performed by a doctor in order to detect any physical abnormalities, such as the thickening of breast tissue. Further tests are then done to confirm diagnosis, including:
- Mammogram: an X-ray photograph of the breast that the doctor uses to detect, evaluate, and follow the progression of cancer. However, invasive lobular carcinoma cannot be detected in mammograms, causing cancer to be missed in its early stages and allowing it to progress
- Ultrasound: an imaging test that sends high-frequency sound waves through the breast which are converted into images. Ultrasound cannot be used as a sole screening test for breast cancer as it is not a reliable method to diagnose lobular breast cancer at early stages of the disease
- Magnetic resonance imaging (MRI): imaging that uses magnets and radio waves to provide an image. It is used for screening of high-risk people AFAB who have gene abnormalities or a family history of cancer. It can also be used for monitoring cancer recurrence and for gathering further information if suspicions are raised by the results of anultrasound or a mammogram
- Biopsy:ia biopsy is the only method thatconfirms the presence of cancer. A biopsy is a small operation where the doctor removes a small piece of tissue from the suspicious area to examine it under the microscope
How can I prevent lobular breast cancer?
Breast awareness is the key for breast cancer prevention. Know the size, shape and consistency of your breast. It is important to be aware that the breast changes during the menstrual period, potentially becoming more tender and lumpy. Breast awareness can be practiced by incorporating the following into your lives:
- Knowing how your breasts normally look and feel
- Knowing what changes to look for
- Visiting the doctor immediately if you monitor any changes
- Routine screening if you are above 40 years of age
- Self-breast examination
Self examination can be done monthly after each menstrual cycle. The steps for checking for breast cancer at home are as follows:
- Step 1: Examine your breast in a mirror with hands on hip
Check that the breast is of normal size and shape and that no swelling or distortion is present
- Step 2: Examine the breast in a mirror with hands raised and look for changes
- Step 3: Look for breast fluid
- Step 4: Examine the breast for lumps while lying down
Use the right hand to feel the left breast and the left hand for the right breast. Use the pads of your fingers and not the fingertips when checking your breasts, keeping fingers flat and together. You can move your fingers in a circular motion and follow a pattern
Lifestyle changes can help lower your risk of developing lobular breast cancer. Avoiding hormone replacement therapy, leading a healthy lifestyle by controlling your diet and exercising, and avoiding consumption of substances (like alcohol and tobacco) are changes that help lower your chances of developing breast cancer. It is also recommended to breastfeed your children.
Who is at risk of lobular breast cancer?
Lobular breast cancer affects people AFAB of any age, although itmost commonly develops in people AFAB between the ages of 45 and 55
How common is lobular breast cancer?
Lobular breast cancer is the second most common type of breast cancer after invasive ductal carcinoma. According to cancer research UK, about 15% of people affected by breast cancer suffer from lobular breast cancer. The incidence rate of lobular carcinoma have increased in the past two decades. In 2021, an estimated 43,700 cases of invasive lobular breast cancer were identified.
When should I see a doctor?
Visit the doctor if you observe any signs or symptoms of breast cancer when performing a self-examination.It is also recommended to ask your doctor when it is recommended to start routine screening for early detection of cancer.
Routine screening methods include self-breast examination, physical examination and mammograms. Regular mammograms are recommended for people AFAB who are older than 40 years of age. For high-risk individuals, it is recommended to start routine screening at an earlier age.
Invasive lobular breast cancer is a serious condition that primarily affects people assigned female at birth. Although lobular breast cancer has a good prognosis when detected and treated early, current diagnostic tests and the lack of cancer awareness may delay the diagnosis process. It is important that people learn how to perform self-examinations for breast cancer and conduct regular screenings in order to detect cancer early. Lobular breast cancer can be treated with surgery alongside adjuvant therapies. Prevention of cancer is done by implementing lifestyle changes and seeking medical help, especially if you have a family history of breast cancer.
- Collaborative Group on Hormonal Factors in Breast Cancer. Familial breast cancer: collaborative reanalysis of individual data from 52 epidemiological studies including 58 209 women with breast cancer and 101 986 women without the disease. The Lancet. 2001 Oct 27;358(9291):1389-99. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(01)06524-2/fulltext
- Dossus L, Benusiglio PR. Lobular breast cancer: incidence and genetic and non-genetic risk factors. Breast Cancer Research [Internet]. 2015 Mar 13 [cited 2023 Feb 10];17(1):37. Available from: https://doi.org/10.1186/s13058-015-0546-7
- Wong YM, Jagmohan P, Goh YG, Putti TC, Ow SGW, Thian YL, et al. Infiltrative pattern of metastatic invasive lobular breast carcinoma in the abdomen: a pictorial review. Insights into Imaging. 2021 Dec;12(1). https://insightsimaging.springeropen.com/articles/10.1186/s13244-021-01120-4