Lobular Breast Cancer: Recognising The Subtle Signs & Finding The Right Treatment For You

When it comes to breast cancer, most people think of a detectable lump. But what if a cancer doesn’t form a lump at all, slipping under the radar of standard screenings? This is the reality for many patients with lobular breast cancer—a less common but uniquely challenging form of breast cancer that accounts for approximately 10-15 per cent of all cases. While this may sound like a small percentage, it translates to approximately 40,000 new diagnoses annually in the United States alone.

What is Lobular Breast Cancer?

Lobular breast cancer (LBC), also known as invasive lobular carcinoma, originates in the breast’s lobules—the glandular structures responsible for milk production. Unlike the more common invasive ductal carcinoma (IDC), which comprises nearly 80 per cent of breast cancer cases and often forms a distinct, easily identifiable lump, LBC grows in lines or sheets of cells, infiltrating the breast tissue in a dispersed manner. This growth pattern can make lobular cancer difficult to detect through routine mammograms or self-exams, as it rarely presents as a palpable lump.

Why Early Diagnosis Can Be Difficult?

The symptoms of lobular breast cancer are often subtle. Patients may notice a vague sense of fullness or firmness in the breast or experience skin and nipple changes, such as redness or discharge. However, in its early stages, many individuals might not experience any symptoms at all. This stands in stark contrast to ductal breast cancer, which typically forms a noticeable lump that is more readily detected through physical exams or imaging. 

The non-cohesive growth pattern of lobular breast cancer cells poses significant challenges for early detection. Standard mammograms may miss LBC, leading to diagnoses at a later stage when the tumour size is larger, and lymph node involvement is more extensive than indicated. Enhanced imaging techniques, such as ultrasound, contrast-enhanced mammography, or MRI, can help improve detection, especially for high-risk women or those who present with symptoms.

Understanding Non-Invasive Lobular Conditions

It’s important to differentiate lobular breast cancer from non-invasive lobular conditions. Conditions such as lobular carcinoma in situ (LCIS) and atypical lobular hyperplasia (ALH) are considered precursors, increasing the risk of developing invasive breast cancer without being invasive themselves. Individuals diagnosed with LCIS or ALH benefit from careful monitoring and may consider preventive strategies to mitigate their risk of developing invasive cancer. 

Tailored Treatment Approaches

Treatment approaches for lobular breast cancer are comprehensive and tailored to the unique characteristics of the disease. Surgical intervention is often the first line of treatment, aiming to remove cancerous tissue and evaluate lymph node involvement. Hormone therapy is also frequently employed, as lobular breast cancer is commonly hormone receptor-positive, meaning it can rely on estrogen and other hormones for growth. By blocking these hormones, hormone therapy helps prevent the cancer cells from proliferating. 

Additionally, targeted therapy has gained prominence, utilising drugs that focus on specific molecular changes associated with breast cancer, including inherited mutations and those unique to the cancer cells. Radiation therapy may follow surgery to target any remaining cancer cells in the breast or nearby tissue, reducing the risk of recurrence and improving treatment outcomes. This targeted approach helps reduce the risk of recurrence, enhancing the overall efficacy of the treatment plan for individuals diagnosed with lobular breast cancer. 

 Prognosis and the Importance of Long-Term Monitoring

The prognosis for lobular breast cancer can vary based on several factors, primarily the stage at diagnosis. Generally, early-stage lobular breast cancer is associated with better outcomes and a lower chance of recurrence. However, lobular breast cancer is known for its potential to recur many years after the initial diagnosis—often later than ductal breast cancer.

When lobular breast cancer metastasises, it often spreads in unique patterns. Unlike ductal cancers, which tend to form discrete tumours in other organs, lobular breast cancer may spread along the linings of organs such as the ovaries, uterus, gastrointestinal tract, and even the central nervous system. This distinctive spread requires a vigilant, long-term monitoring approach for those diagnosed with lobular breast cancer. 

As we deepen our understanding of lobular breast cancer, we gain hope for more precise diagnostic tools and individualised treatment strategies, leading to improved outcomes for patients. Continued research and a focus on patient-centered care pave the way for innovative approaches that could transform breast cancer management. Each breakthrough brings us closer to a future where lobular breast cancer is identified earlier, treated effectively, and managed with an insight that minimises recurrence and enhances overall quality of life.

Dr. Neil M. Iyengar

Guest Author MD, Breast Medical Oncologist, Memorial Sloan Kettering Cancer Center, New York, US