Lobular breast cancer is more likely to be multifocal (more than one tumor per breast), bilateral (diagnosed in both breasts at the same time), and both estrogen receptor-positive and progesterone receptor-positive (ER+/PR+) than ductal breast cancer, the most common type. Please also see lobular breast cancer survival data. Show Lobular breast cancer is also more likely to have a hereditary component. Palpable lobular tumors (i.e., those that can be felt by hand even if only as a firmer area) are associated with higher tumor grade and worse overall survival than nonpalpable lobular tumors. Women with lobular carcinoma in situ (LCIS), also known as lobular neoplasia, are at higher than average risk for invasive breast cancer, but the risk is higher for developing ductal as well as lobular breast cancer. One study found that the seven-year cumulative invasive breast cancer incidence was 9.9% after an initial diagnosis of atypical hyperplasia or LCIS. A 2020 study reported that 7.8% of women with atypical hyperplasia and 5.7% of women with LCIS developed invasive breast cancer during the first ten years after diagnosis. Efforts to predict which LCIS patients will progress to invasive breast cancer have so far been unsuccessful. Use of hormone replacement therapy (HRT), or menopausal hormone therapy, containing both estrogen and progestin has been shown to increase the risk of invasive lobular breast cancer. Being overweight also increases the risk of lobular breast cancer and recurrence after menopause. Although still rare, women with lobular breast cancer are more likely to get ovarian and gastric (stomach) metastases than those with other types of breast cancer. While lobular breast cancer may have indolent, non-aggressive characteristics compared to ductal breast cancer and other types, both the primary tumor in the breast and distant metastases can be difficult to detect. As a result, long-term prognosis is not superior to that of ductal breast cancer. Lymph node micrometastases in lobular breast cancerAs is the case for other types of breast cancer, lobular breast cancer patients with positive lymph nodes have worse prognosis than those with clear lymph nodes. However, the significance of lymph node micrometastases appears to differ. Micrometastases include metastases of 2 mm or less, tiny cell clusters, and isolated tumor cells. Generally speaking, micrometastases in lymph nodes have not been found to significantly influence breast cancer prognosis. For example, one study found that undetected micrometastases influence prognosis in patients with sentinel lymph nodes that are initially classified as negative, but the magnitude of the difference in outcome at five years was only 1.2%. Since identifying such micrometastases requires more intensified pathological assessment of lymph nodes, these study findings could result in less use of techniques to find micrometastases (metastases which would otherwise remain occult or undetected). However, because of the diffuse nature of lobular breast cancer, lymph node metastases are more likely to be micrometastases than in ductal breast cancer. Forgoing pathological techniques that could find otherwise undetectible micrometastases in lobular breast cancer cases might cause some tumors to be incorrectly staged. Multifocal and contralateral tumorsAs noted above, lobular breast cancer is more likely to be multifocal or multicentric (more than one tumor per breast) and bilateral (diagnosed in both breasts) than other breast cancer types. While five-year survival rates are similar, ten-year survival rates are lower for multifocal breast cancer. In addition, five-year survival rates are lower for women with contralateral breast cancer compared to those with tumors only in one breast. This appears to be because bilateral breast tumors tend to have more aggressive characteristics. Lobular breast cancer patients should receive MRIs of both breasts before surgery to identify all tumors. The higher possibility of undetected lesions in lobular breast cancer argues for systemic treatment in addition to lumpectomy and radiotherapy even for relatively small lobular tumors. Other factors associated with recurrenceOne large Swedish study, which followed women with lobular breast cancer for over 20 years, reported that positive lymph node status, high proliferation (defined as Ki-67 ≥ 30%), and significant tumor size (≥ 20 mm) each were associated with recurrence. Triple negative (ER-/PR-/HER2-) lobular breast cancer has relatively poor prognosis. On the other hand, one study reported that lobular breast cancer patients with clear lymph nodes, low proliferation and small tumor size had favorable long-term outcomes, with a breast cancer mortality rate of 12% after 20 years. Below are links to recent studies on this topic. For a more complete list of studies, please click on the tag lobular breast cancer. Please also see our articles on lobular breast cancer survival data, lobular breast cancer characteristics and diet for lobular breast cancer patients and survivors. Zhang Y, Luo X, Chen M, Yang L, Lei T, Pu T, et al. Biomarker profile of invasive lobular carcinoma: pleomorphic versus classic subtypes, clinicopathological characteristics and prognosis analyses. Breast Cancer Research and Treatment. Springer Science and Business Media LLC; 2022; 194:279-295 10.1007/s10549-022-06627-y Chen Y, Zhang T, Liu Y, Zheng J, Lin W, Chen Y, et al. Identification of a 5-gene-risk score model for predicting luminal A-invasive lobular breast cancer survival. Genetica. Springer Science and Business Media LLC; 2022; 10.1007/s10709-022-00157-7 Bychkovsky B, Laws A, Katlin F, Hans M, Knust Graichen M, Pace LE, et al. Initiation and tolerance of chemoprevention among women with high-risk breast lesions: the potential of low-dose tamoxifen. Breast Cancer Research and Treatment. Springer Science and Business Media LLC; 2022; 10.1007/s10549-022-06577-5 Dalenc F, Lusque A, De La Motte Rouge T, Pistilli B, Brain E, Pasquier D, et al. Impact of lobular versus ductal histology on overall survival in metastatic breast cancer: a French retrospective multicentre cohort study. European Journal of Cancer. Elsevier BV; 2022; 164:70-79 10.1016/j.ejca.2021.12.031 Okines A, Irfan T, Asare B, Mohammed K, Osin P, Nerurkar A, et al. Clinical outcomes in patients with triple negative or HER2 positive lobular breast cancer: a single institution experience. Breast Cancer Research and Treatment. Springer Science and Business Media LLC; 2022; 10.1007/s10549-021-06432-z Weiser R, Polychronopoulou E, Hatch SS, Haque W, Ghani HA, He J, et al. Adjuvant chemotherapy in patients with invasive lobular carcinoma and use of the 21‐gene recurrence score: A National Cancer Database analysis. Cancer. Wiley; 2022; 10.1002/cncr.34127 Yaghi M, Jabbal I, Bilani N, Zerdan MB, Elson L, Li H, et al. Abstract PD14-06: Does chemotherapy benefit patients with HR+/HER2- invasive lobular breast cancer?. Cancer Research. American Association for Cancer Research (AACR); 2022; 82:PD14-06-PD14-06 10.1158/1538-7445.sabcs21-pd14-06 Han B, Gu Z, Liu Z, Ling H. Clinical Characteristics and Survival Outcomes of Infiltrating Lobular Carcinoma: A Retrospective Study of 365 Cases in China. Cancer Management and Research. Informa UK Limited; 2022; Volume 14:647-658 10.2147/cmar.s346319 Kwon D, Ko BK, Jung SP, Kim H, Kim E, Jung YS, et al. Survival analysis in patients with invasive lobular cancer and invasive ductal cancer according to hormone receptor expression status in the Korean population. PLOS ONE. Public Library of Science (PLoS); 2022; 17:e0262709 10.1371/journal.pone.0262709 Chuang A, Watkins JC, Young RH, Lerwill MF. Lobular Carcinoma of the Breast Metastatic to the Ovary. American Journal of Surgical Pathology. Ovid Technologies (Wolters Kluwer Health); 2021; 46:179-189 10.1097/pas.0000000000001812 WATANABE J, NAKAMOTO S, SUGINO T. The Real-world Outcomes of Patients With Advanced Invasive Lobular Carcinoma of the Breast Compared With Invasive Ductal Carcinoma: A Review at a Single Institution. Anticancer Research. Anticancer Research USA Inc.; 2021; 41:4619-4627 10.21873/anticanres.15275 Nunes R, Sella T, Treuner K, Atkinson JM, Wong J, Zhang Y, et al. Prognostic utility of Breast Cancer Index to stratify distant recurrence risk in invasive lobular carcinoma. Clinical Cancer Research. American Association for Cancer Research (AACR); 2021;:clincanres.0733.2021 10.1158/1078-0432.ccr-21-0733 Cocco D, ElSherif A, Wright MD, Dempster MS, Kruse ML, Li H, et al. Invasive Lobular Breast Cancer: Data to Support Surgical Decision Making. Annals of Surgical Oncology. Springer Science and Business Media LLC; 2021; 28:5723-5729 10.1245/s10434-021-10455-7 Chamalidou C, Fohlin H, Albertsson P, Arnesson L, Einbeigi Z, Holmberg E, et al. Survival patterns of invasive lobular and invasive ductal breast cancer in a large population-based cohort with two decades of follow up. The Breast. Elsevier BV; 2021; 10.1016/j.breast.2021.07.011 Hewitt KC, Miller P, Piper M, Prionas N, Son JD, Alvarado M, et al. Positive margins after mastectomy in patients with invasive lobular carcinoma of the breast: Incidence and management strategies. The American Journal of Surgery. Elsevier BV; 2021; 10.1016/j.amjsurg.2021.05.021 Hosio M, Urpilainen E, Hautakoski A, Marttila M, Arffman M, Sund R, et al. Association of antidiabetic medication and statins with survival from ductal and lobular breast carcinoma in women with type 2 diabetes. Scientific Reports. Springer Science and Business Media LLC; 2021; 11 10.1038/s41598-021-88488-x Finnegan L, McAnena P, O’Halloran N, Curran C, Lowery A, Kerin M. AB009. SOH21AS214. Invasive lobular breast cancer—patterns of metastatic disease and survival. Mesentery and Peritoneum. AME Publishing Company; 2021; 5:AB009-AB009 10.21037/map-21-ab009 Zarwan C, Diamond O, Lam P, Ghebremichael MS, Lotz M, Shen AH, et al. Longitudinal study of breast cancer risk markers. The Breast Journal. Wiley; 2020; 10.1111/tbj.14097 Christgen M, Gluz O, Harbeck N, Kates RE, Raap M, Christgen H, et al. Differential impact of prognostic parameters in hormone receptor–positive lobular breast cancer. Cancer. Wiley; 2020; 126:4847-4858 10.1002/cncr.33104 Conforti F, Pala L, Pagan E, Viale G, Bagnardi V, Peruzzotti G, et al. Endocrine-responsive lobular carcinoma of the breast: features associated with risk of late distant recurrence. Breast Cancer Research. Springer Science and Business Media LLC; 2019; 21 10.1186/s13058-019-1234-9 Where does lobular breast cancer spread first?While ductal spreads to the liver, lungs, bones, and brain, lobular tends to go to the bones and ovaries or enmesh itself in the gastrointestinal tract, the abdominal lining, or the tissue around the kidneys and ureters.
Is Chemo Effective for invasive lobular carcinoma?What does all this emerging data regarding chemotherapy and invasive lobular carcinoma mean? This new data suggests that although most patients with ILC are not chemosensitive, there is a subset of high-risk ILC patients that benefit from chemotherapy to increase their survival rate.
Is lobular cancer fast growing?“Invasive lobular breast cancer is slow-growing compared to other breast cancers,” she says, “but because it is difficult to detect on a mammogram, these tumors can be large by the time they are diagnosed.”
Is lobular breast cancer aggressive?The good news is that ILC tends to be slow-growing and responsive to hormonal treatment. But it also tends to metastasize aggressively, so early detection is important. The best path to early detection involves regular mammograms and reporting any changes you notice in your breasts to your doctor immediately.
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