OPTIMAL SURGICAL-TREATMENT OF INVASIVE LOBULAR CARCINOMA OF THE BREAST

Background: The roles of breast conservation and surgical evaluation o f the contralateral breast in the treatment of lobular carcinoma of th e breast remain unclear. The aim of this study was to compare local re currence, 5-year survival, and incidence of contralateral breast cance r in women with lobular carcinoma to that in women with infiltrating d uctal carcinoma. Methods: Women with infiltrating ductal carcinoma (ID C) and invasive lobular breast carcinoma (ILC) diagnosed during the ye ars 1984 to 1994 were identified through a statewide tumor registry. T he women were divided into groups based on their histology and treatme nt (breast conservation or modified radical mastectomy). The incidence s of contralateral breast cancer, local recurrence, and 5-year surviva l were compared within each histologic group and treatment category. R esults: During the period 1984 to 1994, 4886 women were diagnosed with invasive lobular or ductal breast carcinoma. Of these, 316 (6.5%) had infiltrating lobular cancer. The 5-year survival rates were 68% and 7 1% for ILC and IDC, respectively (p = 0.5). The local recurrence rates were 2.8% and 4.3% for ILC treated with lumpectomy and axillary nodal dissection (LAND) and modified radical mastectomy (MRM), respectively , which were not significantly different from that obtained with IDC ( LAND = 2.5%, MRM = 2.1%). The incidence of contralateral breast cancer during the period was 6.6% and 6.5% for ILC and IDC, respectively. Co nclusions: Invasive lobular carcinoma can be safely treated with breas t conservation with no difference in local recurrence or survival. In the absence of a suspicious finding on clinical or radiologic examinat ion, routine contralateral breast intervention is not recommended.