 Dr Mukhtar on Recurrence Risk in Invasive Lobular Carcinoma 

Rita Mukhtar, MD, breast oncologic surgeon, associate professor of surgery, Division of Surgical Oncology, Invasive lobular Carcinoma Program, University of California, San Francisco, discusses the risk of disease recurrence in patients with invasive lobular carcinoma compared with those with invasive ductal carcinoma.

Due to the lower sensitivity of screening tools like mammography, patients with invasive lobular carcinoma are often diagnosed at more advanced stages of disease, which inherently increases the risk of recurrence, Mukhtar begins. However, Mukhtar explains that the majority of invasive lobular carcinomas tend to grow at a slower rate. She adds that patients with invasive lobular carcinoma more often present with grade 2 tumors compared with grade 3. Additionally, patients with invasive lobular carcinoma tend to have estrogen receptor–positive, HER2-negative disease, and these tumors generally exhibit lower proliferation rates with a lower Ki-67 index, Mukhtar continues. Despite this, she notes that patients with invasive lobular carcinoma can still have faster-growing tumors.

In the initial years following diagnosis, patients with invasive lobular carcinoma generally experience favorable outcomes, Mukhtar explains, noting that these patients could have lower recurrence rates compared with those with invasive ductal carcinoma. However, when patients with invasive lobular carcinoma move beyond the 5-year mark following diagnosis, the risk of recurrence for this patient population increases steadily year by year, Mukhtar adds. The risk of late recurrence for a patient with invasive lobular carcinoma is higher than a patient within the same subtype of breast cancer who had invasive ductal carcinoma, she says.

The higher rate of late disease recurrence observed in this patient population underscores the need for ongoing vigilance and long-term follow-up to support patients diagnosed with invasive lobular carcinoma, Mukhtar continues. Although many patients diagnosed with early-stage invasive lobular carcinoma can have a good prognosis following initial treatment, the cumulative risk of late recurrence necessitates sustained monitoring and potential interventions to mitigate this risk over time, she concludes.

Videos

Rita Mukhtar, MD, discusses the risk of disease recurrence in patients with invasive lobular carcinoma.

Dr Mukhtar on Recurrence Risk in Invasive Lobular Carcinoma 

Dr Mukhtar on Challenges in the Diagnosis and Management of Invasive Lobular Carcinoma 

Rita Mukhtar, MD, breast oncologic surgeon, associate professor of surgery, Division of Surgical Oncology, Lobular Breast Cancer Program, University of California, San Francisco, discusses challenges in the diagnosis and locoregional management of invasive lobular carcinoma.

Invasive lobular carcinoma is the second most common type of breast cancer behind invasive ductal carcinoma, comprising approximately 10% to 15% of patients, Mukhtar begins. Research over the past 15 years has helped identify more histological differences between invasive lobular carcinoma and invasive ductal carcinoma, she adds.

Historically, breast cancer histology did not significantly influence treatment planning, Muktar continues. However, research has demonstrated that patients with invasive lobular carcinoma face unique challenges compared with those with invasive ductal carcinoma. One notable difference is the growth pattern of invasive lobular carcinoma, which tends to be more diffuse, she says, adding that this complicates detection via imaging modalities such as mammograms, often resulting in later-stage diagnoses for patients with invasive lobular carcinoma. Consequently, invasive lobular carcinoma tumors are generally larger at the time of detection and may have a higher likelihood of lymph node involvement, Muktar says.

Additionally, the difficulty in accurately visualizing invasive lobular carcinoma tumors through imaging also poses significant implications for surgical treatment, Mukhtar explains. Surgeons may enter the operating room without a clear understanding of the tumor's true size, increasing the risk of positive margins, she notes. This uncertainty can lead to the need for additional surgeries, including re-excisions or even mastectomies, to achieve clear margins. The potential for multiple operations could increase the physical and emotional burden for patients, and delay the overall treatment process, she says.

Mukhtar emphasizes the importance of developing improved imaging techniques and strategies tailored specifically for patients with invasive lobular carcinoma to enhance early detection and precise surgical planning. Although the overall understanding of invasive lobular carcinoma has improved, significant challenges remain in its locoregional management, she says. Continued research and the development of specialized imaging techniques are essential to improve the management and outcomes for patients with invasive lobular carcinoma, Mukhtar concludes.

Rita Mukhtar, MD, discusses challenges in the diagnosis and management of invasive lobular carcinoma.

Rita Mukhtar, MD

Articles

Dr Mukhtar on Recurrence Risk in Invasive Lobular Carcinoma

Dr Mukhtar on Challenges in the Diagnosis and Management of Invasive Lobular Carcinoma