Invasive Lobular Cancer (ILC)

ILC cells (A-above left) form a distinct, single-file pattern that is very different to the more common ductal breast cancer cells (B-above right).

So far, the group has developed a white paper, launched a website, presented a poster at the San Antonio Breast Cancer Symposium, organized a series of educational webinars and established a partnership with the Metastatic Breast Cancer Project — a genomic research initiative out of Dana Farber Cancer Institute and the Broad Institute of MIT and Harvard — to help identify lobular patients and expedite their tumor analysis.

“Although superficially we think of lobular and ductal as the same, and treat them interchangeably, they might have biological differences that would have clinical differences,” she said.

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Risk Factors

Overall, Pate said she’s encouraged by the recent uptick in interest in ILC research and believes that the opportunities for improvement will “make a big difference to patients.”

Having breast cancer in one breast means the risk of developing a new primary breast cancer in the other breast is slightly higher than in someone who has never had breast cancer. With invasive lobular breast cancer, this risk is widely held to be slightly higher than with other types of breast cancer, but is still low overall. Some series report a higher incidence of bilateral breast cancer, although this finding has not been consistently demonstrated across all studies. Historically, ILC has been associated with higher rates of contralateral breast cancer (CBC) than IDC, with reported risk ranging from 1.8 to 4.3 times higher, however, most of the studies are dated and frequently included lobular carcinoma in situ. Recently, a large cohort database review found no difference in the risks of CBC in ductal and lobular histologies.

Invasive Lobular Cancer (ILC)

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“We’ve known for a long time that lobular acts differently; lobular tumors are bigger and more spread out; they metastasize differently and are somewhat more likely to be bilateral,” said Fred Hutch pathologist Dr. Peggy Porter, who has been involved in a number of ILC research collaborations. “It’s a pattern that’s been histologically defined and clinically defined for years.”

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What makes lobular breast cancer different?

Examining your breasts regularly, knowing the symptoms of breast cancer and speaking to your doctor as soon as possible if you notice something that isn’t normal for you is crucial. This is because early diagnosis and treatment of breast cancer improves the chances of fighting the disease.

Fred Hutch clinical researcher and SCCA oncologist Dr. Hannah Linden said lobular is found more often by MRI than by traditional imaging (unfortunately, MRIs may not be covered by insurance), but stressed that “just because imaging isn’t as good, it doesn’t mean it’s useless.”

The results provide additional insight to inform patients regarding the well-known multicentricity of disease, the lower than historically reported risk of CBC, and the limitations of standard imaging in detecting this distinct, and often imaging occult disease. At presentation, 6% had a diagnosis of CBC, 33% had multifocal/multicentric disease and preoperative magnetic resonance imaging (MRI) led to an identification of additional disease in 20% of the patients. Imaging occult nodal disease was identified in 24% of patients.

Lobular breast cancer comes into the research spotlight

Margaret Flowers of the Breast Cancer Research Foundation interviews lobular breast cancer expert Dr. Steffi Oesterreich of the University of Pittsburgh and Seattle patient advocate Leigh Pate during the 2017 San Antonio Breast Cancer Symposium. Video courtesy of Breast Cancer Research Foundation

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Current treatment for ILC follows similar treatment protocols as for other histological subtypes of breast cancer.

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Above left: Standard two view 2D mammogram. The cancer, in the area marked by red arrows, is not well seen.
Above right: Irregular mass (in area of red ovals) is much better seen on the tomosynthesis (3D) slices than the 2D images.

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Molecular Characteristics of ILC / Receptor Status

“The sheer lack of tumor material to study is a problem,” said Pate. “We’re trying to bridge that.”

Patient advocate Leigh Pate is working with researchers and patients to raise the profile of lobular breast cancer, which many consider to be “understudied.” Photo by Robert Hood / Fred Hutch News Service

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