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.