[Lobular carcinoma in situ--what is the best treatment]

There are at present four different approaches to the management of lobular carcinoma in situ. (i) ipsilateral mastectomy with contralateral biopsy; (ii) ipsilateral segmental excision with block dissection of the axilla; (iii) bilateral mastectomy; and (iv) diagnostic excision biopsy and lifelong follow-up of both breasts with clinical examination and mammography. There are arguments in favour and against all four approaches. Based on the well-established fact that the risk of the patient developing infiltrating lobular carcinoma is equal in both breasts, the most rational approach is excisional diagnostic biopsy of the known lesion and lifelong follow-up of both breasts. Any infiltrating carcinoma will be discovered early with this approach, and the 20-year survival is 95%. If the patient insists that the risk of developing carcinoma must be totally excluded, bilateral mastectomy with breast reconstruction is the only option.