title: Invasive lobular carcinoma of the breast: should this be regarded as a chronic disease?
abstract: BACKGROUND
  The surgical treatment of patients with invasive lobular carcinoma is still controversial due to its different clinical and pathological features. Most studies report local recurrence after relatively short follow-up periods, which is usually 5 years. However there is some evidence to suggest that local recurrence may occur late in the course of follow-up.
  
  
  OBJECTIVE
  To study the implications and outcome of extending the follow-up period of patients treated for invasive lobular carcinoma.
  
  
  METHODS
  Patients (268) treated between 1989 and 1996 were reviewed. Thirty-three patients were excluded as they had primary hormonal therapy. The outcomes for 235 patients were analyzed.
  
  
  RESULTS
  Seventy-nine patients (33.6%) had breast conservation surgery (group I), which was followed by re-excision due to positive margins in 23 patients (29%), and 156 patients (66.3%) had mastectomy (group II). Compared to group II, tumours in group I were smaller (mean size 17 vs. 37 mm, P=0.001), multifocal [20 (25%) vs. 14 (9%), P=0.003] and with more positive margins [23 (29%) vs. 24 (15%), P=0.0009]. Only 33 patients (21%) in group II, and all patients in group I had post-operative radiotherapy (P=0.0001). Forty-eight patients (17.9%) developed local recurrence [27 (34%) in group I and 21 (13.4%) in group II, P=0.0005] after a median follow-up period of 167.8 months. The mean time to local recurrence was 127 (range 24-196) months. Univariate analysis showed that the type of surgery, margin status, adjuvant radiotherapy and chemotherapy significantly affected local recurrence (P=0.0005, 0.02, 0.04 and 0.05 respectively). Cox regression analysis showed that the only factor affected local recurrence was the type of surgery (relative risk 2.43, 95% confidence interval 1.22-4.83, P=0.01) The overall survival was 99.3 months (78.2%). Univariate and Cox regression analyses showed that only the patients age at diagnosis significantly affected survival (P=0.003).
  
  
  CONCLUSIONS
  Local recurrence may be a late event in patients treated for invasive lobular carcinoma of the breast and extended follow-up may be considered. In this study mastectomy offers better local control.
authors.affiliation: Breast Surgery Unit, Norfolk & Norwich University Hospital, Norwich, UK.
authors.forename: I F
authors.initials: IF
authors.lastname: Anwar
authors.forename: S K
authors.initials: SK
authors.lastname: Down
authors.forename: S
authors.initials: S
authors.lastname: Rizvi
authors.forename: N
authors.initials: N
authors.lastname: Farooq
authors.forename: A
authors.initials: A
authors.lastname: Burger
authors.forename: A
authors.initials: A
authors.lastname: Morgan
authors.forename: M I
authors.initials: MI
authors.lastname: Hussien
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D018275:Carcinoma, Lobular / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008207:Lymphatic Metastasis; D008408:Mastectomy / Q000379:methods*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology