Lobular Breast Cancer
Written by Caroline Streatfield
In October 2021 I was referred for my first mammogram, there having been a delay due to Covid, this was a year later than it should have been. I was told that often after an initial mammogram, patients are recalled to the breast clinic in Brighton as a clear picture may not have been obtained, therefore I wasn't too concerned about attending this recall appointment. As the appointment progressed it became obvious that there was some concerns relating to a mass in my left breast, culminating in three biopsies. I could have cancer and if so would need an operation.
One week later I received the diagnosis of invasive lobular breast cancer. Luckily my family hasnot been affected by breast cancer in the past therefore I was fairly naive to the fact that there are several different types and treatment can be targeted to the characteristics of the diagnosis. About 15 % of all breast cancers are Lobular breast cancer. Essentially this means that the tumor originates in the lobules, the milk producing glands, in the breasts rather than the ducts.
Lobular cancer behaves differently to other breast cancers in that it grows not as a solid tumor but in lines of cells which expand like a spider's web. This can make diagnosis difficult as often, as with my case there is no visible lump. Often the cancer cannot be seen on a mammogram and when it is detected tends to be larger and more likely to have spread outside of the breast to the lymph nodes or other areas of the body, giving rise to a metastatic diagnosis.
My tumor was 55mm -around 2 and a half inches and after being reassured originally that the lymph nodes were not affected, cancer was found in the sentinel node which is the first lymph node into which a tumor drains in the armpit. Each individual has a differing number of lymph nodes, statistically the more lymph nodes which test positive for cancer, the poorer the prognosis.
Another feature of Lobular breast cancer is that it is more likely to be multifocal, this means two or more malignant tumors occurring within the same breast. An MRI confirmed that I had multifocal disease and I was advised that a mastectomy was recommended without immediate reconstruction. It is also commonly understood that lobular breast cancer is more likely to occur bilaterally -meaning a tumor may develop in the other breast. The evidence for this is disputed by some physicians. I requested a double mastectomy to mitigate the risk of this happening in the future but was initially denied and had a single mastectomy six weeks after my diagnosis.
Chemotherapy then followed as a precaution as the spread to the lymph node meant that I was at higher risk of further spread. I then received radiotherapy. Lobular breast cancer tends to be very hormone driven, the tumor is tested for hormone receptors and a score out of 8 given for oestrogen and progesterone elements. My score was 8 for both which means hormone therapy is also an effective treatment for me to further reduce the risk of recurrence. This medication is taken for 7 to 10 years, I also have a monthly stomach injection to suppress my ovary function. I am also eligible for a new targeted therapy so will be taking that for two years together with a six monthly bone infusion. All together a lot of interventions.
The NHS agreed to a second mastectomy at my request in February 2023. I have recovered well and deal with the side effects of the medications as best as I can, but prolonged treatments have left me with fatigue, low immunity and of course psychologically the threat of recurrence is always with me.
The scariest thing about having a Lobular diagnosis, specifically, is the fact that there is no visible lump to indicate that cancer may be present. I am however grateful that there are so many new treatments being made available for all types of breast cancer.
