Treatment of lobular breast cancer

Lobular breast cancer is a type of breast cancer that starts in the glands that make milk when breastfeeding, known as lobules, and spreads into the surrounding breast tissue. It is also known as invasive lobular breast cancer or invasive lobular carcinoma.

There is a lack of up-to-date data on the number of people diagnosed with lobular breast cancer. The Office for National Statistics has published statistics showing the number of people diagnosed with Lobular Breast Cancer in England each year from 2006 to 2016. According to this data, there were a total of 6765 people diagnosed with lobular breast cancer in 2016: 6754 women and 11 men.

Cancer Research UK has reported that around 15% of all breast cancers are lobular breast cancer.

The charity Lobular Breast Cancer UK has published a list of signs and symptoms of Lobular Breast Cancer:

• a tugging sensation in the breast
• changes in the skin of the breast, including dimpling, puckering or a dent
• stabbing pains, or constant pain in the breast
• a thickening area in the breast
• new swelling or fullness in the breast
• persistent itching on the skin or inside the breast
• changes to the nipple, including inversion (pointing inward or lying flat) or pointing in a different direction
• discharge or oozing from the nipple.

All women aged from 50 to 71 are invited for breast cancer screening every three years. NHS breast cancer screening uses x-ray scans called mammograms to look for cancers that may be too small to feel.

More information on NHS breast screening can be found on the government website, updated in October 2024.

In September 2024, the government updated guidance on protocols for the surveillance of women at higher risk of developing breast cancer.

Unlike other breast cancers, lobular breast cancer tends to spread out in straight lines rather than amassing to form a firm lump. A person is more likely to have a thickened area of breast tissue as a symptom rather than a lump.

This can make lobular breast cancer difficult to detect in physical examination and when using imaging scans such as mammograms and ultrasound. Whilst lobular breast cancer is slow-growing compared to other cancers, tumours can often be large by the time that the cancer is diagnosed.

Various academic evidence indicates that magnetic resonance imaging (MRI), which can produce detailed images of inside the breast, offers improved detection and characterisation of lobular breast cancer.

There is no national standard treatment or guidelines for patients with lobular breast cancer. It is treated in the same way as more common types of invasive cancer. Treatment will depend on various factors including:

• the size of the cancer and where it has spread
• how abnormal the cancer cells look and whether they might respond to certain drugs
• the health and fitness of the patient

Potential treatment options include:

• drug treatments before surgery, such as chemotherapy to shrink the cancer
• surgery to remove the area of cancer and surrounding healthy tissue, known as breast conserving surgery, or removal of the whole breast, known as mastectomy
• drug treatments after surgery, such as radiotherapy, chemotherapy, hormone therapy, targeted cancer drug therapy and drugs that help to prevent or slow down bone thinning or bone damage

The National Institute for Health and Care Excellence (NICE) guidelines on early and locally advanced breast cancer and advanced breast cancer sets out recommendations about the diagnosis and management of breast cancer, including lobular breast cancer. In relation to lobular breast cancer in particular, the guidelines on early and locally advanced breast cancer include a specific recommendation to offer an MRI scan before surgery to assess tumour size where breast-conserving surgery is planned (recommendation 1.1.3).

The Lobular Moon Shot Project was set up in 2023. This project aims to raise funds to support research to improve understanding of how lobular breast cancer develops and spreads, to identify new drugs that could be used to treat the condition and to test these in clinical trials. In November 2024, the Lobular Moon Shot Project announced a partnership with the Manchester Breast Centre to help expedite research into Invasive Lobular Breast Cancer.

The European Lobular Breast Cancer Consortium is a network of researchers focused on improving understanding, diagnosis and treatment of the condition.

Several charities, including Lobular Breast Cancer Alliance and Lobular Breast Cancer UK, have highlighted a need for research that focuses on lobular breast cancer and treatment pathways specifically for it.

Some MPs have called for government funding for research for lobular cancer treatment pathways and the government have responded to several parliamentary questions about its activity to support diagnosis, treatment and research for lobular breast cancer. In its responses, the government has highlighted general funding to support cancer research such as £1.5 million for research via the National Institute of Health and Care Research (NIHR) and £29 million to the Institute of Cancer Research and the Royal Marsden NIHR Biological Research Centre. In addition, it has pointed to:

• £1.3 million of funding for a NIHR research project that will assess the effectiveness of a new form of MRI scan to detect breast cancers that have been missed by mammograms.
• NIHR research infrastructure funding that supports Biomedical Research Centres and the NIHR Clinical Research Network. The government have stated that the Clinical Research Network has supported 10 lobular breast-cancer studies in the past five years.