Better predicting breast cancer risk from lobular neoplasia

Lobular neoplasia are noncancerous breast lesions linked to at least a 20% chance of a person developing breast cancer.

“There is something about the breast tissue in women who develop lobular neoplasia that makes them form these atypical cells, and then eventually breast cancer,” said Dr. Anna Beck, a UW Health | Carbone Cancer Center surgical oncologist, researcher and an assistant professor of surgery at UW School of Medicine and Public Health.

Data shows these patients can reduce their cancer risk by taking long-term anti-estrogen therapy. However, a low number of patents opt into this route because of the uncomfortable and disruptive side effects.

Beck is leading research to identify the biological features driving the development of cancer in women with lobular neoplasia. The goal is to develop reliable biomarkers that clinicians can use to forecast patients as lower or higher risk of developing cancer. That way, patients can make a more informed decision about preventive care.

Beck said lobular neoplasia does not cause obvious symptoms and is typically found during a mammogram. Data shows there's been about a 10% increase every year over the past 20 years in the number of women diagnosed with lobular neoplasia.

UW Health’s Prevention, Assessment and Tailored Health Screening (PATHS) Clinic serves patients who are at a higher risk of breast cancer.

Women with lobular neoplasia are recommended for supplemental imaging, such as a breast MRI, to monitor potential cancer growth, and anti-estrogen therapy for prevention. Data shows anti-estrogen therapy cuts the odds of breast cancer development in half. Since these drugs inhibit the body’s estrogen production, they can cause menopause-like side effects, such as joint pain, hot flashes, fatigue, and mood changes. It can also interfere with a woman’s plans to get pregnant.

Beck’s research aims to better individualize these care recommendations to those most at risk of cancer.

“We know that only about 20% of women with lobular neoplasia will develop a breast cancer, but that means that 80% won't,” Beck said. “When you don't have a cancer diagnosis and it's preventive care, it is really difficult to balance the risks of taking these medications to hopefully prevent a cancer, versus all the symptoms that these women can experience.”

For this research, Beck is collaborating with fellow Carbone Cancer Center researchers Wei Xu, PhD, and Drs. Lee Wilke, Noelle LoConte, Mai Elezaby and Madhu Roy. Xu is a professor of oncology, Wilke is a professor of surgery, LoConte is a professor of medicine, Elezaby is an associate professor of radiology, and Roy is an associate professor of pathology.

To find biological markers that can predict the development of a future breast cancer, they are using novel methods to analyze breast tissue and identify changes that indicate developing cancer is more or less likely.

Based on what they find, Beck hopes to establish a method of scoring or categorizing risk level for each patient, so they can decide their best personal plan.

“Our goal is to identify women who are have the highest risk so that we, as medical professionals, can better counsel them on the benefits of taking these risk-reducing medications,” Beck said. “But we also want to be able to identify the women who are lower risk and can chose not to take anti-estrogen therapy with greater confidence. Long term, we want to help women understand their breast cancer risk as an individual so that they can make decisions around managing their risk with confidence and hope moving forward.”