Rita Wilson Undergoes Bilateral Mastectomy

Actress Rita Wilson has announced that she recently underwent a bilateral mastectomy with reconstructive surgery to treat breast cancer. In a statement she said:

“I have taken a leave from the play Fish in the Dark to deal with a personal health issue. Last week, with my husband [two-time Academy Award winner Tom Hanks] by my side, and with the love and support of family and friends, I underwent a bilateral mastectomy and reconstruction for breast cancer after a diagnosis of invasive lobular carcinoma. I am recovering and most importantly, expected to make a full recovery. Why? Because I caught this early, have excellent doctors and because I got a second opinion.”

She went on to say that doctors have been following her for “an underlying condition of LCIS (lobular carcinoma in situ), which has been vigilantly monitored through yearly mammograms and breast MRIs. Recently, after two surgical breast biopsies, PCIS (pleomorphic carcinoma in situ) was discovered.”

The adjective pleomorphic refers to the fact that the sizes and shapes of breast cells are highly variable when viewed through a microscope.  In situ is a Latin phrase that translates literally to “on site” or “in position.”

Wilson stressed the importance of getting a second opinion whenever a diagnosis of breast cancer is made:

“My gut told me that was thing to do. A different pathologist found invasive lobular carcinoma. His diagnosis of cancer was confirmed by, yet, another pathologist. I share this to educate others that a second opinion is critical to your health. You have nothing to lose if both opinions match up for the good, and everything to gain if something that was missed is found, which does happen. Early diagnosis is key.”

What is LCIS (Lobular carcinoma in situ)?

breastFirst, a little about breast anatomy:

The mature female breast is composed of essentially four structures: lobules or glands; milk ducts; fat and connective tissue.  There are 15 to 20 sections (lobes) arranged in a spoke pattern,  each lobe being made of many smaller sections (lobules). Lobules have groups of tiny glands that can make milk. After a baby is born, breast milk flows from the lobules through thin tubes (ducts) to the nipple. Fibrous tissue and fat fill the spaces between the lobules and ducts.

The glandular tissue is not uniformly distributed throughout the breast. There tends to be more glandular tissue in the upper outer portion of the breast. This is why many women complain of pain in this area just before their periods. It is also the site of about half of all breast cancers.

Lobular carcinoma in situ (LCIS) is diagnosed when abnormal cells grow inside the lobules of the breast, but have not spread to nearby tissue or beyond.  LCIS is not considered invasive breast cancer as it tends to remain in place (in situ). However, those diagnosed with LCIS are at a higher risk of developing breast cancer. Women with LCIS are considered eight to 10 times more likely to develop invasive cancer which can occur as either invasive lobular or ductal carcinoma.

lobular carcinoma in situThere are special breast cancer screening guidelines for women with LCIS. They should have breast exams every 6-12  months and get a yearly mammogram. Several groups, such as the American Cancer Society and the National Comprehensive Cancer Network, also recommend that women with  LCIS (or those with a personal history of breast cancer, ductal carcinoma in situ (DCIS),  atypical ductal hyperplasia (ADH), or atypical lobular hyperplasia (ALH)) speak with their doctors about having an MRI scan as well.

If you would like to assess your breast cancer risk, click here to use the Breast Cancer Risk Tool

Some women diagnosed with LCIS are treated with the anti-estrogen drugs tamoxifen or raloxifene to try to lower their risk of breast cancer. Tamoxifen has been shown to be slightly more effective in cancer prevention than raloxifene, but it comes with the risk of greater side effects.

Invasive Lobular Breast Cancer (ILC)  is the second most common type of breast cancer. About 1 of every 10 women with breast cancer has lobular carcinoma which begins in a breast lobule. The majority of those with breast cancer have invasive ductal carcinoma which begins in the milk ducts.

The choice of treatment for ILC is dependent on the same factors as other breast cancers:

  • The stage of the cancer (the size of the tumor and whether it is in the breast only or has spread to lymph nodes or other places in the body).
  • Estrogen receptor and progesterone receptor levels in the tumor tissue.
  • Human epidermal growth factor type 2 receptor (HER2/neu) levels in the tumor tissue.
  • Whether the tumor tissue is triple-negative (cells that do not have estrogen receptors, progesterone receptors, or high levels of HER2/neu).
  • How fast the tumor is growing.
  • How likely the tumor is to recur (come back).
  • A woman’s age, general health, and menopausal status (whether a woman is still having menstrual periods).
  • Whether the cancer has just been diagnosed or has recurred (come back).
Michele R. Berman, M.D. was Clinical Director of The Pediatric Center, a private practice on Capitol Hill in Washington, D.C. from 1988-2000, and was named Outstanding Washington Physician by Washingtonian Magazine in 1999. She was a medical internet pioneer having established one of the first medical practice websites in 1997. Dr. Berman also authored a monthly column for Washington Parent Magazine.

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