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ILC Program of Excellence “Clinical ILC Team”

The histologic growth pattern of invasive lobular breast cancer (ILC) shows a hallmark single file pattern compared to the more cohesive growth pattern seen in invasive ductal breast cancer, or breast cancer of no special type (NST). This is due to the loss of the membranous cell adhesion protein E-cadherin in ~90% of all ILCs, and leads to more difficult diagnosis on imaging.

UPMC has a large multidisciplinary clinical program for the treatment of all breast cancer stages and types (https://www.upmc.com/services/breast). We are fortunate to have several clinicians focusing on ILC. Further, the L-O Lab has a number of exciting collaborative studies with physician-scientists at UPMC/Pitt.

Medical Oncology

Dr. Julia Foldi

Julia Foldi, MD, PhD

Julia Foldi, MD, PhD, is an Assistant Professor of Medicine in the Division of Malignant Hematology and Medical Oncology at the University of Pittsburgh School of Medicine and the UPMC Hillman Cancer Center and a Breast Medical Oncologist at the Magee Womens Cancer Center. She treats patients with all types and stages of breast cancer, but is particularly focused on ILC. She works closely with basic science and translational investigators to design prospective clinical trials and correlative studies to address the unmet needs of patients with ILC.

Some of Dr. Foldi’s specific research projects dedicated to ILC include:

Here is a link to Dr. Foldi’s ILC publications

Dr. Marija Balic

Marija Balic, MD, PhD, MBA

UPMC breast medical oncologist Marija Balic, MD, PhD, MBA is actively engaged in both the clinical and research components of breast cancer. Dr. Balic is chief of Medical Breast Oncology at Magee-Womens Cancer Center and the co-director of UPMC Comprehensive Breast Center. She is also professor in the Department of Medicine, Division of Hematology/Oncology at the University of Pittsburgh and Scientific Director of the NSABP Foundation Translational Research Program. She has a longstanding interest in ILC and the role of liquid biopsy to improve its detection and molecular characterization.

Some of Dr. Balic’s papers investigating ILC include:

Here is a link to Dr. Balic’s ILC publications.

Breast Surgical Oncology

Dr. Priscilla McAuliffe

Priscilla McAuliffe, MD, PhD, FACS, FSSO

Priscilla McAuliffe, MD, PhD, FACS, FSSO is a breast surgical oncologist at UPMC Hillman Cancer Center and an associate professor of surgery at the University of Pittsburgh School of Medicine. She treats patients with all breast diseases, with a special interest and research emphasis on ILC, pre-invasive neoplasms including LCIS, premenopausal and older patients with breast cancer, breast conservation therapy and locally advanced breast cancer.

Dr. McAuliffe together with Dr. Rachel Jankowitz, Director of the Rena Rowan Breast Center and a medical oncologist at Penn Medicine, completed the first ever clinical trial exclusively for patients with ILC. This study aimed to learn more about how three commonly prescribed anti-estrogen therapies affect the tumor tissue of patients diagnosed with ILC (clinical trial info here)

Additionally, Dr. McAuliffe has a particular interest in “right-sizing” surgical care for patients with ILC and other breast cancer – specifically in older patients. In general, patients with ILC are diagnosed at later ages than those with invasive ductal cancer, making these questions particularly salient. She has evaluated the applicability of the Choosing Wisely guidelines (omission of axillary surgery for certain patients aged 70 years old and older) for patients with ILC, and she has recently completed a prospective trial demonstrating a decrease in low-value care for older patients.

Lastly, Dr. McAuliffe has created close collaborations with both ILC survivors/advocates, and with basic science researchers. She created and leads a program in which excess tumor tissue and blood, generously donated by patients, can be quickly delivered from the operating room to the laboratory for study. This program has resulted in the establishment of patient-derived organoids, specifically from patients with ILC, allowing direct analysis of the surgical tissues themselves. Her role also includes educating the next generation of physician scientists.

Some of Dr. McAuliffe’s interests and recent publications on ILC include:

Here is a link to Dr. McAuliffe’s ILC publications.

Breast Pathology

Dr. Rohit Bhargava

Rohit Bhargava, MBBS

Rohit Bhargava, MBBS is the Chief of Pathology at UPMC Magee-Womens Hospital and Professor of Pathology at the University of Pittsburgh School of Medicine. Dr. Bhargava is an experienced breast pathologist and specializes in diagnostic histopathology and immunohistochemistry. He is actively involved in identifying novel diagnostic and prognostic markers for breast cancer, predictive biomarkers in breast carcinoma and their correlation to clinical outcomes and has specific interest in studying invasive lobular breast cancer. His involvement with projects in the Lee-Oesterreich Lab has been critical in bringing the clinical focus of ILC projects to the forefront.

Some of Dr. Bhargava’s papers investigating ILC include:

Here is a link to Dr. Bhargava’s ILC publications.

Screening

Wendie A. Berg, MD, PhD

Wendie A. Berg, MD, PhD

1) General advances in screening

Wendie A. Berg, MD, PhD’s work defines where supplemental imaging adds meaningful cancer yield beyond mammography, and what trade-offs to expect. In the clinical trial ACRIN 6666, adding annual screening ultrasound to mammography in women at elevated risk increased detection of mostly small, node-negative invasive cancers; a single screening MRI found still more cancers missed by both tests (with higher recalls/biopsies), establishing a risk-adapted, multimodal paradigm. 

She has also led prospective evaluation of contrast-enhanced mammography (CEM) as an alternative to MRI. In the multicenter SCEMAM trial, CEM alone identified additional invasive cancers (several lobular) that other modalities missed, supporting CEM as a practical, high-sensitivity option in dense-breast and personal-history cohorts. 

Complementing these anatomic/contrast studies, Dr. Berg’s positron-based work showed high accuracy of positron emission mammography (PEM) for primary breast cancer and characterized histology-specific FDG uptake, lower in ILC/DCIS than in high-grade IDC, which helps explain performance differences of functional imaging across subtypes.   

2) Focus on invasive lobular carcinoma (ILC) & lobular neoplasia

Dr. Berg has repeatedly documented mammography’s reduced sensitivity for ILC, which contributes to later or larger presentations; in preoperative staging, mammography detected 34% of ILC vs 81% of IDC, reinforcing the need for adjunct imaging pathways.   

Evidence from ACRIN 6666 and subsequent practice-pattern data underscores that ultrasound, MRI, and CEM can help close ILC’s detection gap; a recent survey of breast radiologists reports broad support for imaging beyond mammography when screening or staging ILC.     

For lobular neoplasia, Dr. Berg has co-authored management studies showing higher upgrade risk for LCIS (especially variant LCIS, pleomorphic/florid) than for atypical lobular hyperplasia, supporting selective surgical excision; her guidance on image-guided biopsy also outlines when excision is generally warranted for high-risk lesions.     

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