De-escalation of Surgical Intervention and Contemporary Management Recommendations for Lobular Neoplasia, Atypical Ductal Hyperplasia, and Ductal Carcinoma In Situ

Abstract Purpose of ReviewIn which patients is it oncologically safe to offer active surveillance instead of surgery for DCIS or a benign breast lesion with upgrade potential (BWUP)?Recent FindingsMost contemporary studies are retrospective or registry studies for BWUP and frequently demonstrate lower than historically reported upgrade rates for all entities, consistent with improved imaging and biopsy techniques. Determining which patients should undergo surgical excision involves shared decision-making between the patient and surgeon, with input from breast imaging and pathology. Three international trials offering active monitoring (AM) for low-risk DCIS have been activated, although results are still pending.SummaryOpportunities for de-escalation of surgical intervention for BWUP breast lesions exist, and decisions for when to omit surgery should be made as a multidisciplinary team. The oncologic safety of omitting surgery for DCIS has yet to be determined, but AM trials are actively enrolling.
Source: Current Breast Cancer Reports - Category: Cancer & Oncology Source Type: research