De-Escalating the Management of In Situ and Invasive Breast Cancer

Simple Summary De-escalation of breast cancer treatment reduces morbidity and toxicity for patients. De-escalation is safe if cancer outcomes, such as recurrence and survival, remain unaffected compared to more radical regimens. This review provides an overview on treatment de-escalation for ductal carcinoma in situ (DCIS), local treatment of breast cancer, and surgery after neoadjuvant systemic therapy. Improvements in understanding the natural history and biology of breast cancer, imaging modalities, and adjuvant treatments have facilitated de-escalation of treatment over time. It is necessary to identify appropriate areas of de-escalation in breast cancer treatment to minimize morbidity and maximize patients' quality of life. Less radical treatment modalities, or even no treatment, have been reconsidered if they offer the same oncologic outcomes as standard therapies. Identifying which patients benefit from de-escalation requires particular care, as standard therapies will continue to offer adequate cancer outcomes. We provide an overview of the literature on the de-escalation of treatment of ductal carcinoma in situ (DCIS), local treatment of breast cancer, and surgery after neoadjuvant systemic therapy. De-escalation of breast cancer treatment is a key area of investigation that will continue to remain a priority. Improvements in understanding the natural history and biology of breast cancer, imaging modalities, and adjuvant treatments will expand this even further. Future efforts will continue to challenge us to consider the true role of various treatment modalities.

Automated summary

De-escalation of breast cancer treatment can reduce morbidity and improve patients' quality of life. It is considered safe if the cancer outcomes are not affected compared to more aggressive treatments. This review provides an overview of de-escalation in the treatment of ductal carcinoma in situ (DCIS), local treatment of breast cancer, and surgery after neoadjuvant systemic therapy. Advancements in understanding the natural history and biology of breast cancer, imaging techniques, and adjuvant treatments have allowed for the reduction of treatment intensity. Identifying appropriate areas for de-escalation is crucial to minimize side effects while maintaining cancer outcomes. Less aggressive treatment modalities, or even no treatment, have been reconsidered if they achieve similar oncologic results as standard therapies. Careful consideration is needed to identify which patients benefit from de-escalation, as standard therapies still offer adequate cancer outcomes. This review highlights the importance of investigating de-escalation in breast cancer treatment, with future efforts aiming to clarify the role of different treatment modalities.