"Current approaches and emerging strategies in the treatment of ductal carcinoma in situ and premalignant breast lesions".

Abstract

Ductal carcinoma in situ (DCIS) and premalignant breast lesions represent a heterogeneous spectrum of non-invasive breast neoplasia with variable potential for progression to invasive breast cancer. The widespread use of screening mammography has led to a marked increase in DCIS detection, raising concerns about overtreatment and highlighting the need for risk-adapted management strategies. Current standard treatment for DCIS includes breast-conserving surgery or mastectomy, often followed by adjuvant radiotherapy to reduce local recurrence when breast conservative surgery (BCS) is performed. Endocrine therapy with tamoxifen or aromatase inhibitors is recommended for selected patients with hormone receptor-positive disease to lower the risk of ipsilateral and contralateral events. However, despite improved local control, these interventions have not consistently demonstrated a survival benefit, prompting reassessment of treatment intensity. Emerging strategies aim to individualize therapy by integrating clinicopathologic factors with molecular and genomic profiling to better stratify recurrence and progression risk. Ongoing clinical trials are evaluating active surveillance for carefully selected low-risk DCIS, as well as de-escalation approaches that may safely omit radiotherapy or surgery. Management of premalignant lesions such as atypical ductal hyperplasia increasingly emphasizes risk reduction, surveillance, and patient-centered decision-making. The aim of our review is to summarize current therapeutic approaches and emerging strategies in the management of DCIS and premalignant breast lesions, with a particular focus on risk stratification, treatment de-escalation, and future directions toward personalized care.