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Precancerous lesions of the breast

Nature Clinical Practice Oncology volume 5, pages 700–704 (2008)Cite this article

Abstract

The management of precancerous lesions of the breast has become a considerable clinical problem in the past 20 years, mostly as a consequence of increased detection due to the introduction of mammographic screening. It is not possible to identify with absolute certainty which of these lesions will progress to invasive carcinoma, and tailoring the treatment according to each individual case remains a challenge. There is a particular dilemma for surgeons, who must balance the risk of resecting too much and causing unnecessary cosmetic damage, or resecting too little and leaving an increased risk of recurrence. Further knowledge in the field of predictive and prognostic factors together with the development of gene-profiling techniques will, hopefully, provide answers to these questions. Among precancerous lesions of the breast, particular attention should be paid to ductal carcinoma in situ or intraductal carcinoma, appropriate treatment of which is crucial to prevent invasive breast cancer. Nearly all possible combinations of surgery, radiotherapy and medical treatments (anti-estrogens) have been tested in different clinical trials, but the situation is far from satisfactory. We believe that an important contribution can come from oncoplastic surgery, which is the application of plastic and reconstructive surgical techniques to ensure both radical excision of the disease and acceptable cosmetic outcomes.

Key Points

  • Precancerous lesions of the breast are increasingly diagnosed as a consequence of the introduction of mammographic screening

  • We are still unable to identify which of these lesions will progress to invasive carcinoma,leading to a consequent constant risk of overtreatment or undertreatment

  • Described biomarkers to monitor the progression to invasive cancer include estrogen receptors, p53, HER2, Ki-67, vascular endothelial growth factor and bcl-2 oncoprotein

  • Different combinations of surgery, radiotherapy and medical treatments have been tested without satisfactory results

  • Cosmesis-oriented surgical techniques (i.e. oncoplastic breast surgery) seem to be the methods most likely to become the gold standard treatment of these lesions

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Author information

Authors and Affiliations

  1. A Costa is Director of the European School of Oncology, Milan, and Breast Unit Coordinator at Fondazione Maugeri, Pavia, Italy and Canton Ticino, Lugano, Switzerland.,

    Alberto Costa

  2. V Zanini is Head of Oncoplastic Breast Surgery, Fondazione Maugeri, Pavia, Italy.,

    Vittorio Zanini

Authors
  1. Alberto Costa
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  2. Vittorio Zanini
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Correspondence to Alberto Costa.

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The authors declare no competing financial interests.

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Costa, A., Zanini, V. Precancerous lesions of the breast. Nat Rev Clin Oncol 5, 700–704 (2008). https://doi.org/10.1038/ncponc1239

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