Current Management of High-Risk Breast Lesions

Purpose of review The purpose of this review is to describe recent updates in the management of high-risk breast lesions. We review the various high-risk breast lesions and evaluate the collective literature regarding the rates of upgrade to invasive cancer or ductal carcinoma in situ with excisional biopsy as well as the increased risk for future breast cancer development that a diagnosis of a high-risk breast lesion may portend. For those lesions associated with an increased risk of breast cancer, we discuss the appropriate surveillance regimens as well as risk reduction opportunities available to patients. Recent findings Recent studies may suggest a role for close imaging observation in certain clinical settings when a benign intraductal papilloma or flat epithelial atypia is identified by core needle breast biopsy. Ongoing prospective clinical trials should reveal valuable data to help answer this question. Summary Clinical management of high-risk breast lesions identified and determined to be concordant after image-guided core needle biopsy varies and prospective data are needed to better guide management decisions. High-risk breast lesions require close radiologic-pathologic correlation when diagnosed by image-guided breast core needle biopsy. Excisional biopsy can exclude a higher-grade lesion such as DCIS or invasive cancer; however, in certain cases, close observation with follow-up may be appropriate. Additionally, women who have certain high-risk lesions such as lobular carcinoma in situ, atypical ductal hyperplasia, or atypical lobular hyperplasia are at an increased risk for the future development of breast cancer and should undergo risk assessment and discussion of risk reduction measures. Ongoing and future prospective trials may provide data to better guide these management decisions and optimize patient care.