De-escalation of breast surgery for early stage breast cancer

Breast cancer treatment is rapidly evolving toward precision-based de-escalation strategies for oncological safety and minimizing treatment-related morbidity. In early stage disease, minimally invasive approaches, such as non-surgical ablation techniques, including cryoablation and radiofrequency ablation, potentially constitute alternatives to conventional surgery for carefully selected low-risk tumors. Active surveillance trials challenge the necessity of immediate surgery for low-risk ductal carcinoma in situ, reflecting a paradigm shift toward risk-adapted management. In the neoadjuvant setting, achieving radiologic and pathologic complete responses, particularly in HER2-positive and triple-negative subtypes, is being investigated to determine the feasibility of omitting breast surgery under strict imaging and biopsy-guided protocols. Circulating tumor DNA-based minimal residual disease assays offer a promising tool for refining risk stratification and potentially guiding the extent of surgery and adjuvant therapy. These strategies represent a transformative movement toward biologically tailored, response-adapted, less invasive treatments for early breast cancer to optimize quality of life without compromising long-term outcomes.