Management of High-Risk Lesions and In Situ Cancers

Percutaneous biopsy is commonly performed to evaluate a mammographic abnormality, resulting in more than 1 million benign breast biopsies performed annually in the United States. (1) Benign breast biopsies that have histologic epithelial abnormalities associated with increased risk of breast cancer are characterized as high-risk lesions. (2) Such increased breast cancer risk occurs in one of two scenarios; either a lesion with high risk that cancer is currently present in the tissue but undiagnosed due to undersampling by core needle biopsy (CNB), or a lesion with high /increased risk of breast cancer over the long-term future. (3) As screening imaging increases and percutaneous diagnostic biopsy is adopted as the standard of care, it is increasingly important to understand the implications of and appropriate management strategies for these diagnoses, including who should undergo surgical excision and/or high risk screening, who should be offered chemoprevention, and what is the future risk of breast cancer for patients with these high risk lesions.