导管原位癌是一种多样化的疾病，其中仅有50%的病变会进展为侵袭性癌症，但不幸的是，所有患者都会接受相似的治疗建议，而不考虑疾病变异性。去轻化是一种哲学，认为应根据未来进展和复发的可能性来区别治疗这种疾病。四项手术试验正在研究从算法中移除手术干预，这是当前治疗的主要支柱。分子测定已经被开发出来，以帮助区分同侧乳腺肿瘤复发的风险，并可能指导术后放射治疗的效用。初级内分泌疗法也正在作为标准局部治疗的替代疗法进行研究。导管原位癌治疗是一个非常复杂的算法，在共同决策中应进行讨论和治疗。 版权所有©2023 Elsevier Inc.保留所有权利。

Ductal carcinoma in situ is a diverse disease in which only 50% of lesions progress to invasive carcinoma, but unfortunately, all patients receive similar treatment recommendations independent of the disease variability. De-escalation is the philosophy that treatment for this disease should be differentiated based on the likelihood of future progression and recurrence. Four surgical trials are looking at the possibility of removing surgical intervention, the current mainstay of treatment, from the algorithm. Molecular assays have been developed to help differentiate the risk of an ipsilateral breast tumor recurrence and potentially guide the postsurgical utility of radiation therapy. Primary endocrine therapy is also being explored as an alternative to standard local therapy. Ductal carcinoma in situ therapy is a very complicated algorithm that should be discussed and treated through shared decision-making.Copyright © 2023 Elsevier Inc. All rights reserved.