Research Progress on Surgical Step-Down Therapy for Early Breast Cancer

Breast cancer is one of the most common malignant tumors in women worldwide, posing a serious threat to women’s health. The incidence of breast cancer is on the rise, and the proportion of early-stage breast cancer is also increasing. Breast cancer will account for 32% of all new cases in women in 2024, ranking first among all malignancies. Early-stage breast cancer refers to lesions that are confined to the breast and regional lymph nodes at the time of diagnosis without distant metastasis. Treatment strategies include neoadjuvant therapy before surgery, local treatment (surgery and/or radiotherapy), and adjuvant therapy after surgery. The purpose of the surgery is to completely remove the lesion while providing precise typing and staging to guide the systemic treatment strategy; neoadjuvant therapy downgrades the tumor, increases the chances of being operable, breast-preserving, and axillary-preserving, and assesses the sensitivity of the treatment to guide adjuvant intensive therapy; adjuvant therapy is classified based on the risk of disease recurrence for patients to improve their prognosis. This article reviews the expansion of indications and technical optimization for breast-conserving surgery, the progress of sentinel lymph node biopsy replacing axillary dissection, the role of neoadjuvant therapy in promoting surgical downgrading, and the application of artificial intelligence in treatment decision-making, and explores current challenges and future directions, aiming to provide references for clinical practice.