De-Escalation of Surgery in Ductal Carcinoma In Situ

In women with low-risk DCIS, incidence of ipsilateral invasive cancer was not higher with active monitoring compared with guideline-concordant care.

Clinicians have long known that not all ductal carcinoma in situ (DCIS) progresses to invasive cancer. Many women likely live out their lives harboring an underlying DCIS that never impacts their health. These observations have supported efforts to identify patients with low-risk subtypes of DCIS that could be candidates for de-escalation of standard interventions, including radiation therapy, adjuvant endocrine therapy, and now, surgery.

The noninferiority COMET trial compared outcomes between patients randomized to current guideline-concordant care (surgery with or without radiation therapy) or active monitoring without surgical intervention (breast imaging and physical exam every 6 months). Eligible participants were women aged 40 years a…

Reviewing Author

William J. Gradishar, MD

Disclosures

Consultant/Advisory BoardLilly; AstraZeneca; Gilead

Grant/Research SupportBreast Cancer Research Foundation

Editorial BoardsClinical Breast Cancer; Oncology; Annals of Surgery; Breast Cancer Research and Treatment

Leadership Positions in Professional SocietiesNational Comprehensive Cancer Network (Chair, Breast Cancer Panel); American Board of Internal Medicine (Medical Oncology Board)