Are your ductal carcinoma in situ patients over-treated?
Currently, ductal carcinoma in situ (DCIS) is treated just as aggressively as an invasive breast cancer. This treatment includes surgery, radiation, and often endocrine therapy to block estrogen. The treatment can be burdensome on patients with significant side effects including scarring and loss of sensation with surgery as well as damage to surrounding organs with radiation. Treatment for DCIS does not appear to improve overall survival or to substantially lower the risk of breast cancer-specific mortality.1
Most cases of low-risk DCIS will never become an invasive breast cancer if untreated. This dichotomy between treatment and pathology has lead cancer researchers and clinicians to ask the question, “Are we over-treating DCIS?” At the University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center (UMGCCC), we want to help answer this important question, and thereby minimize morbidity, without sacrificing outcomes, in our patients.
Therefore we have opened the Comparison of Operative to Monitoring and Endocrine Therapy (COMET) trial (Principal investigator: Suliat Nurudeen, MD). The COMET study is a randomized Phase III clinical trial comparing active surveillance, also called close monitoring or watchful waiting, with or without endocrine therapy to current standard of care (surgery with radiation and endocrine therapy). Women age 40 years or older with recently diagnosed low- or intermediate-grade DCIS are eligible for enrollment.
Results of this study will provide important information on the outcomes for low-risk DCIS. As we learn more about DCIS, we will be better equipped to communicate the risks and benefits of active surveillance and aggressive cancer treatments for our patients. Most importantly, our patients may experience a better quality of life knowing they are being monitored carefully while avoiding potentially unnecessary physical, emotional, and financial burdens.
1Narod SA, Iqbal J, Giannakeas V, Sopik V, Sun P. Breast Cancer Mortality After a Diagnosis of Ductal Carcinoma In Situ. JAMA Oncol. 2015 Oct;1(7):888-96. doi: 10.1001/jamaoncol.2015.2510.