No Surgery for DCIS — Studies and Support

Research shows that at least 3 out of 4 women (75%) with DCIS that is not treated will not get a future invasive breast cancer.

PLS for “Genomic analysis defines clonal relationships of ductal carcinoma in situ and recurrent invasive breast cancer.”

Cancer Outcomes in DCIS Patients Without Locoregional Treatment

Results

A total of 1286 DCIS patients who did not undergo locoregional therapy were identified. Median age at diagnosis was 60 years (inter-quartile range = 51–74 years), with median follow-up of 5.5 years.

Among patients with tumor grade I/II, the 10-year net risk of ipsilateral invasive breast cancer was 12.2% (95% confidence interval [CI] = 8.6% to 17.1%) compared with 17.6% (95% CI = 12.1% to 25.2%) among patients with tumor grade III (n = 244) and 10.1% (95% CI = 7.4% to 13.8%) among patients with unknown grade (n = 495).

Among all patients, the 10-year cumulative incidences of ipsilateral invasive cancer, contralateral breast cancer, and all-cause mortality were 10.5% (95% CI = 8.5% to 12.4%), 3.9% (95% CI = 2.6% to 5.2%), and 24.1% (95% CI = 21.2% to 26.9%), respectively.

Conclusion

“Despite limited data, our findings suggest that DCIS patients without locoregional treatment have a limited risk of invasive progression. Although the cohort is not representative of the general population of patients diagnosed with DCIS, the findings suggest that there may be overtreatment, especially among older patients and patients with elevated comorbidities.”

OMISSION OF SURGERY FOR LOW-RISK DCIS

“A recent evaluation of data from the SEER registry of women diagnosed with DCIS from 1992-2014 who did not undergo surgery at the time of diagnosis indicates that the rate of invasive progression is highly variable between individuals and that the 10-year net risk of ipsilateral invasive breast cancer ranged from 15%-28%, depending on age at diagnosis and histologic features.”45

Comparing Treatment Options for Women with Low-Risk Ductal Carcinoma In Situ (DCIS) — The COMET Study

“Only 20–30 percent of DCIS cases turn into invasive cancer, which is cancer that spreads and causes illness.”

Surgical Upstaging Rates for Vacuum Assisted Biopsy Proven DCIS: Implications for Active Surveillance Trials

Conclusions

“DCIS upstaging rates in women eligible for active surveillance trials are low (6–10%), and in this series, all those with invasive disease were early-stage, node-negative. The careful patient selection for DCIS active surveillance trials has a low risk of missing occult invasive cancer and additional studies will determine clinical outcomes.”

Survival Benefit of Breast Surgery for Low-Grade Ductal Carcinoma In Situ

“For low-grade DCIS, the weighted 10-year breast cancer–specific survival of the nonsurgery group was 98.8% and that of the surgery group was 98.6%.”

Overtreatment of Low-Grade Ductal Carcinoma In Situ

“Surgery for DCIS has remained largely unchanged since the 1970s, and mastectomy is now performed more often than is seen with invasive cancer. It is 40 years since the inception of the first breast screening programs, and it is time to question the appropriateness and the outcomes of these management policies for screen-detected DCIS.”

Current Clinical Trials

Low-risk ductal carcinoma in situ (DCIS) lesions often do not progress to invasive breast cancer during the patient’s lifetime. Therefore, active surveillance (active monitoring) without surgery as a management strategy for low-risk DCIS is being evaluated in three Clinical Trials, called the COMET (USA)- LORIS (UK)- and LORD (The Netherlands/EU)-trial. 

“Alternative” Perspectives, Support, and Resources

About Donna Pinto

I am originally from New Jersey and moved to Los Angeles with my family at age 12. After graduating from San Diego State University with a BA in Journalism, I had a short-stint in magazine advertising sales before landing my "dream job" with Club Med. For two years I worked at resorts in Mexico, The Bahamas, The Dominican Republic and Colorado. My husband Glenn & I met in Ixtapa, Mexico and we embarked on a two year honeymoon around the world. This was also a research project for a book we wrote called "When The Travel Bug Bites: Creative Ways to Earn, Save and Stay Abroad." I am also the author of a quote book for new graduates -- "Cheatnotes on Life: Lessons From The Classroom of Life." In 1997, we settled in San Diego and I was blessed to work part-time from home for non-profit organizations while raising our two boys. In 2010, a DCIS diagnosis changed my life. DCIS 411 is the culmination of my on-going journey and discoveries.
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2 Responses to No Surgery for DCIS — Studies and Support

  1. Kirsten says:

    Thanks for posting this! Great info!

    Like

  2. informedconsent2014 says:

    fabulous information and progress! This is the type of info and data we will be able to take to our doctors in the future to stop overtreatment!

    Like

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