Active Surveillance for DCIS: A Shift in Breast Cancer Treatment?
Barcelona, Spain – Early results from the LORD trial, presented at the 15th European Breast Cancer Conference (EBCC15), suggest that active surveillance may be a viable alternative to immediate surgery for women diagnosed with low-risk ductal carcinoma in situ (DCIS). This approach, involving regular check-ups rather than automatic surgical removal of abnormal cells, is prompting a re-evaluation of standard breast cancer care.
Understanding DCIS and the Current Approach
DCIS is characterized by abnormal cells within the milk ducts, but these cells haven’t yet spread to surrounding breast tissue. While it’s not invasive breast cancer, it can develop into it. Traditionally, DCIS has been treated similarly to invasive breast cancer, often with surgery, and sometimes radiotherapy or hormone therapy. However, research indicates that a significant proportion of DCIS cases – around four out of five – will never develop into life-threatening.
The LORD Trial: Empowering Patient Choice
The LORD trial, initiated in 2017, aimed to determine if women with low-risk DCIS could be safely monitored through active surveillance. Initially, patients were randomly assigned to either surgery or surveillance. However, following patient feedback, the trial shifted to allow patients to choose their preferred approach. Remarkably, around three-quarters of participants opted for active surveillance.
Early Findings: Reassuring Results
Data from 1,423 patients, followed for an average of two years, reveals encouraging trends. Among those who underwent immediate surgery, 9% were found to have invasive breast cancer either at the start of the trial or subsequently diagnosed. In the active surveillance group, 6% developed invasive cancer. While tumors detected in the surveillance group were slightly larger on average (6mm vs. 9mm), they weren’t more aggressive.
Professor Jelle Wesseling, leading the research, emphasized the principle of “first, do no harm,” stating the goal was to avoid unnecessary treatment without compromising patient safety. He described the interim results as “reassuring,” noting no indication that active surveillance leads to worse early outcomes compared to immediate surgery.
The Rise of De-escalated Care in Breast Cancer
This trial contributes to a growing movement towards “de-escalated” care in breast cancer, questioning whether all DCIS cases require the same aggressive treatment. Professor Isabel Rubio, Chair of EBCC15, highlighted the trial’s significance as one of the largest prospective studies focusing on low-risk DCIS, suggesting that carefully monitored active surveillance could offer outcomes similar to surgery while avoiding overtreatment.
What Does This Mean for Patients?
The findings suggest that women with low-risk DCIS may soon have more options. Active surveillance doesn’t mean withholding treatment; it means close monitoring with surgery remaining an option if needed. This approach could spare many women the physical and emotional toll of unnecessary surgery.
Did you know? The LORD trial protocol stipulated that the study would be halted once 60 patients in the active surveillance group were diagnosed with invasive cancer. The trial was stopped after reaching this threshold.
Future Directions and Long-Term Follow-Up
Researchers are continuing to follow all trial participants to assess the long-term safety of both approaches. They are also analyzing data to identify which patients are most likely to safely avoid immediate surgery. Longer follow-up is crucial before changes are made to existing clinical guidelines.
Frequently Asked Questions
What is DCIS? DCIS is a non-invasive breast condition where abnormal cells are found in the milk ducts.
What is active surveillance? Active surveillance involves regular check-ups and monitoring for changes, rather than immediate surgery.
Is active surveillance right for everyone with DCIS? Currently, it appears most suitable for women with low-risk DCIS.
What happens if cancer develops during active surveillance? Surgery remains an option at any time if cancer is detected.
Pro Tip: If you’ve been diagnosed with DCIS, discuss all treatment options – including active surveillance – with your healthcare team to determine the best course of action for your individual situation.
Want to learn more about breast cancer screening and prevention? Visit the National Cancer Institute website for comprehensive information.
Have questions about this research or your own breast health? Share your thoughts in the comments below!
