ASO Author Reflections: Active Surveillance for Ductal Carcinoma In Situ (DCIS)
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: Active Surveillance for Ductal Carcinoma In Situ (DCIS) Tawakalitu O. Oseni, MD1, and Manisha Bahl, MD, MPH2 Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Boston, MA; 2Division of Breast Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA
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PAST The incidence of ductal carcinoma in situ (DCIS), i.e. noninvasive breast cancer, has markedly increased due to the widespread use of screening mammography. The risks of DCIS are twofold: it can be upgraded to invasive cancer at the time of surgery or it can progress to invasive cancer over a woman’s lifetime. The natural history of this disease is not well understood, and thus surgery remains the mainstay of management. Increasing recognition that DCIS is a heterogeneous disease and that, left untreated, a subset of DCIS may not progress to invasive cancer have led to concerns regarding overtreatment, particularly in the setting of increasing bilateral mastectomy rates in women with DCIS. PRESENT Several active surveillance (AS) trials for DCIS are currently underway across the world.1 With AS, women do not undergo surgery or radiation but instead obtain imaging and clinical follow-up to monitor disease progression and, in some cases, take endocrine therapy. The success of these trials depends on careful selection of patients; namely, eligibility criteria must be designed to exclude women with
The source article was presented at the Radiological Society of North America (RSNA) Annual Meeting, Chicago, IL, USA, December 2018. Ó Society of Surgical Oncology 2020 First Received: 10 May 2020 M. Bahl, MD, MPH e-mail: [email protected]
DCIS that is likely to upgrade to invasive cancer at surgery and women at high risk of progression to invasive disease. In our retrospective study of women with DCIS who met the eligibility criteria for the COMET, LORD, and/or LORIS trials, we found that upgrade rates ranged from 5.0 to 12.0%.2 Other retrospective studies report variable upgrade rates among eligible women, ranging from 0 to nearly 20%.3–5 FUTURE The AS trials will advance our understanding of the natural history of DCIS and provide insight into the safety and efficacy of various management options for women with DCIS. However, ours and other studies suggest that more precise eligibility criteria are needed to ensure appropriate patient selection. Emerging tools such as deep learning-based computer vision algorithms, molecular biomarkers, and genomic prognostic testing may be able to identify with more precision the women with DCIS who are most likely to benefit from surgical intervention.
FUNDING This work was supported by the Agfa HealthCare/Radiological Society of North America (RSNA) Research Scholar Grant (Principal Investigator (PI): Dr. Manisha Bahl) and the Electronic Space Systems Corporation (ESSCO)-MGH Breast Cancer Research Fund (PI: Dr. Manisha Bahl and Dr. Tawakalitu O. Oseni). DISCLOSURE Tawakalitu O. Oseni and Manisha Bahl have no disclosures to
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