Should Surgery And Radiation Be The Standard Treatment For DCIS? The COMET Study Is Finding Out
About 1 out of every 5 new breast cancer diagnoses are categorized as DCIS (Ductal Carcinoma In Situ), making up roughly 60,000 cases in the United States every year.
When women receive a diagnosis of DCIS — also known as Stage 0 cancer or pre-cancer — their doctors often recommend that they get a mastectomy or lumpectomy, in case the cancer becomes aggressive.
But what if more doctors adopted a “wait and see” approach?
Dr. Shelley Hwang, who is the chief of breast surgery at the Duke Cancer Institute, is leading a study to determine what happens when women don’t immediately go under the knife after a DCIS diagnosis.
“The estimates are that about 70% of women who are diagnosed with DCIS may never develop invasive cancer,” Dr. Hwang says in the video below, “and so what the study is trying to determine is whether it may be safe to monitor those women rather than intervening early with surgery or radiation.”
The results of this study could overhaul how pre-cancer in the breast is treated.
A diagnosis of DCIS didn’t even really exist before mammograms. But ever since doctors have been able to see breast cancer at such an early stage — before it has the chance to become invasive — they’ve treated it aggressively.
The ten-year survival rate for DCIS is 98% to 99%, so treating it aggressively obviously works. But what if doctors could treat it less aggressively and still get those same results?
“DCIS is treated now as it has been for the past 40 years,” Dr. Hwang said during an interview at the 2017 San Antonio Breast Cancer Symposium (SABCS).
Surgery comes with its own side effects, both mental and physical, and a mastectomy often goes hand-in-hand with more surgeries to reconstruct the breast. And if an infection sets in, women undergo even more surgeries.
“We’re getting all of these new diagnoses before we really know what’s going to happen,” Dr. Hwang told the Atlanta Journal-Constitution. “The question is what are we going to do with all that information? It creates tremendous anxiety and that leads to a lot of unnecessary procedures.”
But, on the flip side, taking a less aggressive approach can make both patients and doctors nervous, and rightly so. Will taking some time to monitor pre-cancer just allow it to become invasive?
There is still a lot the medical community doesn’t know about DCIS, like if there are genetic markers or biomarkers that can predict if the pre-cancer will turn invasive, and how long it will take until it does turn invasive.
So in 2017, Dr. Hwang began a clinical trial that seeks to find the best treatment path for women with a DCIS diagnosis. It’s called COMET, which stands for Comparison of Operative to Monitoring and Endocrine Therapy.
Participants are women who are age 40 or older who have been diagnosed with low-risk DCIS. They are randomly split into two groups: in one group, women undergo the standard treatment for DCIS, which is typically either a lumpectomy or a mastectomy; in the other group, women go under “active surveillance,” which includes regular screenings as well as endocrine therapy (hormone therapy) if needed.
Her end goal is to enroll 1,200 women with low-risk DCIS at about 100 cancer centers throughout the US. Currently, 260 women are enrolled and the study is still actively recruiting. (To contact them about enrolling, head to their contact page here.)
It will be a few years before results are available.
Dr. Hwang knows that active surveillance won’t work for some women, who would perhaps experience heightened anxiety having to wait rather than taking immediate action. There is not a one-size-fits all approach to cancer treatment.
Hopefully once we have more information about the nature of DCIS, there will be more options available for treating it effectively without over-treating it, and women can undergo the treatment plan that works best for their situation.
Learn more about the trial in this video.