Monitoring May Be Sufficient for Low-Risk Ductal Carcinoma in Situ

Hwang ES, Hyslop T, Lynch T, et al. Active Monitoring with or without Endocrine Therapy for Low-Risk Ductal Carcinoma In Situ: The COMET Randomized Clinical Trial. JAMA. 2024; in press.

Morrow M, Barrio AV. Is It Time to Abandon Surgery for Low-Risk DCIS? JAMA. 2024; in press.

Diagnosis of low-risk ductal carcinoma in situ (DCIS) is increasing due to widespread use of mammography. Current guidelines recommend surgery with or without radiation as the preferred treatment for these patients. Omission of surgery with close monitoring using breast imaging and physical examination has been suggested as an alternative management strategy.

This study reported outcomes from the COMET randomized noninferiority trial that compared rates of cancer diagnosis in groups (n = 484 and 473, respectively) treated with monitoring or guideline-concordant care.

Over a 2-year interval the rate of cancer diagnosis was 4.2% in the monitoring group and 5.9% in the guideline-concordant group.

The authors concluded that monitoring was an acceptable strategy for patients with low-risk DCIS.

In the editorial that accompanied the article, Morrow and Barrio noted that the 2-year follow-up interval is not sufficient to detect all cancers in the monitoring group; for this reason, a definitive conclusion on the safety of monitoring cannot be reached using these data and guideline concordant care should continue to be the preferred approach for patients with low-risk DCIS.