Active Monitoring for Low-Risk DCIS: A Viable Option for Patient Well-Being
Table of Contents
A groundbreaking study presented at the 2024 San Antonio Breast Cancer symposium has revealed that patients with low-risk ductal carcinoma in situ (DCIS) experience similar physical, emotional, and psychological outcomes whether they choose active monitoring or upfront treatment. These findings, part of the COMET trial, offer new insights into managing DCIS and could reshape clinical approaches for this common breast cancer diagnosis.
The Rise of DCIS and the Treatment Dilemma
The increasing use of mammography and other screening methods has led to a higher detection rate of DCIS, a non-invasive breast cancer that accounts for about 20% of all breast cancer diagnoses in the U.S. However, the controversy surrounding DCIS treatment stems from the fact that only 25% to 60% of cases progress to invasive cancer. This uncertainty has fueled debates about the most effective and patient-centered approach to managing the condition.
In a previous analysis of the COMET trial, researchers found that active monitoring and standard-of-care treatment resulted in comparable rates of invasive breast cancer diagnosis. Building on these findings, the latest study focused on the quality of life for patients in both treatment arms.
Study Overview and Methodology
The COMET trial enrolled 995 patients with low-risk DCIS, defined as grade 1 or 2, hormone receptor-positive, HER2-negative tumors without evidence of microinvasive or invasive disease. Participants were randomly assigned to either active monitoring or guideline-concordant care, which included surgery with or without adjuvant radiation. patients in the active monitoring group could opt for surgery if their condition progressed, while both groups had the option to receive endocrine therapy.
The study’s secondary analysis, presented by Ann Partridge, MD, MPH, Interim Chair of the Department of Medical Oncology at Dana-Farber Cancer Institute and Professor at Harvard Medical school, evaluated patient-reported outcomes to assess the impact of each treatment approach on quality of life.
dr. Partridge emphasized that one of the primary concerns with de-escalating treatment is the potential for increased anxiety among patients. “Patients often worry that delaying or avoiding surgery might increase the risk of their cancer worsening or recurring,” she explained. “This study aimed to address those concerns by comparing the experiences of patients in both treatment arms.”
Key Findings and Implications
After normalizing scores for factors such as race, age, tumor grade, and endocrine therapy use, the study found no important differences in physical functioning, emotional well-being, or psychological outcomes between the active monitoring and upfront treatment groups. These results suggest that active monitoring does not negatively impact patients’ quality of life in the short term.
“The data are encouraging,” Dr. Partridge noted. “They show that, in the short term, active monitoring is a reasonable approach in terms of patient experience. If longer-term data confirm these findings, this could become a viable management option for women with low-risk DCIS.”
The study’s findings could have significant implications for clinical practice, particularly in the U.S., were DCIS diagnoses are on the rise.By offering patients a less invasive option without compromising their well-being, active monitoring may help alleviate the physical and emotional burdens associated with more aggressive treatments.
Funding and Disclosures
the COMET trial was funded by several prestigious organizations, including the Patient-Centered Outcomes Research Institute, the Breast Cancer Research foundation, and the National cancer Institute.Dr. Partridge reported no conflicts of interest.
As researchers continue to explore the long-term benefits and risks of active monitoring, the COMET trial serves as a pivotal step toward personalized and patient-centered care for those diagnosed with low-risk DCIS.
exploring Active Monitoring for Low-Risk DCIS: A Conversation with Dr. Ann Partridge
The recent findings from the COMET trial have sparked notable interest in the potential of active monitoring as a treatment option for low-risk ductal carcinoma in situ (DCIS). To delve deeper into these groundbreaking results, we sat down with Dr.Ann Partridge, Interim Chair of the Department of Medical Oncology at Dana-Farber Cancer Institute and Professor at Harvard Medical School, to discuss the implications of this study for patient care and clinical practice.
The rise of DCIS and the Treatment Dilemma
Senior Editor: Dr. Partridge, thank you for joining us today. The rise in DCIS diagnoses due to increased screening has led to a significant treatment dilemma. Can you explain why this condition has become such a focal point in breast cancer management?
Dr. partridge: Absolutely. DCIS now accounts for about 20% of all breast cancer diagnoses in the U.S., largely due to the widespread use of mammography. Though,the challenge lies in the fact that only a subset of these cases will progress to invasive cancer. This uncertainty has made it difficult to determine the most effective and patient-centered approach to treatment.
Study Overview and Methodology
Senior editor: The COMET trial is a pivotal study in this field. Can you walk us through the methodology and how it differs from previous approaches?
Dr.Partridge: Certainly. The COMET trial enrolled 995 patients with low-risk DCIS, defined by specific criteria such as grade 1 or 2 tumors and hormone receptor-positive, HER2-negative status. Participants were randomly assigned to either active monitoring or guideline-concordant care, which included surgery with or without adjuvant radiation. The study’s secondary analysis focused on patient-reported outcomes to assess the impact on quality of life.
Key Findings and Implications
Senior editor: The findings suggest that active monitoring does not negatively impact patients’ quality of life. What are the key takeaways from this study, and how could it influence clinical practice?
Dr. Partridge: The data are very encouraging. We found no significant differences in physical functioning, emotional well-being, or psychological outcomes between the active monitoring and upfront treatment groups. This suggests that active monitoring is a reasonable approach in the short term. If longer-term data confirm these findings, it could become a viable management option for women with low-risk DCIS, offering a less invasive alternative without compromising patient well-being.
Addressing Patient Concerns
Senior Editor: One of the primary concerns with de-escalating treatment is the potential for increased anxiety among patients. How did the study address these concerns?
Dr. Partridge: Patients often worry that delaying or avoiding surgery might increase the risk of their cancer worsening or recurring. This study aimed to address those concerns by comparing the experiences of patients in both treatment arms.The results show that active monitoring does not lead to increased anxiety or negatively impact quality of life, which is a significant reassurance for both patients and clinicians.
Future Directions and Clinical Impact
Senior Editor: What are the next steps for research in this area, and how might these findings influence clinical practice in the U.S.?
dr. Partridge: We need to continue exploring the long-term benefits and risks of active monitoring. If future studies confirm the short-term findings, this approach could become a standard option for managing low-risk DCIS in the U.S. Given the rising rates of DCIS diagnoses, offering patients a less invasive option without compromising their well-being could considerably alleviate the physical and emotional burdens associated with more aggressive treatments.
Conclusion
Senior Editor: Dr. Partridge, thank you for sharing your insights. The COMET trial represents a significant step forward in personalized and patient-centered care for those diagnosed with low-risk DCIS. We look forward to seeing how these findings will shape future clinical approaches.
Dr. Partridge: Thank you for having me. It’s an exciting time in this field, and I’m hopeful that these findings will lead to better outcomes for our patients.
