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Breast Cancer Risk in Women Receiving No or Delayed Treatment for DCIS
Standard treatment for ductal carcinoma in situ (DCIS) includes surgery, often with radiation and endocrine therapy, but its favorable prognosis has generated concern about overtreatment. In a recent randomized trial, active monitoring of low-risk DCIS was not associated with increased risk of invasive breast cancer compared with standard care; longer-term follow-up is pending. Meanwhile, observational studies offer further evidence to inform clinical decision making. In the current one, researchers assessed the risk of subsequent ipsilateral invasive breast cancer in 1800 U.S. women with biopsy-confirmed DCIS who received no surgery or radiation within six months of diagnosis (38% of women eventually had surgery and 25% received endocrine therapy).
During a median follow-up of 5 years, 7% developed invasive breast cancer, and breast cancer mortality was 1.6%. The estimated 8-year cumulative incidence of invasive breast cancer was 11%, ranging from 9% in women with low-risk DCIS (defined as low-grade histology, hormone receptor–positive, and age ≥40) to 14% in those with high-risk DCIS.
Comment
The reasons for delayed or absent treatment in these patients are unknown, and this was not a study of active surveillance. Nonetheless, the risk for invasive breast cancer after a DCIS diagnosis was low, as noted by the authors; the range is similar to the risk associated with benign atypia, which is often managed with surveillance. The management of low-risk DCIS will continue to evolve as clinicians and patients weigh overtreatment against the risk of invasive breast cancer. Several ongoing randomized trials will help clarify the best strategies for low-risk DCIS. For now, I think we can reassure patients that short-term delays in treatment are unlikely to increase their risk for invasive breast cancer.
Citation(s)
Author:
Ryser MD et al.
Title:
Cancer outcomes in women without upfront surgery for ductal carcinoma in situ: Observational cohort study.
Source:
BMJ
2025
Jul
8; [e-pub].
(Abstract/FREE Full Text)
Empfohlen von
David S. Weisman, DO, FACP