• Posted December 13, 2024

'Watch and Wait' May Equal Active Treatment for Early DCIS Breast Cancers, Studies Find

A “watch-and-wait” strategy might be the best option for some women with early-stage, low-risk breast cancer.

According to two new studies presented Thursday at the San Antonio Breast Cancer Symposium, active monitoring of ductal carcinoma in situ (DCIS) resulted in breast cancer recurrence rates similar to those of women who had surgery to remove their cancer. Not only that, women who were provided such watchful waiting also had a similar quality of life to those who received treatment right away, in terms of physical, emotional and psychological outcomes.

“All current treatments for DCIS aim to reduce the risk of future invasive cancer, despite a growing body of evidence that not all DCIS is destined to progress,” said Dr. Shelley Hwang, a professor of surgery and radiology at Duke University School of Medicine in Durham, N.C.

“Thus, current practice may result in the over-treatment of women whose tumors are at low risk of progression, leading to chronic pain, altered body image, reduced quality of life and other side effects that may be avoidable,” Hwang added in a meeting news release.

DCIS involves abnormal cells found within a milk duct in the breast. It’s an early, noninvasive form of breast cancer that accounts for about 20% to 25% of all new breast cancer cases in the United States, the National Breast Cancer Foundation says.

A steady increase in mammography and other breast cancer screening methods has led to the detection of more cases of DCIS, researchers explained in background notes.

But DCIS poses little risk to women unless it progresses to invasive disease, raising the question of whether active surveillance would be better than going ahead and getting surgery and radiation.

Both of the new studies involved the same clinical trial, which was designed to compare active monitoring against surgery for women diagnosed with DCIS.

The first study looked at outcomes related to breast cancer, and the second at outcomes related to quality of life.

In the clinical trial, 673 women with DCIS were randomly assigned to either receive active monitoring or have their cancerous cells surgically removed.

After two years, nearly 9% of the women who’d gotten surgery went on to develop cancer in the breast where the DCIS was first found, compared with 3% in the watch-and-wait group, results show.

Slightly more patients in the active monitoring group received hormone therapy for their DCIS: about 71% compared with 66%, researchers said.

Nevertheless, the rate of breast cancer was 7% in those who received hormone therapy and surgery, versus 3% for those simply monitored, results show.

“Omission of surgery has been highly controversial, with both patients and providers fearing that it might result in an unacceptably high rate of patients who develop invasive cancer,” Hwang said. “Our findings are reassuring, and longer-term follow up will have important implications for the future inclusion of active monitoring as a treatment option for low-risk DCIS."

Those fears were the focus of the second study out of the clinical trial.

A common concern is that watchful waiting might make patients feel more anxious about their cancer, harming their quality of life, researchers said.

“It is critical that we understand how women feel when they are living with an active-monitoring approach and how it impacts on their overall quality of life, psychosocial health, worries about DCIS, anxiety and depression, and other related symptoms,” explained researcher Dr. Ann Partridge, interim chair of medical oncology at Dana-Farber Cancer Institute in Boston.

The study found there were no significant differences between the two groups in terms of physical function, anxiety or depression.

“The data suggest that, in the short-term, active monitoring is a reasonable approach in terms of patient experience,” Partridge said. “If longer-term data hold up, this approach could be considered as a management option for women with low-risk DCIS.”

The first study was published Dec. 12 in the Journal of the American Medical Association, while the second in the Dec. 12 issue of the journal JAMA Oncology.

More information

The National Breast Cancer Foundation has more about DCIS.

SOURCE: San Antonio Breast Cancer Symposium, news releases, Dec. 12, 2024