Clinical Report: DCIS and Active Monitoring: When Immediate Surgery May Not Be the Only Conversation

Overview

The management of ductal carcinoma in situ (DCIS) is evolving towards treatment de-escalation, with evidence suggesting that some patients may safely undergo active monitoring instead of immediate surgery. The COMET trial indicates that active monitoring can yield similar invasive cancer rates compared to traditional surgical approaches in select low-risk patients.

Background

Ductal carcinoma in situ (DCIS) has historically been treated with surgical excision and additional therapies, but recent findings highlight the biological diversity of DCIS. This has prompted discussions on whether immediate surgery is necessary for all patients, particularly those identified as low-risk.

Data Highlights

Key Findings

• Active monitoring may be a viable option for low-risk DCIS patients, as shown in the COMET trial.
• The trial demonstrated noninferiority of active monitoring compared to guideline-concordant care in terms of invasive cancer rates.
• Risk stratification is essential for determining eligibility for active monitoring, focusing on factors such as nuclear grade and hormone status.
• Structured surveillance protocols are necessary for active monitoring, including regular imaging and predefined escalation pathways.
• Current evidence does not support a complete abandonment of traditional treatment paradigms for DCIS.

Clinical Implications

Clinicians should consider risk-adapted management strategies for patients with DCIS, particularly those identified as low-risk.

Conclusion

The findings from the COMET trial support the potential for active monitoring in select low-risk DCIS patients.

Related Resources & Content

1. The ASCO Post, 2025 -- Is Active Monitoring a Safe Option for Patients With Ductal Carcinoma In Situ?
2. The ASCO Post, 2024 -- Active Monitoring May Be a Viable Option for Some Patients With Low-Risk DCIS
3. Annals of Oncology, 2024 -- Early breast cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up
4. JAMA Network -- Active Monitoring With or Without Endocrine Therapy for Low-Risk Ductal Carcinoma In Situ: The COMET Randomized Clinical Trial
5. The ASCO Post — Is Active Monitoring a Safe Option for Patients With Ductal Carcinoma In Situ?
6. the asco post — Some Patients With Low-Risk Ductal Carcinoma In Situ May Be Able to Avoid Surgery
7. Guidelines - American Society for Radiation Oncology (ASTRO)
8. Recommendations | Early and locally advanced breast cancer: diagnosis and management | Guidance | NICE
9. Early breast cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up☆ - Annals of Oncology
10. Update on the management of ductal carcinoma in situ of the breast: current approach and future perspectives - PMC
11. Active Monitoring With or Without Endocrine Therapy for Low-Risk Ductal Carcinoma In Situ: The COMET Randomized Clinical Trial | Trials | JAMA | JAMA Network
12. Meetings - The ASCO Post
13. Key Surgical takeaways from EBCC15 | Association of Breast Surgery
14. Abstract PS3-03-08: Initial results from RECAST DCIS: Multicenter platform trial testing active surveillance and novel endocrine therapy agents for DCIS management | Clinical Cancer Research | American Association for Cancer Research
15. Trends in Nonsurgical Management for Low-Risk, Hormone Receptor–Positive Ductal Carcinoma In Situ | Cancer Biomarkers | JAMA Network Open | JAMA Network