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

The management of ductal carcinoma in situ (DCIS) is entering a period of increasing treatment de-escalation

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The management of ductal carcinoma in situ (DCIS) is shifting towards treatment de-escalation, moving away from immediate surgery for all patients.
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The COMET trial provided evidence that active monitoring can be noninferior to surgery in certain low-risk DCIS patients.
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Risk stratification is essential for active monitoring, considering factors like nuclear grade, hormone status, and clinical presentation.
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Active monitoring requires structured surveillance with defined triggers for diagnostic escalation, not passive observation.
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Surgical excision remains crucial in DCIS management, but timing may become more individualized for low-risk patients.

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