Durham, NC – A groundbreaking study led by Duke University’s Dr. Shelley Hwang offers hope for women diagnosed with ductal carcinoma in situ (DCIS), often referred to as “stage-zero breast cancer.” The findings indicate that for some low-risk patients, regular monitoring may be as safe and effective as traditional treatment, which often involves surgery and radiation.
Rethinking Treatment for DCIS
DCIS is a non-invasive condition in which abnormal cells are detected within the milk ducts of the breast. While DCIS can sometimes lead to invasive breast cancer, the progression is far from guaranteed. Dr. Hwang, who serves as the Director of the Breast Oncology Program and Vice Chair of Research in Duke’s Department of Surgery, explains:
“Probably between 20% and 30% of women eventually develop a DCIS-related cancer, so the majority of women with DCIS probably never develop cancer.”
Despite this, standard treatments for DCIS—such as mastectomy, lumpectomy, and radiation—are often as aggressive as those used for invasive cancers. According to Hwang, this approach can mean unnecessary surgeries for women who may never develop invasive disease.
The COMET Study: A Less Invasive Approach
Dr. Hwang is leading the COMET study (Comparing an Operation to Monitoring with or without Endocrine Therapy), which aims to evaluate whether low-risk DCIS patients can safely avoid surgery. Instead, participants undergo routine mammograms every six months to monitor their condition.
Early results from the study are promising. After two years:
•5.9% of women in the surgical group developed invasive cancer.
•4.2% of women in the monitoring group developed invasive cancer.
These findings suggest that for some women with low-risk DCIS, surgery may not always be necessary.
“We treat this cancer to prevent cancer,” said Dr. Hwang. “But the treatment we give to prevent cancer is the same as what we would give if a patient has cancer. I started to worry that many of the people we operated on were not really benefiting.”
A Patient’s Perspective
Laura Colletti, of Pittsboro, was diagnosed with DCIS in 2014 and participated in the COMET study. Rather than opting for surgery, she chose a less invasive approach: regular mammograms every six months combined with endocrine therapy.
