OnCo
ideasIdea

After the COMET trial: surveillance pathways and a new name for low-risk DCIS

Low-risk DCIS is a breast change that may never become cancer. Trials now show watching it is safe in the short term. The next step is a proper pathway and a name that does not say cancer.

COMET (US) reported two-year outcomes supporting active monitoring of low-risk DCIS; LORIS and LORD add European data. Propose an implementation programme: eligibility criteria, imaging protocol, an endocrine therapy option, a registry with safety stopping rules, and a terminology change tested for its effect on choice.

Hypothesis
Implementation halves surgery for low-risk DCIS with ipsilateral invasive cancer at five years no more than 3 percentage points above the surgery arm rate.
Rationale
Terminology drives treatment choice in experiments; pathways make surveillance the safe rather than the brave option.
What would test it
Registry with pre-specified safety rules and an embedded randomised trial of terminology on decision.
Maturity
being tested at scale
Who has to act
clinic
Cost to try
Medium ($1M to $50M)
Years to first evidence
5
Bottlenecks it attacks
  • Overdiagnosis and false alarms · Finding more cancer is not the same as saving lives. Screening also finds cancers that would never have hurt anyone, and treats them.

Connected

4top