Breast Surgeon Faith Goldman, MD, from Englewood Health shares information about a new breast cancer study on ductal carcinoma in situ (DCIS), which is evaluating less aggressive treatments, with the goal of expanding available treatment options.

Ductal Carcinoma In Situ (DCIS)

DCIS is a noninvasive breast disease in which some cells in the milk ducts of the breast appear atypical. There are three grades of DCIS: low, intermediate and high. Generally, low and intermediate (grades I and II) are considered to be “low risk,” with the lowest chance of becoming an invasive cancer or of recurrence.

An estimated 70% to 80% of women diagnosed with DCIS could likely live their lives with this breast condition without any health consequences. DCIS is a diagnosis that we, as breast specialists, are trying to better understand.

The COMET Clinical Trial: Studying Low-risk DCIS

Englewood Health is a clinical trial site for the Comparison of Operative to Monitoring and Endocrine Therapy (COMET) study for low-risk ductal carcinoma.

Standard therapy for DCIS includes surgery, with or without radiation and with or without hormonal therapy. The COMET trial is studying close clinical monitoring in lieu of surgery (and possibly radiation).

Women who are newly diagnosed with low-risk DCIS are eligible for the COMET trial. As part of the study, participants are randomly assigned to one of two groups:

active surveillance—ongoing monitoring with mammogram and physical exam every six months

surgery with or without radiation and an annual mammogram

Participants in both groups can choose to receive adjuvant hormonal therapy.

With active surveillance, doctors monitor for progression of disease. If progression is seen on a mammogram, the patient is re-biopsied, and if it is determined that her cancer is high risk, she receives appropriate treatment.

An unusual aspect of this study is that participants may opt out if they are randomly assigned to a study pathway they would prefer not to participate in. They can still be followed for quality of life through the study’s ongoing questionnaires. This enables researchers to continue to gather important information about DCIS.

Currently, a woman diagnosed with DCIS is not given the option of active surveillance. Many breast cancer specialists think that close monitoring is likely an acceptable way to treat low-risk DCIS. However, we need clinical trials to confirm this.

We Understand That a Breast Cancer Diagnosis is Stressful.

My Englewood Health colleagues and I understand the tremendous stress experienced by a woman who receives a diagnosis of breast cancer, whether low-grade or high-grade DCIS—or an invasive cancer. In our practice, a woman who receives a diagnosis of breast cancer is able to see the breast surgeon right away for a consultation. We educate all our patients about their specific disease, which often helps to alleviate their stress.

At The Lefcourt Family Cancer Treatment and Wellness Center, a multidisciplinary team of specialists, including patient navigators and integrative medicine practitioners, focus on different aspects of care. These multiple perspectives contribute to treatment recommendations, helping to ensure the best plan for each patient throughout the course of her care.

What Is Most Gratifying About Caring for Women with Breast Cancer?

What I find most gratifying about being a doctor are the wonderful relationships I develop over time with my patients. Breast cancer patients see their oncologists regularly and long term. My patients update me on what is going on their lives, and I update them on mine. Because of this unique relationship, and my training as both a breast surgeon and an obstetrician/gynecologist, patients often share with me health concerns that they might not discuss with other doctors. They seek my guidance on other medical topics they might not feel comfortable talking about (such as sexual health).

By Dr. Faith Goldman

Faith Goldman, MD, is a breast surgeon at Englewood Health and a member of The Lefcourt Family Treatment and Wellness Center at Englewood Health.