Ductal carcinoma in situ (DCIS) can be treated with surgery, or with Active Monitoring for low-risk DCIS. Chemotherapy is not needed, although sometimes radiation or hormone therapy are suggested. Most DCIS never develops into an invasive cancer. In part 2 of the DCIS webinar series, we discuss where research is taking us. For those who have already received treatment and surgery, this will be essential information to learn and share with family and friends so they know their level of risk too. You can also share this information with your medical team to help them keep up with the latest DCIS research and care. Our panelists, Dr. Shelley Hwang and Deborah Collyar, discuss ways to de-escalate the fear of recurrence and ways to ensure decisions are made without fear.

1. © Patient Advocates In Research (PAIR)
Deborah Collyar
President,
Patient Advocates in Research
Part 2:
DCIS Latest Research:
De-escalating the Fear of
Recurrence
SHARE
Educational Program
February 6, 2024
Shelley Hwang, MD
Duke University
• Part 1: https://www.youtube.com/watch?v=GxQSPzMKaoc

2. © Patient Advocates In Research (PAIR)
Poll question #1
What sounds better to you?
1. Non-cancerous lesion
2. Stage 0 breast cancer
3. Abnormal cells that look like cancer
4. Pre-cancerous lesion
5. A “non-obligate pre-cursor” to breast
cancer
6. Non-invasive breast cancer
7. Breast disease

3. © Patient Advocates In Research (PAIR)
COMET Study Patient Leadership Team
Words Matter!
• Need updated
descriptions
• Need updated
mindsets

4. © Patient Advocates In Research (PAIR)
• Patients lose some or all of breast
• Surgery and/or radiation can cause
side-effects that may affect
daily life and can be long-term
• More surgery (re-excision) may be
required if margins are not clear
• Potential need for 2nd surgery
(re-excision)
• Removes DCIS
• Lowers risk that DCIS cells could
become invasive someday
• In about 1 in 10 patients (10%)
with low-risk DCIS, some cells
may be invasive. Surgery
removes this.
• May create closure for some
• Find out about possible ‘upstaging’
Advantages & disadvantages for surgery
Adapted from Qualitative Research Integrated within Trials (QuinteT)
For more information about COMET: cometstudy.org, https://bit.ly/3vEBqJ0, and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6429899/

5. © Patient Advocates In Research (PAIR)
• Possible anxiety that DCIS might
grow or lead to invasive breast cancer
• Clinical exam + mammogram
every 6 months; extra radiation?
• Commitment to diligent follow-up
• More extensive treatment might be
needed later
• Lack of support/understanding
from friends, family and “support
groups”
• Avoids side-effects of surgery
& radiation
• About 8-9 out of 10 patients (80-90%)
are able to stay on active monitoring
for at least 10 years
• If concerning breast changes are seen,
can have surgery and other treatment
as needed
Advantages & disadvantages for active monitoring
Adapted from Qualitative Research Integrated within Trials (QuinteT)
For more information about COMET: cometstudy.org, https://bit.ly/3vEBqJ0, and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6429899/

6. © Patient Advocates In Research (PAIR)
COMET Study treatment approaches
described in a balanced way
Surgery
• Aims to remove the DCIS in an
operation (followed by radiation
therapy if needed), to reduce the
risk of invasive breast cancer
Active Monitoring
• Aims to monitor the DCIS closely and
frequently, to avoid surgery unless
there is concern for invasive breast
cancer
Surgery
• Lumpectomy or mastectomy
• Radiation therapy if needed
Active Monitoring
• Regular check-ups & mammograms
• Biopsy / change of treatment if needed
Surgery
• Breast is changed post-surgery
• Treatment side-effects, but…
Active Monitoring
• Natural breast is unchanged
• Worry DCIS could change, but …
Adapted from Qualitative Research Integrated within Trials (QuinteT)
For more information about COMET: cometstudy.org, https://bit.ly/3vEBqJ0, and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6429899/

7. © Patient Advocates In Research (PAIR)
Changing language & mindsets for low-risk DCIS
• https://cometstudy.org
• https://dcisoptions.org

8. © Patient Advocates In Research (PAIR)
Changing language: PRECISION
• PRECISION Patient Advocate Involvement Panel, https://www.dcisprecision.org

9. © Patient Advocates In Research (PAIR)
Deciding what
to do
* https://dcisoptions.org/dst

10. © Patient Advocates In Research (PAIR)
Poll question #2
What type of DCIS have you had?
1. Low grade DCIS
2. Medium grade DCIS
3. High grade DCIS
4. DCIS + invasive breast cancer
5. I have not had DCIS
6. I’m not sure

11. © Patient Advocates In Research (PAIR)
Decision Support Tool*
- what you think
* https://dcisoptions.org/dst

12. © Patient Advocates In Research (PAIR)
Decision Support Tool* - treatment info
* https://dcisoptions.org/dst

13. © Patient Advocates In Research (PAIR)
Decision Support Tool* - risk info
* https://dcisoptions.org/dst

14. © Patient Advocates In Research (PAIR)
Decision Support Tool * - risk info
* https://dcisoptions.org/dst

15. © Patient Advocates In Research (PAIR)
Decision Support Tool* - what’s best for me?
* https://dcisoptions.org/dst

16. © Patient Advocates In Research (PAIR)
Decision Support Tool* - questions to ask
* https://dcisoptions.org/dst

17. © Patient Advocates In Research (PAIR)
© Patient Advocates In Research (PAIR)
Discussion time

18. © Patient Advocates In Research (PAIR)
Poll question #3
Do you feel less anxious after
hearing this program?
1. Yes
2. No
3. No change
4. Unsure