ArticleJournal of the National Cancer Institute2016
Outcomes of Active Surveillance for Ductal Carcinoma in Situ: A Computational Risk Analysis.
Article in Journal of the National Cancer Institute, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 42 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
42 citing papers in PubMed, 1 synthesis or guideline pooled it, 77 citations in OpenAlex.
- The impact of patient characteristics and lifestyle factors on the risk of an ipsilateral event after a primary DCIS: A systematic review.Breast (Edinburgh, Scotland) · 2020Pooled it
- Cause-specific mortality after a diagnosis of ductal carcinoma in situ: Associations with screening and socio-economic status.International journal of cancer · 2026Article
- Article
- Eco-Evolutionary Guided Pathomic Analysis Detects Biomarkers to Predict Ductal Carcinoma In Situ Upstaging.Cancer research · 2025Article
- Mitigating overtreatment of ductal carcinoma in situ.Radiology advances · 2025Review
- The natural history of ductal carcinoma in situ: development, validation, and estimated outcomes of the SimDCIS model.Breast cancer research and treatment · 2025Article
- An early economic evaluation of active surveillance for low-risk ductal carcinomaFuture oncology (London, England) · 2024Article
- Defining precancer: a grand challenge for the cancer community.Nature reviews. Cancer · 2024Review
- Imaging Changes and Outcomes of Patients Undergoing Active Monitoring for Ductal Carcinoma In Situ: Seven-Year Follow-up Study.Academic radiology · 2024Article
- Progression from ductal carcinoma in situ to invasive breast cancer: molecular features and clinical significance.Signal transduction and targeted therapy · 2024Review
- The effects of contemporary treatment of DCIS on the risk of developing an ipsilateral invasive Breast cancer (iIBC) in the Dutch population.Breast cancer research and treatment · 2024Article
- Association of DCIS size and margin status with risk of developing breast cancer post-treatment: multinational, pooled cohort study.BMJ (Clinical research ed.) · 2023Article
- Active surveillance versus treatment in low-risk DCIS: Women's preferences in the LORD-trial.European journal of cancer (Oxford, England : 1990) · 2023Article
- Should low-risk DCIS lose the cancer label? An evidence review.Breast cancer research and treatment · 2023Review
- Variation in the Diagnosis of Noninvasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features.The Journal of clinical endocrinology and metabolism · 2022Article
- Prediction Models and Decision Aids for Women with Ductal Carcinoma In Situ: A Systematic Literature Review.Cancers · 2022Review
- A web-based personalized decision support tool for patients diagnosed with ductal carcinoma in situ: development, content evaluation, and usability testing.Breast cancer research and treatment · 2022Article
- Ductal Carcinoma in Situ: State-of-the-Art Review.Radiology · 2022Review
- Chronological Trends of Breast Ductal Carcinoma In Situ: Clinical, Radiologic, and Pathologic Perspectives.Annals of surgical oncology · 2021Article
- DUCHESS: an evaluation of the ductal carcinoma in situ score for decisions on radiotherapy in patients with low/intermediate-risk DCIS.Breast cancer research and treatment · 2021Article
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Authors and funding
6 authors at 2 institutions in 2 countries.
Funding
Abstract
backgroundDuctal carcinoma in situ (DCIS) is a noninvasive breast lesion with uncertain risk for invasive progression. Usual care (UC) for DCIS consists of treatment upon diagnosis, thus potentially overtreating patients with low propensity for progression. One strategy to reduce overtreatment is active surveillance (AS), whereby DCIS is treated only upon detection of invasive disease. Our goal was to perform a quantitative evaluation of outcomes following an AS strategy for DCIS.
methodsAge-stratified, 10-year disease-specific cumulative mortality (DSCM) for AS was calculated using a computational risk projection model based upon published estimates for natural history parameters, and Surveillance, Epidemiology, and End Results data for outcomes. AS projections were compared with the DSCM for patients who received UC. To quantify the propagation of parameter uncertainty, a 95% projection range (PR) was computed, and sensitivity analyses were performed.
resultsUnder the assumption that AS cannot outperform UC, the projected median differences in 10-year DSCM between AS and UC when diagnosed at ages 40, 55, and 70 years were 2.6% (PR = 1.4%-5.1%), 1.5% (PR = 0.5%-3.5%), and 0.6% (PR = 0.0%-2.4), respectively. Corresponding median numbers of patients needed to treat to avert one breast cancer death were 38.3 (PR = 19.7-69.9), 67.3 (PR = 28.7-211.4), and 157.2 (PR = 41.1-3872.8), respectively. Sensitivity analyses showed that the parameter with greatest impact on DSCM was the probability of understaging invasive cancer at diagnosis.
conclusionAS could be a viable management strategy for carefully selected DCIS patients, particularly among older age groups and those with substantial competing mortality risks. The effectiveness of AS could be markedly improved by reducing the rate of understaging.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.