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

Source: https://onco.cc/ideas/idea-prev-low-risk-dcis-surveillance-pathway/  
OnCo record `idea-prev-low-risk-dcis-surveillance-pathway` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

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.

## Summary

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.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- 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.
- Proposed test: Registry with pre-specified safety rules and an embedded randomised trial of terminology on decision.
- Maturity: being-tested-at-scale
- Actor: clinic

## Sources

- Bottleneck evidence (Overdiagnosis and false alarms): Welch & Black, Overdiagnosis in cancer (JNCI 2010): https://doi.org/10.1093/jnci/djq099

## Connected records

- cancers: [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/)
- fronts: [Early Detection & Screening](https://onco.cc/fronts/early-detection/)
- technologies: [Mammography & tomosynthesis](https://onco.cc/technologies/mammography/)
- bottlenecks: [Overdiagnosis and false alarms](https://onco.cc/bottlenecks/b-overdiagnosis/)
- key papers: [Overdiagnosis in cancer](https://onco.cc/key-papers/paper-welch-j-natl-cancer-inst/)

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