{"entity":{"id":"idea-prev-low-risk-dcis-surveillance-pathway","kind":"idea","name":"After the COMET trial: surveillance pathways and a new name for low-risk DCIS","aka":[],"tldr":"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.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Overdiagnosis and false alarms): Welch & Black, Overdiagnosis in cancer (JNCI 2010)","url":"https://doi.org/10.1093/jnci/djq099"}],"tags":[],"related":[],"cancers":["breast-hr-positive"],"sections":["early-detection"],"technologies":["mammography"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-overdiagnosis"],"keyPapers":["paper-welch-j-natl-cancer-inst"],"journals":[],"dependsOn":[],"notes":[],"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.","test":"Registry with pre-specified safety rules and an embedded randomised trial of terminology on decision.","maturity":"being-tested-at-scale","actor":"clinic","cost":"medium","horizonYears":5},"route":"/ideas/idea-prev-low-risk-dcis-surveillance-pathway/","neighbours":{"cancer":[{"id":"breast-hr-positive","kind":"cancer","name":"HR-positive / HER2-negative breast cancer","route":"/cancers/breast-hr-positive/"}],"section":[{"id":"early-detection","kind":"section","name":"Early Detection & Screening","route":"/fronts/early-detection/"}],"technology":[{"id":"mammography","kind":"technology","name":"Mammography & tomosynthesis","route":"/technologies/mammography/"}],"bottleneck":[{"id":"b-overdiagnosis","kind":"bottleneck","name":"Overdiagnosis and false alarms","route":"/bottlenecks/b-overdiagnosis/"}],"paper":[{"id":"paper-welch-j-natl-cancer-inst","kind":"paper","name":"Overdiagnosis in cancer","route":"/key-papers/paper-welch-j-natl-cancer-inst/"}]}}