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Watch and Wait for DCIS?

Standard treatment for ductal carcinoma in situ (DCIS), a noninvasive precursor to breast cancer typically limited to a single milk-producing duct, usually includes surgery, potentially followed by radiation and hormone therapy, but results presented this week at the San Antonio Breast Cancer Symposium (SABCS) may open the door for some people to hold off on treatment. DCIS accounts for up to 25% of breast cancer diagnoses, more than 50,000 each year, and about 20% of DCIS cases advance to invasive disease. For the COMET study, presented Dec. 12 at SABCS and simultaneously published in JAMA, researchers enrolled nearly 1,000 women 40 and older with a DCIS diagnosis. They were assigned to one of two groups, one that received treatment in line with current guidelines and one that received no immediate treatment but enrolled in active monitoring. Patients in the active monitoring group received regular tests to watch for signs of progression, including screening mammograms every six months on the breast where DCIS was discovered and every year on the unaffected breast. After following these patients for two years, researchers discovered the invasive cancer rate in the monitored group was 4.2%, compared with 5.9% in the treated group. “All current treatments for DCIS aim to reduce the risk of future invasive cancer, despite a growing body of evidence that not all DCIS is destined to progress,” surgical oncologist E. Shelley Hwang, a study author and vice chair of research in the surgery department of Duke Cancer Institute in Durham, North Carolina, said in a press release cited in Cancer Research Catalyst. “Thus, current practice may result in the overtreatment of women whose tumors are at low risk of progression, leading to chronic pain, altered body image, reduced quality of life, and other side effects that may be avoidable.” But breast medical oncologist Neil Iyengar of Memorial Sloan Cancer Center in New York City, who was not involved in the study, said it may be too soon to change the standard of care for DCIS. “Ultimately, I caution against people making conclusions that suggest it’s safe to not do surgery for DCIS,” he said in USA Today. “We need that long-term follow-up before we definitively say that it’s okay to not do surgery.”

Draft Guidelines Add Self-test for Cervical Cancer Screening Recommendations

In July, the Food and Drug Administration (FDA) approved two self-administered tests to detect the potentially cancer-causing human papillomavirus (HPV). Draft guidelines released Dec. 10 by the U.S. Preventive Services Task Force incorporate these self-administered tests as an option for women to check for HPV infection by collecting vaginal samples in a doctor’s office or other health-care setting. The guidelines state that women in their 20s should get a Pap test that looks for cervical cancer cells every three years, while women 30 to 65 should get a Pap test every three years or a Pap test accompanied by an HPV test every five years. According to the guidelines, the HPV test could be self-administered or done by a doctor. Cervical cancer rates have dropped in the U.S. due to screening and an HPV vaccine recommended for preteens, but even so, nearly 14,000 new cases were diagnosed this year with more than 4,000 deaths. Experts hope allowing self-testing might lead to greater reductions in cervical cancer cases. “I’m very hopeful that self-collection will help even more women get screened and help us reduce even further the burden of cervical cancer among women,” John Wong, a physician at Tufts University School of Medicine and task force vice chair, said in an Associated Press story. The draft recommendations are open for public comment until Jan. 13.

Leukemia Death Rates Higher in Disadvantaged Areas Due to Lack of Treatment Access

Acute myeloid leukemia (AML) patients living in disadvantaged areas are less likely to receive potentially life-saving bone marrow transplants compared with patients from better-resourced communities. A study presented Dec. 8 at the American Society of Hematology’s annual meeting in San Diego and published in the journal Blood found that people living in neighborhoods with a lower education level had a 32% lower likelihood of receiving bone marrow transplants compared with people from more educated areas. Education level, measured as the proportion of people with less than a high school education, was one indication of a disadvantaged community used in the study. Other metrics included the percentage of households receiving food stamps or Supplemental Security Income (SSI) and an area’s poverty rate. Researchers from Fred Hutchinson Cancer Center in Seattle tracked nearly 700 patients being treated at 13 academic and community treatment centers in California, Missouri, North Carolina and Washington state. They found that AML patients had a greater likelihood of dying without a transplant if they lived in areas where a larger percentage of residents lacked a high school degree (21% more likely) or received SSI (41% more likely). When patients living in a disadvantaged area received transplants, their survival rate was similar to those receiving transplants in more affluent areas, suggesting access to therapy, not treatment effectiveness, was the primary hurdle facing these patients. “The way we interpret it [is that] if patients are able to overcome the barriers to transplant … perhaps the outcomes could be comparable to patients from other socioeconomic backgrounds,” hematologist-oncologist Natalie Wuliji of Fred Hutchinson Cancer Center and the study’s lead author, said in STAT.