Active surveillance offers a different approach to managing low-risk DCIS. It is not a passive option, which means receiving no medical care at all. Active surveillance involves frequently monitoring a patient’s condition. More aggressive treatments, such as surgery and radiation, are not recommended unless test results show that the condition has changed and may require them. Active surveillance aims to protect quality of life by avoiding aggressive treatments and their side effects unless they are necessary (see DCIS treatments).
There are a number of different terms used for active surveillance. It may be called active monitoring, close monitoring or watchful waiting. You may hear these terms used interchangeably, but they can also mean something slightly different. Active surveillance is generally considered to be a more active approach. It also involves regular routine or targeted testing. Watchful waiting usually involves a less intensive type of monitoring. It also involves fewer follow-up tests. In some ways, active surveillance may be thought of as an ongoing intervention.
Active surveillance is increasingly used for a number of other conditions. For example, it is now standard of care for low-level changes to the thyroid and for early prostate cancer. Active surveillance may be a good treatment choice for women with low-risk DCIS as well. A clinical trial called the COMET Study (Comparison of Operative to Monitoring and Endocrine Therapy for low-risk DCIS) is now trying to determine if active surveillance may result in the same outcomes as surgery and radiation for low-risk DCIS (see the COMET tab and the Making Decisions tab on this website).
During active surveillance, doctors monitor patients more often than usual or standard care. Women will have regular clinical examinations and imaging tests. Mammograms will be conducted regularly (every six months) to look for any DCIS changes. Magnetic resonance imaging (MRI) and ultrasound may also be recommended. These tests help doctors see if the DCIS has changed in any way. They also allow physicians to monitor patients, but without surgery. If the DCIS does not change, surgery may be avoided.
If at any point your DCIS has changed or you decide you no longer want to do active surveillance, you will be provided with information about treatment options. You and your physician can make a shared decision about potential treatments.
If there are signs that your DCIS has changed, you may need further tests. If symptoms develop, or if tests indicate the DCIS is progressing, a biopsy may be recommended. Even if DCIS has changed to invasive cancer, it will likely be detected early and you will be advised to begin standard treatment such as surgery and possibly radiation and endocrine (hormone-blocking) therapy. This will often be the same as if you had chosen treatment at the time of your original DCIS diagnosis. Treatment for early stage invasive breast cancer is highly successful.
Currently, active surveillance is not considered standard of care for DCIS and it is not routinely offered. However, it may be an alternative to standard care for some women. Low-risk DCIS grows slowly or not at all and may never be noticed during a woman's lifetime. Many women live out their normal life span before their DCIS would ever require any aggressive treatment. For this reason, active surveillance may be of particular benefit to older women diagnosed with low-risk DCIS, allowing them to avoid the potential burdens of standard treatment.
Active surveillance may be a consideration for patients concerned about quality of life and the potential side effects of standard treatments. These include physical, emotional, and psychological side effects, and financial burdens such as medical costs and absence from work. For some women, these side effects may outweigh any potential benefit. This may be especially true for women with additional health problems for whom the potential side effects of standard care could be particularly burdensome or complicate their other treatments.
Active surveillance may benefit women by sparing them from the side effects of surgery and radiation, as well as related financial burdens. DCIS (especially low-risk DCIS) represents very few dangers and there is increasing concern about overtreatment. Many women with the condition may gain little benefit from aggressive treatments such as surgery. However, there is a chance that active surveillance may not have equal or better outcomes than standard care treatments. The Comparison of Operative to Monitoring and Endocrine Therapy for low-risk DCIS (COMET) trial is studying these outcomes.
You may wish to consider the trade-offs between standard care and active surveillance. Standard care involves more aggressive treatment immediately. This may give some women peace of mind; however, there could be potential side effects from these treatments. Active surveillance involves no surgery or radiation. However, there is a chance your DCIS may change over time. It is important to carefully consider how these trade-offs could impact your quality of life and to make the decisions that are best for you (see also “Making Decisions” tab).