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Comment & Response
May 7, 2020

De-Escalating Breast Cancer Surgery for Low-Risk Ductal Carcinoma in Situ

Author Affiliations
  • 1Duke University Medical Center, Durham, North Carolina
  • 2Baylor College of Medicine, Houston, Texas
  • 3Divisions of Diagnostic Oncology and Molecular Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands
JAMA Oncol. Published online May 7, 2020. doi:10.1001/jamaoncol.2020.0816

To the Editor We read with interest the Viewpoint by Morrow and Winer considering the need for surgery in diagnoses ranging from ductal carcinoma in situ (DCIS) to postneoadjuvant invasive breast cancer.1 These are 2 very different clinical situations, so here we consider in more detail the situation for DCIS. Arguing against active surveillance, Morrow and Winer cite the risk of missing invasive cancer, the need for more intensive follow-up, more biopsies, and patient anxiety. These are all arguments that over the years have been deployed against the concept of active surveillance for thyroid cancer, prostate cancer, and renal carcinoma for which, based predominantly on evidence from prospective trials, active surveillance is now an accepted management option.

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