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Eur J Cancer. 2015 Nov;51(16):2296-303. doi: 10.1016/j.ejca.2015.07.017. Epub 2015 Aug 18.

Addressing overtreatment of screen detected DCIS; the LORIS trial.

Author information

1
Department of Breast Surgery, Nuffield House University Hospital Birmingham, Edgbaston, Birmingham, B15 2TH, UK.
2
Western General Hospital, Edinburgh, UK.
3
Sussex Health Outcomes, Research & Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Brighton, BN1 9RX, UK.
4
Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge, CB2 2QQ, UK.
5
Ontario Institute for Cancer Research, Toronto, Ontario M5G 0A3, Canada.
6
Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, University of Birmingham, Birmingham, B15 2TT, UK.
7
Health Economics Unit, University of Birmingham, Birmingham, B15 2TT, UK.
8
St. James's Hospital, Leeds, UK.
9
Department of Histopathology, Academic Unit of Pathology, St James's University Hospital, Leeds, UK.
10
Division of Cancer Studies, Department of Research Oncology, King's College London, UK.
11
Ninewells Medical School, Dundee, DD1 9SY, UK.
12
University of Sussex, Brighton, BN1 9PX, UK.
13
Independent Cancer Patients Voices, London, EC1R 0LL.

Abstract

Overdiagnosis, and thus overtreatment, are inevitable consequences of most screening programmes; identification of ways of minimising the impact of overdiagnosis demands new prospective research, in particular the need to separate clinically relevant lesions that require active treatment from those that can be safely left alone or monitored and only need treated if they change characteristics. Breast cancer screening has led to a large increase in ductal carcinoma in situ (DCIS) diagnoses. This is a widely heterogeneous disease and most DCIS detected through screening is of high cytonuclear grade and therefore likely to be important clinically. However, the historic practice of surgical treatment for all DCIS is unlikely to be optimal for lower risk patients. A clearer understanding of how to manage DCIS is required. This article describes the background and development of 'The low risk' DCIS trial (LORIS), a phase III trial of surgery versus active monitoring. LORIS will determine if it is appropriate to manage women with screen detected or asymptomatic, low grade and intermediate grade DCIS with low grade features, by active monitoring rather than by surgical treatment.

KEYWORDS:

Breast cancer; Breast screening; Clinical trial; DCIS; Low grade DCIS; Over treatment

PMID:
26296293
DOI:
10.1016/j.ejca.2015.07.017
[Indexed for MEDLINE]

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