Active monitoring, also called active surveillance, is a strategy for managing low-risk DCIS in which a patient has regular imaging (including mammograms, MRIs or ultrasounds) and check-ups with her doctor. It is a strategy that avoids or delays surgery and radiation absent signs of worsening of the DCIS or invasive progression. If concerning changes occur, surgery and other treatments may be warranted. Imaging types and frequency vary, but most common is diagnostic magnification mammograms every 6-months, moving possibly to yearly mammograms for patients with stable imaging results. For some patients, active monitoring can be combined with hormone therapy to further reduce the risk of disease progression.
Active monitoring is not “no treatment,” but rather a strategy to treat only if and when your DCIS warrants treatment. It is based on the idea that most low-risk DCIS will never turn invasive or life-threatening, and therefore a patient’s best quality of life is achieved by avoiding the physical and emotional side effects of surgery and radiation.
Active monitoring has long been used successfully in the prostate cancer field, where it is a viable option for men with low-risk prostate cancer who decide not to undergo immediate radical treatments. Over 30% of men have prostate cancers that are so slow growing that active monitoring is considered a better choice than immediate local treatment with surgery or radiation.
Clinical trials are underway to determine the safety and feasibility of active monitoring for low-risk DCIS patients. Most notably in the United States is the Comparing an Operation to Monitoring, with or without Endocrine Therapy (COMET) trial, a phase III randomized clinical trial comparing rates of invasive breast cancer and physical, emotional and psychological outcomes for women following active monitoring as compared to women who received standard of care treatments. The first results of COMET were released in December 2024 and showed comparable outcomes for women in both treatment arms, suggesting that active monitoring is a safe and reasonable treatment approach for low-risk patients, at least in the short term.
Similar active monitoring trials have been underway in Europe, including the LORD trial in the Netherlands, the LORIS trial in the United Kingdom, and the LORETTA trial in Japan.
If you want to find out whether active monitoring might be an option for you, we encourage you to talk to your doctor (share the COMET study results) and, if needed, seek a second (or third) opinion. While active monitoring holds promise as a viable treatment option for patients with low-risk DCIS, it is currently not widely available outside of a trial or a trial-participating medical institution. In the U.S., the COMET study is no longer accepting new patients, but some of the doctors that have patients enrolled in the trial have been willing to follow non-trial patients on active monitoring if they meet the COMET eligibility criteria. Click here to see a list of those locations. Additionally, the RECAST trial, evaluating whether active monitoring and hormonal therapy is an effective management strategy for low-risk DCIS, is currently enrolling new patients at multiple locations in California, North Carolina, Pennsylvania and Tennessee.
Last updated February 28, 2025
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