Saving women with harmless premalignant breast disease the burden of needless surgery and radiotherapy

We want to make overtreatment of Ductal Carcinoma in Situ (DCIS) a thing of the past to save thousands of women the burden of intensive but needless treatment.

DCIS was virtually unknown before breast cancer screening was implemented, but it now accounts for 25% of all ‘breast cancers’ detected. Conventional management includes surgery supplemented by radiotherapy and/or endocrine therapy. Regrettably, this results in overtreatment of the majority of women with DCIS. In effect, women with DCIS are turned into ‘cancer patients’ with all the concomitant anxiety and implicit negative impact on family life that is almost certainly unwarranted for many.

We started a unique initiative to test if active surveillance of low-grade DCIS, as found by calcifications detected by screening, is as safe as the current standard treatment. This study, called the LORD trial (‘LORD’ acronym for ‘LOw Risk Dcis’) will deliver superior patient value, as it aims to overcome overtreatment thousands of women annually confronted with a diagnosis of DCIS. In addition, it will preserve their quality of life as well as reduce health care and societal costs.

Importantly, ‘Borstkankervereniging Nederland’, representing the women confronted with a diagnosis of DCIS or breast cancer, has been centrally involved from the very start in designing, communicating and implementing the trial. They team up with a multidisciplinary team of specialized nurses, surgeons, radiologists, pathologists and radiation oncologists. In addition, this study is well embedded in the Europa by consensus support from the EORTC Breast Cancer Group, coordinating the trial in mainland Europe. According to the guidelines and trial protocol, Integrated Practice Units for the diagnosis and treatment of breast cancer are in place. Our efforts will have even more impact as our global ‘PRECISION Initiative’ is tackling the DCIS dilemma from various angles by complementary, synergistic collaborations for which we received the Cancer Research UK Grand Challenge Award in partnership with KWF Dutch Cancer Society. A such we team up with the similar trials in the US and the UK (www.dcisprecision.org).

In the LORD trial, women will be randomized between active surveillance and standard treatment, Therefore, 1,240 patients from 30 plus Netherlands Centers as well as from a number of European Cancer Centers are and will be including women with low grade DCIS.

On top of overcoming the overtreatment of harmless DCIS, this will reduce costs for unnecessary treatment. Per 1000 patients for which active surveillance is safe, our initiative will save 10M euros.