American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

2018 Special Study on DCIS Breast Cancer (COMET)

Dear Physicians and Registrars,

As you may recall from prior communications, the Commission on Cancer (CoC) initiated a pilot study at 20 CoC accredited facilities in the fall of 2017 as a component of the Comparison of Operative to Monitoring and Endocrine Therapy (COMET) clinical trial (PIs: Drs. Shelley Hwang, Ann Partridge, Alastair Thompson). The study examines the risks and benefits of active surveillance compared to usual care for patients diagnosed with low risk Ductal Carcinoma in situ (DCIS), commonly known as stage 0 breast cancer.

The pilot study concluded January 1, 2018. Following data analysis, a CoC Special Study will be launched in spring 2018 to investigate outcomes from DCIS treatment retrospectively. Much information is being gleaned from this pilot study that will aid in development of the 2018 Special Study. We will identify participating institutions following conclusion of the aforementioned data analysis. We will contact selected institutions in advance of the full study launch; please refrain from requesting confirmation of your site’s participation in the full study at this time. Questions not related to site participation should be routed to specialstudy@facs.org. Please note that all VA and DoD sites are exempt from participating in Special Studies.

Please find below a brief summary of the Special Study, launching in spring 2018.

Special Studies


Ductal Carcinoma in situ (DCIS), or stage 0 breast cancer, is diagnosed in over 50,000 women in the United States each year. Current NCCN guidelines dictate that DCIS be treated upon diagnosis with a combination of surgery, radiation and hormonal therapy—treatments similar to those recommended to patients with invasive cancer. However, there is an emerging debate around whether "active surveillance" for DCIS may also be a safe and less morbid option in women with some subtypes of DCIS.

In February 2017, the Alliance for Clinical Trials in Oncology Comparison of Operative to Monitoring and Endocrine Therapy (COMET) clinical trial was activated to look at the risks and benefits of active surveillance compared to usual care in the setting of a pragmatic prospective randomized trial for low risk DCIS. As an important adjunct to this trial, a Commission on Cancer (CoC) Special Study will be launched in 2018 to investigate outcomes from DCIS treatment retrospectively.