The Risk of Early-Stage Breast Cancer Being Dismissed

The COMET trial, a recent study published in JAMA, explores whether active monitoring is a safe alternative to the conventional treatment of surgery and radiation for women with low-risk ductal carcinoma in situ (DCIS).

DCIS, often referred to as stage 0 breast cancer, is non-invasive and carries a variable risk of progression to invasive breast cancer. The trial enrolled nearly 1,000 women aged 40 and older and found that over a two-year period, women who opted for active monitoring (regular imaging and exams without immediate surgery) had no higher rates of invasive cancer compared to those who underwent surgery and radiation. The findings suggest that, for this group, less aggressive treatment may not compromise short-term outcomes.

On the surface, this sounds like progress. Avoiding unnecessary surgery, radiation, and endocrine therapy could spare women from the physical and emotional toll of over-treatment. But as a breast cancer patient and advocate, I can’t help but worry about how these findings could backfire, especially for patients navigating a diagnosis in real time.

A Dangerous Oversimplification

First, let’s be clear: the COMET study focuses on a very specific subset of patients—those with low-risk, hormone receptor-positive DCIS. It doesn’t apply to all DCIS patients or those with higher-grade, aggressive forms of breast cancer. However, as this study garners attention, there’s a real risk that its conclusions will be misinterpreted or misapplied. Some doctors, health systems, or even insurers could use this data as justification to downplay concerns or steer patients away from treatments they may actually need.

For patients, especially those newly diagnosed, it’s overwhelming to hear the phrase “low risk.” What does that mean for them personally? The idea of watching and waiting can feel counterintuitive, even terrifying, when you’re sitting across from a doctor and hear the word “cancer.” This isn’t a theoretical discussion for these women—it’s their lives. Without careful communication, this study risks creating confusion rather than empowerment.

The Impact on Patient Advocacy

This study could also unintentionally stifle patient advocacy. A growing number of patients are stepping into their own roles as advocates, pushing for second opinions and demanding treatment plans tailored to their unique needs. But if medical professionals frame active monitoring as the new “standard” for low-risk DCIS, some patients might feel pressured to go along with it—even if their instincts or circumstances suggest otherwise.

Additionally, this approach could diminish the perceived importance of early detection and prompt action. If patients begin to see DCIS as something that doesn’t always require treatment, they may be less vigilant about follow-ups, screenings, or self-exams. Over time, this could lead to missed opportunities to catch more serious cancers early, when they’re still treatable.

The Mental Burden of Watching and Waiting

There’s also an emotional cost to consider. Active monitoring might spare patients from physical side effects, but what about the mental toll? Imagine living with the knowledge that a cancer diagnosis—no matter how small—exists in your body, and that you’re simply waiting to see if it will grow. For some women, that anxiety could be debilitating, overshadowing any relief they feel from avoiding surgery or radiation.

This is especially true in a world where breast cancer survivors and advocates often talk about “doing everything you can” to beat the disease. Active monitoring challenges that deeply ingrained mindset and could lead to feelings of guilt or regret if a cancer does progress.

A Call for Balance

While the COMET trial provides valuable insights, its results shouldn’t be treated as one-size-fits-all guidance. The study is a reminder that treatment should always be personalized and driven by informed decisions made between patients and their doctors. Patients need to be empowered, not pigeonholed into broad categories or treatment plans based solely on statistics.

It’s also critical for advocates and the medical community to ensure these findings are communicated carefully and responsibly. Low-risk doesn’t mean no risk. And “safe for two years” isn’t a guarantee for what happens after that.

For those of us who have faced breast cancer firsthand, it’s hard to separate data from the human experience. Research like this must be paired with empathy and a commitment to honoring each patient’s unique journey. Only then can we ensure progress doesn’t come at the expense of trust, advocacy, or quality of life.