Clinical Challenges in Breast Surgery: The Management of Ductal Carcinoma In Situ (DCIS)

Behind The Knife: The Surgery Podcast

Science, Health & Fitness, Medicine, Education

4.8 • 1.4K Ratings

🗓️ 8 September 2025

⏱️ 43 minutes

🔗️ Recording | iTunes | RSS

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Summary

Ductal carcinoma in situ (DCIS) represents a clinical crossroads in breast surgery—balancing the risks of over-treatment with the need to prevent invasive cancer. With new data from active monitoring trials, the pressure is on for surgeons to personalize care. Tune in to this essential episode to stay ahead of the curve on DCIS management and to hear expert insights from two leading breast surgical oncologists.

Hosts:
- Rashmi Kumar, MD, PhD
Resident, University of Michigan General Surgery Residency Program
Twitter/X: @RashmiJKumar
- Melissa Pilewskie, MD
Attending Breast Surgical Oncologist, Co-Director of the Weiser Family Center for Breast Cancer, Michigan Medicine
Twitter/X: @MPilewskie
- Stephanie Downs-Canner, MD
Attending Breast Surgical Oncologist & Physician-Scientist, Memorial Sloan Kettering Cancer Center, Program Director of the Breast Surgical Oncology Fellowship Training Program
Twitter/X: @SDownsCanner

Learning Objectives:
- Define DCIS and explain its significance as a precursor to invasive breast cancer.
- Discuss challenges in diagnosing and risk-stratifying DCIS.
- Review current standards for surgical and adjuvant management of DCIS.
- Understand the implications of new research, including the COMET trial, for low-risk DCIS.
- Evaluate patient-centered strategies for managing DCIS and preventing over-treatment.

References:
- Worni M, Akushevich I, Greenup R, et al. Trends in Treatment Patterns and Outcomes for Ductal Carcinoma In Situ. J Natl Cancer Inst. 2015;107(12):djv263. PubMed
- Francis A, Thomas J, Fallowfield L, et al. Addressing overtreatment of screen detected DCIS; the LORIS trial. Eur J Cancer. 2015 Jan;51(16):2296-303. PubMed
- Elshof LE, Tryfonidis K, Slaets L, et al. Feasibility of a non-surgical management strategy for low-grade DCIS: The LORD study. Eur J Cancer. 2015;51(12):1497–1510. PubMed
- Toss MS, et al. Ductal carcinoma in situ (DCIS): current management and future directions. Cancer Treat Rev. 2020;90:102091. PubMed
- Comparative Effectiveness of Surgery versus Active Monitoring for Low-Risk DCIS (COMET) Trial Results. Early COMET Results: King TA, et al. Surgical excision versus active monitoring for low-risk ductal carcinoma in situ (DCIS): 2-year results of the COMET randomized trial. J Clin Oncol. 2024; e2400110. PubMed

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Transcript

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0:00.0	Behind the Knife, the Surgery Podcast, relevant and engaging content designed to help you dominate the day.
0:23.8	Thank you so much for listening to Behind the Knife.
0:24.9	This is Patrick Georgoff.
0:26.4	I want you to imagine this.
0:27.1	It's 2 a.m.
0:31.2	And you're rushing a hypotensive trauma patient to the operating room for exploration.
0:34.6	Maybe you need to go into the neck, the chest, or the abdomen.
0:36.6	Are you prepared for what you might find?
0:39.7	Trauma educational resources are extremely limited.
0:42.5	That's why we created the trauma surgery video atlas.
0:46.5	24 challenging scenarios with high-yield text, beautiful illustrations,
0:50.2	and stunning professional grade video that walks you through the approach and management of devastating injuries in a step-by-step fashion.
0:55.2	Check out the link in the show notes.
1:01.5	For more, there are group discounts available as well. Now, enjoy the episode and dominate the day.
1:09.0	Hello, everyone. Welcome to the Breast Specialty podcast series. This is Behind the Knife. I'm Rushmeekamar,
1:11.7	your resident host for today. I'm a current general surgery resident at the University of Michigan. We're so glad to have you join us as we dive into
1:16.5	the nuances of DCIS. Before we start, I'd like to introduce our two outstanding guests. First, we
1:22.1	have Dr. Melissa Poluski, attending in breast surgical oncologist at the University of Michigan.
1:28.7	She also serves as the co-director of the Wiser Family Center for Breast Care. Thank you so much, Dr. Poluski, for joining us.
1:34.8	Thank you, Rosh for the invitation. It's great to be here today. We're also joined by Dr. Stephanie
1:40.3	Downscanner, breast surgical oncologist and physician scientist at Memorial Sloan Kettering
1:45.2	Cancer Center. Dr. Downscanner is also the current program director of the Breast Fellowship Training
	...

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