Addressing overtreatment of screen detected DCIS; the LORIS trial
Addressing overtreatment of screen detected DCIS; the LORIS trial
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DOI：
10.1016/j.ejca.2015.07.017
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发表时间：
2015-11-01
影响因子：
8.4
通讯作者：
Rea, Daniel
中科院分区：
文献类型：
--
作者：
Francis, Adele;Thomas, Jeremy;Rea, Daniel
过度诊断，因此过度治疗，是大多数筛查计划的不可避免的后果;识别的方法，尽量减少过度诊断的影响需要新的前瞻性研究，特别是需要区分临床相关病变，需要积极治疗，从那些可以安全地留下单独或监测，只需要治疗，如果他们改变的特点。乳腺癌筛查导致导管原位癌（DCIS）诊断大幅增加。这是一种广泛异质性疾病，通过筛查检测到的大多数DCIS具有高细胞核分级，因此可能具有重要的临床意义。然而，所有DCIS的手术治疗的历史实践不太可能是低风险患者的最佳选择。需要更清楚地了解如何管理DCIS。本文介绍了“低风险”DCIS试验（洛里斯）的背景和发展，这是一项关于手术与主动监测的III期试验。洛里斯将通过主动监测而不是手术治疗来确定是否适合管理筛查发现或无症状、低级别和具有低级别特征的中等级别DCIS的女性。(C)2015爱思唯尔有限公司版权所有。
Overdiagnosis, and thus overtreatment, are inevitable consequences of most screening programmes; identification of ways of minimising the impact of overdiagnosis demands new prospective research, in particular the need to separate clinically relevant lesions that require active treatment from those that can be safely left alone or monitored and only need treated if they change characteristics. Breast cancer screening has led to a large increase in ductal carcinoma in situ (DCIS) diagnoses. This is a widely heterogeneous disease and most DCIS detected through screening is of high cytonuclear grade and therefore likely to be important clinically. However, the historic practice of surgical treatment for all DCIS is unlikely to be optimal for lower risk patients. A clearer understanding of how to manage DCIS is required. This article describes the background and development of 'The low risk' DCIS trial (LORIS), a phase III trial of surgery versus active monitoring. LORIS will determine if it is appropriate to manage women with screen detected or asymptomatic, low grade and intermediate grade DCIS with low grade features, by active monitoring rather than by surgical treatment. (C) 2015 Elsevier Ltd. All rights reserved.