This question was central to the PRECISION Cancer Grand Challenge, an international research initiative led by Jelle Wesseling (Netherlands Cancer Institute). After seven years of groundbreaking research, funded by Cancer Research UK and the KWF Dutch Cancer Society, the team has delivered crucial breakthroughs. These new insights will enhance our understanding of DCIS and revolutionize treatment, allowing women to receive more targeted care with fewer unnecessary interventions in the future.
DCIS, or Ductal Carcinoma In Situ, means there are abnormal cells in the milk ducts of the breast. Because of how it looks under the microscope, DCIS has long been seen as an early form of breast cancer. But studies now show that in most cases, about 75%, DCIS does not go on to become invasive. Treating all cases the same can lead to major impacts on a woman’s quality of life and adds significant costs to the healthcare system. To address this issue, the PRECISION consortium received a €18 million grant from Cancer Grand Challenges in 2017. "Our goal was to distinguish harmless DCIS from cases with a higher risk of developing into breast cancer, so that women with non-threatening DCIS could avoid unnecessary treatment," explains lead researcher Jelle Wesseling. Thanks to this research, we are moving closer to a more precise and personalized approach to DCIS care.
The PRECISION team, consisting of scientists, clinicians, and patient representatives from the Netherlands, the United Kingdom, and the United States, has published groundbreaking findings from approximately 50 studies:
- The Biology of DCIS: New insights reveal that genetic changes often affect entire mammary gland systems. This suggests that DCIS is not just a localized abnormality but may have a broader impact on breast tissue.
- New Biomarkers for Risk Prediction: The team identified biomarkers in both mammograms and tissue samples, helping to distinguish between low- and high-risk DCIS more effectively.
- Improved Preclinical Models: Research in mice provided valuable insights into how DCIS develops and potentially progresses into invasive breast cancer.
- DCIS as a Risk Factor: Studies indicate that invasive cancer following DCIS does not always originate from the initial lesion, suggesting that DCIS should be viewed more as a risk factor for breast cancer rather than a direct precursor.
- Regular Monitoring as an Alternative: Studies show that many women prefer regular monitoring (annually or biennially) over immediate surgery, allowing them to avoid unnecessary treatment.
These findings, published in leading scientific journals, are already influencing clinical practice and enabling more personalized treatment options for DCIS.
A key success of this consortium was the active involvement of patient advocates who helped bridge complex research and public understanding. Their efforts included creating plain language summaries, raising awareness of active surveillance clinical trials, and advocating for personalized care options.
“It has been incredible to see how we’ve been able to overcome differences in approach, language, and time zones to include the patient perspective,” shares Hilary Stobart, a UK-based patient advocate. “We’ve demonstrated a safer, more personalized path for women with DCIS.”
While the PRECISION initiative has officially concluded, its legacy endures. Upcoming initiatives include:
- Biomarker validation: Biomarkers identified in PRECISION will be validated in projects such as IMPROVE DCIS Initiative.
- Explainable AI-Driven risk prediction: Inspired by geosciences, the DIRECT-DCIS consortium, led by Wesseling, will integrate clinical, genomic, and patient-preference data for dynamic risk forecasts.
- Global virtual monitoring clinic: Efforts to establish a virtual clinic to make personalized DCIS care accessible worldwide.
As PRECISION’s transformative work draws to a close, it stands as a testament to the power of innovation and collaboration. By challenging traditional approaches and prioritizing patient welfare, the consortium has opened new horizons for DCIS management, aiming to improve health care for thousands of women worldwide. To explore more about PRECISION’s work, visit the Cancer Grand Challenges website or review their publications.
Read the latest scientific perspective from team PRECISION published in Cancer Discovery this month highlighting scientific insights and lessons learnt from this journey of exceptional team science.