Abstract P1-16-04: How patient advocates and researchers work together in PRECISION* to identify low-risk ductal carcinoma in situ (DCIS) that may not need aggressive treatment
Authors: Deborah Collyar, Donna Pinto, Hilary Stobart, Ellen Verschuur, Marja van Oirsouw
Journal: Cancer Research (2020)

Abstract BACKGROUND: Ductal carcinoma in situ (DCIS) was virtually unknown before breast screening and now accounts for up to 25% of all ‘breast cancers’ detected. Over 50,000 women are diagnosed annually with DCIS in the US alone; most receive treatments intended for women with invasive breast cancer which may offer no benefit and are associated with physical and psychological complications, and financial burdens. Observational studies show a majority of DCIS never becomes invasive, even if left untreated. Lack of prospective data and concerns about “overtreatment” are now being addressed by PRECISION - an international consortium of clinicians, scientists and patient advocates - collaborating to understand the biological nature of DCIS and how it evolves. Our goal is to develop tests that distinguish between women with DCIS who will likely develop breast cancer and should be treated, and those who can safely avoid treatment. Patient advocates are fully integrated into PRECISION as well as 3 prospective randomized clinical trials - LORD (EU), LORIS (UK) and COMET (US) – aiming to produce evidence to show whether or not Active Surveillance has equivalent outcomes to surgery for low-risk DCIS. These trials are critical because PRECISION uses biospecimens from each trial, in addition to other DCIS cohorts around the world. PATIENT ADVOCATE AIMS: • Help foster teams that contribute to better outcomes for women with DCIS. • Assist in designing effective informational tools for providers, organizations, and the public. • Understand international differences in health services, medical culture, and patient expectations, and recommend improvements. • Measure the value of patient involvement in PRECISION research. • Raise awareness and communicate about ongoing research and (over)treatment of DCIS. METHODS: The PRECISION Patient Advocate Involvement Panel (PAIP) includes representatives from each country: NL, UK, and US. PAIP members provide encouragement that helps to shape ongoing projects into a cohesive team, while encouraging new synergistic projects that can potentially improve clinical practice. The PAIP actively participates in the Steering Group, all Work Packages (WPs), and a variety of internal and external communications. This includes making posters and presentations at international conferences, preparing for PRECISION reviews, creating website and newsletter content, giving interviews, co-authoring publications, and developing social media campaigns to raise awareness. RESULTS: The PAIP has: a) helped build collaborations between institutions; b) developed public-facing information about PRECISION and the 3 clinical trials; c) offered patient-oriented ideas and feedback to all WPs; d) helped resolve international contract barriers; e) helped identify additional DCIS cohorts; f) suggested ideas to improve recruitment for the clinical trials; g) given feedback on surveys and co-authored publications; h) built relationships with postdocs and PhD students; and i) engaged public and clinician audiences on DCIS dilemmas in each country. Additional ongoing PAIP work includes engaging in research to reduce pathology report DCIS grade discordance within and between countries (a critical issue for women diagnosed with DCIS). CONCLUSIONS: There is a need to better understand DCIS subtypes, stratify associated risks for invasive cancer, synergize accurate communication about DCIS, and improve pathology standards within and between countries. The PAIP will continue to work closely with researchers and communicate evidence that answers important questions related to risk factors for women who may or may not need treatment for DCIS. *PRECISION is sponsored by a Cancer Research UK Grand Challenge Award, which is also funded by the Dutch Cancer Society. Citation Format: Deborah Collyar, Donna Pinto, Hilary Stobart, Ellen Verschuur, Marja van Oirsouw, on behalf of the PRECISION Project. How patient advocates and researchers work together in PRECISION* to identify low-risk ductal carcinoma in situ (DCIS) that may not need aggressive treatment [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-16-04.