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Shelley Hwang, MD, MPH
Professor of Surgery
Chief, Breast Surgical Oncology
Vice Chair of Research, Department of Surgery
Durham, North Carolina
Goal: To identify markers that can detect when pre-invasive cancer progresses to invasive disease.
Impact: Dr. Hwang is investigating ways to personalize treatment for women with ductal carcinoma in situ (DCIS)—a premalignant form of breast cancer that may or may not progress to invasive breast cancer—by tailoring treatment recommendations based on tumor biology. This could spare women who have low-risk lesions from undergoing unnecessary treatment.
What’s next: She and her team will test the clinical utility of biomarkers to predict whether DCIS will become invasive breast cancer.
The progression of DCIS—also called Stage 0 breast cancer—to invasive cancer is not well understood. As a result, most women will undergo standard treatment for early stage invasive breast cancer, including surgery and radiation, whether it’s likely to become invasive or not. Dr. Hwang is conducting a clinical study of patients undergoing surveillance for DCIS to determine which patients may safely forgo surgery.
Full Research Summary
Research goal: Improving treatment of ductal carcinoma in situ (DCIS) so that each patient receives the best treatment for her disease.
Impact: Widespread access to mammographic screening has resulted in more than a five-fold higher detection of DCIS but without a corresponding reduction in the incidence of node-positive or metastatic breast cancer (MBC). Dr. Hwang aims to identify biomarkers in blood and tissue that could predict low versus high risk of progression to invasive cancer. Her findings have the potential to spare many women with DCIS from undergoing unnecessary treatments such as surgery and radiation.
Current investigation: Dr. Hwang is currently building a biospecimen and imaging repository to determine predictors of DCIS. She and her team are collecting cell-free DNA, tissue, and imaging from women enrolled in a prospective randomized trial called COMET (Comparison of Operative to Monitoring and Endocrine Therapy). COMET compares active surveillance (AS)—a strategy to monitor early-stage disease—to usual care for DCIS.
What she’s learned so far: In the last year, Dr. Hwang has expanded the COMET clinical trial for DCIS active surveillance and found candidate biomarkers to predict the potential of DCIS to become invasive breast cancer.
What’s next: She and her colleagues will continue sample collection and building the biospecimen repository. Dr. Hwang is testing the clinical utility of circulating tumor DNA as a predictor of invasive breast cancer at the time of DCIS diagnosis. She is also determining whether genetic differences in the collected DCIS samples correlate with physical differences that could be used to predict whether DCIS will become invasive breast cancer.
Dr. Shelley Hwang, MD, MPH is a Professor of Surgical Oncology, Vice Chair of Research and Chief of Breast Surgery for the Duke Department of Surgery and the Duke University Comprehensive Cancer Center. Her research focus includes breast cancer prevention, identifying less invasive treatments for early stage breast cancers including ductal carcinoma in situ (DCIS), and understanding the genetic and stromal determinants of cancer progression. Dr. Hwang is an experienced clinical trialist with an interest in both the biology and treatment early stage breast cancer including DCIS. She is lead investigator (PI) of a national cooperative group study through the ALLIANCE evaluating the role of preoperative systemic hormonal therapy for DCIS. She is also surgical PI of the Duke NCI National Clinical Trials Network, which promotes and oversees recruitment to cooperative group trials. She serves as a member of the National Cancer Institute Breast Cancer Steering Committee and the NCCN Screening Guidelines Committee. Other interests of the Hwang group include the evolutionary role of tumor and environmental heterogeneity in driving DCIS progression and the impact of the breast density, microenvironmental factors, and the stromal immune infiltrate in determining breast cancer phenotype and response to chemotherapy. Her team incorportates computational models of cancer progression, and have developed progression models for invasive breast cancer.
BCRF Investigator Since
The Tanger Factory Outlets Award