Titles and Affiliations
Professor, Department of Pharmacology, Physiology, and Cancer Biology
Director, Center for Health Equity at Sidney Kimmel Cancer Center
Co-Leader, Cancer Risk and Control Program
Research area
Determining whether women with low-risk DCIS can be safely managed with active monitoring instead of surgery.
Impact
The In the U.S, over 60,000 women are diagnosed annually with ductal carcinoma in situ (DCIS) and almost all of them undergo invasive surgery, including a third that undergo mastectomy. However, many women who undergo surgery may not benefit, because DCIS itself is not harmful, and much DCIS does not progress to invasive cancer. Understanding the progression pathway from DCIS to invasive breast cancer would allow those with the lowest risk disease to avoid overtreatment. An active monitoring (AM) strategy has been proposed to reduce overtreatment of DCIS. Comparing an Operation to Monitoring, with or without Endocrine Therapy (COMET), is a randomized clinical trial that assesses the risks/benefits of AM versus surgery for women with low-risk DCIS. The study enrolled 997 women at 86 sites in the U.S between 2017 and 2023.
The question that the COMET Study is asking is important because until now, very little research has directly compared the experiences and outcomes of patients receiving these different treatments for low-risk DCIS. Initial 2-year findings published in December 2024 may help women to decide whether to undergo surgery or to monitor their low-risk DCIS, treating it only if it develops into invasive breast cancer.
Progress Thus Far
Dr. Hyslop’s COMET study work is in collaboration with Dr. Shelley Hwang and Alliance Foundation Trials. The continued collection of long-term clinical outcomes from the initial COMET cohort will provide an unparalleled opportunity to monitor patients with low-risk disease over a prolonged timescale to determine whether some women can be safely managed with active monitoring instead of surgery; this is critical to provide women with more information to consider their treatment options and enable a change in practice.
What’s next
Blood and tissue samples and imaging will continue to be collected at regular time points from participants in the study; subsequent analysis of these biospecimens/imaging will help doctors to better identify DCIS that may be harmful from DCIS that is not and improve future DCIS pathology diagnostics, prognostics, and care management.
Read more about BCRF’s Health Equity Initiative here.
Biography
Terry Hyslop, PhD is a Professor and Vice Chair of the Department of Pharmacology, Physiology, and Cancer Biology, Director of The Center for Health Equity, and co-Leader of the Cancer Risk and Control program at Thomas Jefferson University’s Sidney Kimmel Cancer Center. In addition, she is the Biostatistician for an NCI-funded cancer survivorship trial and for IRONMAN, an international registry for prostate cancer patients. She also serves as the Biostatistician of the COMET clinical trial in ductal carcinoma in situ for which fellow BCRF-investigator Shelley Hwang is the PI. Prior to her current appointments at Jefferson University, Dr. Hyslop was a professor at Duke University and the Director of Biostatistics at Duke Cancer Institute and obtained her PhD in statistics from Temple University in 2001.
Dr. Hyslop’s research focuses on novel statistical modeling approaches to cancer outcomes, in particular, to elucidate contributions to disparities in cancer outcomes. This methodology incorporates socio-economic, environmental, clinical, and biological factors and their convergence to affect outcomes. Her team is steeped in the development of novel modeling approaches to flexibly integrate social determinants of health with biomarkers and clinical data to understand potential prevention strategies, particularly for underserved groups. She also has significant expertise in the measurement of cancer biomarkers and developing novel approaches to modeling using biomarkers.
She has over 150 publications, with over 20,000 citations, and has been a lead investigator on dozens of grants supported by NCI, Komen, the state of PA, and BCRF. Dr. Hyslop also serves and an advisory board member for several large cancer centers.
