As a surgeon at the Duke Cancer Institute, Dr. Shelley Hwang is trained to perform the most delicate yet common procedure for treating breast cancer: removing tumors, and often much of the breast itself, to give women the best chance of avoiding recurrence and having the cancer spread to other parts of the body. But with better screening and detection of the disease, she became uncomfortable with the drastic approach for some of her patients. The earliest stage of breast cancer, known as ductal carcinoma in situ (DCIS), often does not spread beyond the breast or cause serious disease. So about a decade ago, she proposed a radical idea: asking these women whether they would rather avoid surgery and instead monitor their cancer very closely with more regular mammograms. They could always turn to surgery if their disease worsened.
She created a landmark study to test the idea by randomly assigning women to surgery or active surveillance. In 2024, the first results of the study supported her hunch. Women in both groups showed about the same amount of breast cancer, which suggests that avoiding surgery didn’t lead to a significantly higher risk of the disease. Hwang plans to follow the women for 10 years, but is encouraged by what she’s seen so far. “For the lowest risk DCIS, like the ones in this study, surgery may not ultimately be needed,” she says.