Interim Data From LORD Trial Suggests Active Surveillance Is a Safe Alternative to Immediate Surgery for Low-Risk DCIS

Early LORD trial data suggests monitoring low-risk DCIS is a safe alternative to surgery, helping patients avoid unnecessary treatment without increasing risk.

By: AXL Media

Published: Mar 27, 2026, 7:22 AM EDT

Source: Information for this report was sourced from European Organisation for Research and Treatment of Cancer

Redefining the Clinical Approach to Non-Invasive Breast Cell Abnormalities

For decades, ductal carcinoma in situ, or DCIS, has been managed with the same clinical urgency as invasive breast cancer, despite the fact that the abnormal cells remain confined to the milk ducts. Professor Jelle Wesseling of The Netherlands Cancer Institute argues that this historical framing as early-stage cancer has led to a cycle of overdiagnosis and unnecessary surgical procedures. The LORD trial was established to challenge this status quo, investigating whether a strategy of rigorous monitoring can replace immediate surgery, radiotherapy, or hormone therapy without compromising patient safety or long-term survival.

Statistical Reassurance in the Comparison of Surveillance and Surgery

The interim findings involve 1,423 patients across approximately 60 Dutch hospitals, focusing specifically on grade 1 or 2 DCIS detected through routine screening. Data collected over a median of two years shows that 6% of the active surveillance group were diagnosed with invasive cancer, compared to 9% of those who underwent immediate surgery. While the study reached a predetermined protocol threshold of 60 invasive diagnoses in the surveillance arm, Professor Wesseling noted that these early results remain highly encouraging. The tumors found during monitoring were not more aggressive than those found in the surgery group, suggesting that the delay in intervention did not lead to more dangerous disease progression.

Patient Autonomy and the Preference for Non-Surgical Management

The structure of the LORD trial evolved significantly due to participant feedback, transitioning from a randomized design to one that allowed patients to choose their preferred path of care. An overwhelming three quarters of the participants, totaling 1,025 individuals, opted for active surveillance over immediate surgical intervention. This shift highlights a significant desire among patients to avoid the physical and psychological toll of surgery when a lower-impact monitoring option is available. The high enrollment in the surveillance arm provides a robust dataset for understanding the real-world implications of choosing observation over excision.