{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T21:01:44Z","timestamp":1770757304229,"version":"3.50.0"},"reference-count":41,"publisher":"American Medical Association (AMA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Active surveillance has emerged as a deescalation strategy for low-risk ductal carcinoma in situ (DCIS) to reduce overtreatment while maintaining favorable outcomes. Emerging data in low-risk DCIS, eg, the COMET trial, have highlighted growing interest in surveillance-based management for carefully selected patients. However, recent clinical adoption and national trends in managing low-risk, hormone receptor (HR)\u2013positive DCIS have not been evaluated in the US.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To examine trends and sociodemographic variations in nonsurgical management and other treatment modalities for low-risk, HR-positive DCIS.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cross-sectional study analyzed data from the National Cancer Database from January 1, 2004, to December 31, 2022, and included patients aged 18 years or older with grade 1 to 2, HR-positive DCIS and at least 12 months of follow-up since initial diagnosis. Analyses were performed between January 10 and August 31, 2025.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Year of diagnosis and sociodemographic characteristics.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Nonsurgical management, lumpectomy alone, lumpectomy plus adjuvant radiotherapy, unilateral mastectomy, bilateral mastectomy, and endocrine therapy were measured using descriptive statistics.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 316\u202f590 female patients were included (mean [SD] age, 60.8 [12.0] years; 5.8% Asian or Pacific Islander, 13.9% Black, 6.1% Hispanic, 73.3% White, and 0.9% other race and ethnicity). From 2004 to 2022, nonsurgical management increased from 2.1% to 3.5%, bilateral mastectomy increased from 4.1% to 8.7%, and lumpectomy increased from 22.0% to 25.1%, while lumpectomy plus adjuvant radiotherapy decreased from 50.9% to 45.6% and unilateral mastectomy decreased from 20.9% to 17.1%. Nonsurgical management was more common among Black patients and patients with no insurance. Bilateral mastectomy was common in younger, White, and privately insured patients and those who lived in higher-income areas. Endocrine therapy use increased from 2004 to 2020 but declined thereafter. Endocrine therapy was highest after lumpectomy plus adjuvant radiotherapy (69.6%), followed by lumpectomy alone (43.9%), unilateral mastectomy (35.3%), and nonsurgical management (29.2%), with the lowest use in patients younger than 50 years in the no surgery (15.2%) and lumpectomy alone (38.6%) groups. Since 2018, radiotherapy use has increased and become progressively more risk adapted, with increasing use with higher Oncotype DX DCIS scores (low risk, 34.5%; intermediate risk, 63.9%; high risk, 73.1%).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n This cross-sectional study highlights increasing trends and socioeconomic disparities in the nonsurgical management of and the need for precision-based, patient-centered care for low-risk DCIS. Precision prevention may enhance the identification of patients who could benefit most from preventive surgery, prolonged endocrine therapy, or treatment deescalation, paving the way for individualized strategies.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.58248","type":"journal-article","created":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T16:00:24Z","timestamp":1770739224000},"page":"e2558248","source":"Crossref","is-referenced-by-count":0,"title":["Trends in Nonsurgical Management for Low-Risk, Hormone Receptor\u2013Positive Ductal Carcinoma In Situ"],"prefix":"10.1001","volume":"9","author":[{"given":"Yu","family":"Matsui","sequence":"first","affiliation":[{"name":"Center for Innovation in Global Health, The University of Chicago, Chicago, Illinois"},{"name":"Department of Dermatology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jincong Q.","family":"Freeman","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, The University of Chicago, Chicago, Illinois"},{"name":"Cancer Prevention and Control Research Program, University of Chicago Medicine Comprehensive Cancer Center, Chicago, Illinois"},{"name":"Center for Health and the Social Sciences, The University of Chicago, Chicago, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Poland","sequence":"additional","affiliation":[{"name":"Section of Hematology\/Oncology, Department of Medicine, The University of Chicago, Chicago, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frederick M.","family":"Howard","sequence":"additional","affiliation":[{"name":"Section of Hematology\/Oncology, Department of Medicine, The University of Chicago, Chicago, 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