Category: 8. Health

Researchers have conducted the largest-ever genetic analysis of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), a typically lifelong condition that affects people’s ability to exert physical effort and can be debilitating.

The DecodeME study, which recruited over 15,000 people of European ancestry with the condition, revealed that eight stretches of the genome were tied to the syndrome. These had not previously been linked to ME/CFS. The gene variants found in these locations are also found in some healthy individuals, the research suggests. But in people with ME/CFS, the variants are likely to act alongside environmental factors to increase people’s risk of the condition, the researchers said.

In 2023, Molly Taylor, MD, MS, a pediatric oncologist and attending physician at Seattle Children’s, sat in her parked car with tears streaming down her face. She was preparing to attend the memorial service for an 8-year-old patient she had lost a week prior. The patient’s mother had asked Taylor if she could share a few words about the little girl.

Taylor recalls this experience in “We Grieve Too,” an essay originally published on the JAMA Network:

As I stood up on stage in my technicolor dress, staring back into the tear-soaked faces of her classmates, teachers, neighbors, cousins, grandparents, soccer teammates, youth group friends, aunts, uncles, her younger brother, her dad, her mom — the village that surrounded this little girl during her short life — I had just one thought: I couldn’t save her.

Taylor is not alone in experiencing grief tinged with guilt after losing a patient. Althoughthe prevalence of provider grief hasn’t been widely examined, a JPSM review published in 2023 indicated that it’s a significant issue in many areas of medicine. The review mentions 12 studies with 1137 healthcare providers showing that they commonly had moderate and sometimes long-term grief reactions after a patient’s death. 

While it may feel as if doctors are expected to be detached from these feelings, they are, at the end of the day, simply human. 

Bearing the Burden of Outcomes

Leeat Granek, PhD, is a critical health psychologist and associate professor at York University School of Health Policy and Management in Toronto who publishes extensively on grief and loss. In her decades of research, Granek has learned that the grief physicians experience has a lot to do with their sense of responsibility toward their patients. Consequently, grief over a patient’s death is colored with a sense of failure or guilt, even when they understand they weren’t responsible for the outcome. “And that’s a really hard emotion to sit with,” Granek acknowledges.

She notes that many physicians define error — and, subsequently, failure — as being dependent on outcomes. “But that’s not really the definition of an error,” she explains. “[Physicians] might make the exact same decision in the next case, and it would be lifesaving. So, there’s this construction of a story around a negative outcome that goes back to the individual physician and how they experience grief.”

When grief feels like failure, there can be reluctance to accept it. “A lot of times in medicine, we think of it like a battle we’re trying to fight against whatever disease process is happening that is endangering this life,” says Priya Roy, MD, a third-year fellow in cardiovascular medicine at The Ohio State University. “We have a hard time saying, ‘This person is dying — from a physiological standpoint — and maybe there isn’t something we can do about it,’ and I think that’s what makes people really uncomfortable.”

Granek points out that when her mother died of cancer at a young age, she experienced feelings of sadness, body aches, difficulty sleeping, etc. “But I didn’t feel a sense of failure or guilt because there was no perceived causality between her dying and something I’ve done,” she says.

Long-term Connections 

Granek says that the depth of grief is also related to attachment with the deceased person. The result is that some medical specialties may experience more intense grief than others, for example, in oncology where patient care is often long term. 

The JPSM review noted that, in multiple studies, certain hospital specialties were particularly impacted by provider grief, such as adult and pediatric oncology, palliative care, pediatrics, perinatal care, emergency medicine, critical care, and surgery. A survey of 1000 members of the American College of Obstetricians and Gynecologists indicated that 53.7% of physicians caring for women who had a stillbirth reported high levels of grief; other symptoms reported included self-doubt (17.2%), depression (16.9%) and self-blame (16.4%).

For Roy, that comes with the territory of working in the Coronary Care Unit (CCU). “It might be easier in some capacity not to form bonds with your patients and hold everybody at arm’s length,” she says. “But I want to get to know my patients. I want to learn what’s going on in their lives. I want them to tell me the things that scare them and the things that bring them joy so I can actually help them make decisions that will be beneficial to them.”

Roy’s personal experience of losing her father to cancer has informed her patient relationships, leading her to “get closer to patients who were either nearing the end of their life or who have been dealt a devastating diagnosis,” she says, “because I know what it feels like to feel alone in that.”

Granek’s personal experience with loss also shaped her career as a psychologist, specializing in grief and loss among healthcare professionals. Her mother lived with cancer for nearly 20 years before passing away in 2005 at age 33. During that time, the family formed strong bonds with the healthcare team. “And then those relationships get severed,” Granek says. “It’s a weird experience, because you’ve had this intense, close, important relationship with this team and then you don’t see them ever again.” 

The “Good” Death

There’s also the nature of the death to consider. Was it a “good death” as defined by The Institute of Medicine: “one that is free from avoidable suffering for patients, families and caregivers in general accordance with the patients’ and families’ wishes.” Or a “bad death” where the patient experienced unrelieved physical and emotional suffering — terms that feel loaded with responsibility and judgement, even if indirectly. 

Or was the death unexpected? “Our colleagues in ICU or emergency room have very intense, brief interactions with patients at the end of their life, and it’s a different sort of flavor, and that also complicates the grief,” acknowledges Taylor. 

Additionally, the frequency of patient loss can take a toll. Roy recalls the time her team lost five patients in 48 hours in the CCU. “Some people can become sort of numb to the experience of losing patients,” says Roy. “We’re forced by the nature of the work that we do to compartmentalize to a certain extent. Maybe in the short term that’s helpful to care for your other patients that day, but in the long term, it’s not healthy. It eventually catches up with you.”

Grief Unchecked and Untrained

While everyone experiences grief, pathological bereavement outcomes (ie, complicated grief, traumatic grief, prolonged grief disorder) can develop if it is ignored. After losing her father, Roy recalls how her mother, a pulmonary critical care doctor, used work to distract herself from the devastation of her husband’s passing. 

“The longer grief sits unattended and unprocessed, the more likely it’s going to manifest in any number of other sequelae, like burnout, or sleep disruption or anger problems or substance abuse or even down the pathway to PTSD or suicide risk,” says Christine Yu Moutier, MD, psychiatrist and chief medical officer at the American Foundation for Suicide Prevention. 

In fact, a 2025 study reveals that physicians were three times more likely to have a job-related trauma or loss as part of the lead up to suicide as compared to the general population.

“It’s not a question of, ‘Do we have grief?’ We have grief every day,” says Mark Greenawald, MD, vice chair, family and community medicine at Virginia Tech Carilion School of Medicine. “It’s just a question of how we’re processing it.” In his experience, learning to process grief isn’t built into the medical school curriculum. Instead, Greenawald says he was trained to be compassionate for others, to hold suffering for patients and their families, which can be a lot to bear.

That’s not to say medical education turns a blind eye. “Probably 20-30 years ago, I think the overall idea was, ‘Don’t get close to your patients, this is a job,’ and the issue [of grief] was never really addressed,” says Prarthna Bhardwaj, MD, a hematologist and medical oncologist at Baystate Health in Massachusetts. “You were told not to wear your heart on your sleeve with patients, because they are relying on you to be a professional.” 

Bhardwaj believes medical education has since evolved with “a lot more focus on how to cope with what you experience and more emphasis on overall mental wellbeing. But we still have a long way to go.”

Taylor says there’s no explicit or formal way that dealing with patient loss is addressed in training. The focus is on reviewing procedures during morbidity and mortality rounds, not feelings. “That can be a difficult venue for people to go about processing,” Taylor says. “And if someone says, ‘I did this differently, and I had a great outcome with a patient,’ that doesn’t serve anybody in the moment.”

Greenawald puts it more bluntly: “In healthcare, grief is seen as a sign of weakness or incompetence.”

A Space to Grieve

It’s widely understood that COVID, and the overwhelming number of patient deaths that came with it, took a tremendous toll on healthcare workers. During the pandemic, hospitals were motivated to create what Taylor refers to as “grief adjacent” programs and interventions to improve wellbeing. However, a physician must not only self-enroll in these but also take time outside of work to participate. 

Granek acknowledges that these interventions are well-intentioned but also problematic. “I’m a psychologist; I have nothing against therapy or mindfulness programs,” she says. “But those are very individual solutions to a global problem.” 

They are also reactionary, adds Greenawald. “Crisis interventions are absolutely essential, but it’s just the tip of the need.”

So, what might help? Granek says that when she asks healthcare providers what would best help them cope with loss, they overwhelmingly respond that they want a space where their grief is acknowledged. 

“Historically, on the physician side in medical culture, there hasn’t been an intentional space created for grief,” says Taylor. To fill that gap, she has been deliberate about bolstering a community with her fellow oncologists. “We have a space to debrief, but that’s very informal,” she says, adding that the burden is on physicians to create these groups.

In 2019, Greenawald began to wonder if something could be put in place to help clinicians without being too overt or elementary: a space to talk about difficult cases and their emotional impact. A year later, he launched PeerRXMed, a free, peer-supported program designed to help physicians and others on a care team form meaningful connections. Participants self-select a friend with whom they’ll work through the program, requiring as little as a 15-second weekly check in. Today, PeerRXMed continues to thrive and eventually Greenawald hopes to develop an app. 

Roy and her classmate at the University of Pittsburgh School of Medicine, Kortni Ferguson, MD, launched their website BereaveMED in 2019 to provide a space where medical students experiencing grief and loss could share their stories and build community. The site also offers an extensive list of resources, including links to blogs, podcasts, support groups and research.

Many in the field acknowledge the challenges in creating an in-house grieving space for healthcare providers, because there’s no one-size-fits all solution; grief is contextual. Granek suggests the approach should be integrated into the day-to-day rather than something the physician needs to deal with outside of work. It also needs to be modeled from the top down in order to normalize it, starting with the chair of the department.

She also notes that one must consider the issue of departmental dynamics. “How well do the people get along? How competitive is this environment? You have to deal with the relational culture of the department before you can ask people to open up about their vulnerabilities.” 

“The approach has to be systemic rather than individual,” Granek adds. “And preferably that education starts early in medical education.”

In the meantime, Moutier encourages physicians to talk about patient loss with someone they trust. “Whether that’s a mentor, a peer, a therapist, a grief counselor, a spouse,” she says, “I think the problems are much more likely to be more intense and more severe if you’re not talking about it.” 

Maintaining optimal heart health from birth through adolescence was reported to lead to long-lasting cardiovascular, physical, cognitive, and mental health, according to findings published by investigators in the Journal of the American Heart Association. The study authors noted that cardiovascular health in childhood leads to lower risks of cancer, dementia, lung disease, liver disease, kidney disease, type 2 diabetes (T2D), obesity, depression, and hearing loss, along with better cognitive, dental, and eye health.^1,2

Pediatric Cardiovascular Health

According to the American Heart Association, rising rates of childhood obesity, specifically in the US, have led to an increase in cardiovascular and metabolic disease risk factors. From 2009 to 2010, 17% of pediatrics in the US aged 2 to 19 were obese, and another 15% were overweight, with minority, low-income, and rural populations disproportionately affected. Additionally, children with obesity commonly have worse cholesterol and blood pressure levels, emphasizing the importance of ideal heart health.³

The American Heart Association developed metrics, known as Life’s Simple 7 (LS7), that included 4 health behaviors—diet, physical activity, smoking avoidance, and sleep—and 3 clinical metrics, including body mass index (BMI), blood pressure, cholesterol, and blood glucose.^1,2

“Childhood is a unique window where keeping these cardiovascular health metrics in optimal ranges will have a long-term benefit to all body systems, not just the heart,” Amanda Marma Perak, MD, MSCI, senior author, pediatric cardiologist at Ann & Robert H. Lurie Children’s Hospital of Chicago, and assistant professor of pediatrics and preventive medicine at Northwestern University Feinberg School of Medicine, said in a news release.²

Review Finds Low Cardiovascular Health Globally

Researchers from Ann & Robert H. Lurie Children’s Hospital of Chicago and Northwestern University Feinberg School of Medicine conducted a review that assessed 483 studies that were published between January 2010 and January 2021 that used the LS7 structure.^1,2

The results demonstrated that cardiovascular health was generally low globally and declined with age, despite finding a strong link between cardiovascular health and overall well-being. Additionally, significant disparities were linked with lower cardiovascular health, including underrepresented individuals and those facing adverse social conditions.^1,2

“Parents can focus on the 4 health habits—setting up their child’s daily routines to include a healthy diet, plenty of physical activity, and protected time for sleep, and then making clear their expectations about not smoking or vaping as the child gets older,” Perak said in the news release. “For the 4 clinical factors, parents can check in with the pediatrician at each well-child visit to make sure that their child’s BMI, blood pressure, cholesterol, and blood sugar levels are on track for a healthy future.”²

The findings suggest that ideal cardiovascular health was linked to lower inflammation, as poor cardiovascular health is linked to a decline with age. However, the study authors noted that more research is needed to target more populations and develop improvements for children that face an increased risk of reduced cardiovascular health.^1,2

“Early prevention is key to a healthy adulthood. If parents are concerned about their child’s risk factors for heart disease, the Preventive Cardiology Program at Lurie Children’s can help set kids on a healthier path,” Marma Perak concluded. “We treat children with risk factors like high cholesterol, high blood pressure, metabolic syndrome, or a family history of early heart attacks or strokes. Our goal is to improve measures of cardiovascular health and prevent chronic diseases from head to toe.”²

REFERENCES

1. Aguayo L, Cotoc C. Guo J. et al. Cardiovascular Health, 2010 to 2020: A Systematic Review of a Decade of Research on Life’s Simple 7. Journal of the American Heart Association. doi.org/10.1161/JAHA.124.038566

2. Optimal heart health in children cuts risk of chronic diseases in adulthood. EurekAlert! News release. July 16, 2025. Accessed August 6, 2025. https://www.eurekalert.org/news-releases/1091131

3. Steinberger J, Daniels S. Hagberg N. et al. Cardiovascular Health Promotion in Children: Challenges and Opportunities for 2020 and Beyond: A Scientific Statement From the American Heart Association. Journal of the American Heart Association. doi.org/10.1161/CIR.0000000000000441

Radiologists had the third highest intent to leave the profession (39 percent) among physician specialties, according to a recent American Medical Association (AMA) survey.

Chris Mattern, M.D., in a recent interview with Diagnostic Imaging, said a variety of trends in radiology may be contributing to these survey findings and increasing cases of burnout.

Foremost among these factors is the widening chasm between yearly double-digit increases in imaging utilization and less than one percent annual increases in the number of radiologists, according to Dr. Mattern.

“The math obviously doesn’t work out and at some point, that elastic has stretched to the point of breaking, and we’ve been at or beyond that point now for a few years,” said Dr. Mattern, the associate chief medical officer for radiologist experience at Radiology Partners.

While there are increasing numbers of radiologists are working remotely, Dr. Mattern suggested there may be a growing disconnect with working in more of an isolated setting. Dr. Mattern said this may be a key factor contributing to early retirement for radiologists in their 50s and 60s.

The increased demand for radiologists has also led to higher compensation levels that may enable younger and mid-career radiologists seeking more of a work-life balance to opt for more of a part-time role.

“I think there’s a lot of folks, again in that younger age group than we might have seen before, that are saying, well, there’s a lot of need, and I can find various places I can work at a pretty part-time basis and still make a decent income doing that. That allows me to sort of retire from full-time (work) at a much earlier age,” noted Dr. Mattern, a neuroradiologist affiliated with Greensboro Radiology in Greensboro, N.C.

(Editor’s note: For related content, see “Burnout in Radiology: Key Risk Factors and Promising Solutions,” “Four Strategies to Address the Tipping Point in Radiology” and “Can Short-Term Measures Provide Some Relief with the Radiologist Shortage?”)

For more insights from Dr. Mattern, watch the video below.

With more than 15 years of evidence and the continuing evolution of devices, the Society for Cardiovascular Angiography and Interventions (SCAI) and the Heart Rhythm Society (HRS) have released practice guidelines for stroke prevention with left atrial appendage occlusion (LAAO) in patients with nonvalvular atrial fibrillation (AF).

The document, published online today in both JSCAI and Heart Rhythm Journal, follows an expert consensus paper published by the two societies in 2023. It was designed to standardize an ever-growing practice and identify knowledge gaps, writing committee chair Andrew Goldsweig, MD (University of Massachusetts-Baystate, Springfield), told TCTMD.

The US Food and Drug Administration approval of LAAO with the Watchman device (Boston Scientific) in 2015 was based on studies that are now “outdated,” as medical therapy and imaging technology have advanced, Goldsweig said.

“There’s really tremendous diversity in LAAO practice, especially between interventional cardiologists and electrophysiologists, [as well as] diversity regarding which patients are appropriate, what periprocedural imaging is appropriate, what adjunctive medical therapy is appropriate, [and] how peridevice leak or device-related thrombus should be managed,” he commented.

With more than 100,000 LAAO cases performed in the United States last year, and a patient population that’s likely to grow, according to Goldsweig, it was time for the field to codify practice to be able to move forward in an evidence-based fashion.

The Highlights

The new guidelines include recommendations drawn from more than 3,700 studies. One of the first major issues addressed is whether to send patients for LAAO or to maintain oral anticoagulation. While the guidelines recommended LAAO over no therapy in patients with contraindications to oral anticoagulation, the two options are “sort of equivalent partners” in the general AF population as of now, said Goldsweig.

If LAAO has been decided, preprocedural imaging is recommended conditionally due to a low certainty of evidence, “but there are in fact data to suggest that preprocedural transesophageal echocardiography or CT imaging results in better outcomes,” Goldsweig said. The same goes for intraprocedural imaging with either transesophageal echocardiography (TEE) or intracardiac echocardiography (ICE).

Notably, the FDA released an alert today regarding the risk of air embolism during sheath insertion of Watchman procedures in patients under sedation.

“With ICE guidance, patients are typically under conscious sedation, breathing independently, and therefore do not have positive-pressure mechanical ventilation,” Goldsweig explained. “The FDA alert does not change the guidelines’ recommendation, which is based upon equivalent outcomes with ICE and TEE guidance. However, the warning does underscore the importance of de-airing catheters rigorously, especially in ICE-guided procedures.”

Following the procedure, the experts highlight competing risks of bleeding and stroke when considering anticoagulation or dual antiplatelet therapy (DAPT). There is a conditional recommendation for either option, with those who have significant contraindications to anticoagulation “reasonably” going with DAPT. Goldsweig said this area has substantial knowledge gaps, especially regarding the role of single antiplatelet therapy, that should hopefully be addressed in the ongoing SIMPLAAFY trial.

Regarding postprocedural imaging, there’s a conditional recommendation with a very low certainty of evidence in favor of performing either TEE or CT.

Another unknown is how to treat patients with peridevice leak (PDL). “We know that some percentage of patients will have a peridevice leak, and we don’t know how best to manage it,” Goldsweig said. “Should those patients be anticoagulated? At what frequency should they undergo imaging? Should we be putting plugs in those leaks? We don’t know. But by identifying that as a knowledge gap, hopefully we will promote future research in that area.”

Lastly, the issue of what to do about device-related thrombus (DRT) remains unclear. “We do have data showing a stroke risk associated with DRT that is mitigated by anticoagulation,” Goldsweig said. “So, the panel did recommend anticoagulation for DRT but makes no recommendation about the duration or timing of repeat imaging following DRT.”

Goldsweig praised the multidisciplinary team behind the guidelines, which included interventional cardiologists, electrophysiologists, cardiovascular imaging specialists, and methodological experts. He said SCAI plans to update the document in the next 3 to 5 years.

Patients diagnosed with type 2 diabetes need to be wary of potential adverse effects from receiving glucagon-like peptide-1 receptor agonists (GLP-1 RAs), as a new study published in JAMA Ophthalmology¹ has found that the use of GLP-1 RAs is linked to nonarteritic anterior ischemic optic neuropathy (NAION), which can lead to nerve damage.

NAION is the most common cause of acute optic nerve injury in those 50 years and older, with those of White race at higher risk compared with other ethnic groups.² Previous studies have shown a connection between NAION and semaglutide but the association with other GLP-1 RAs remains to be explored. This study evaluated the association between various GLP-1 RAs and NAION, specifically evaluating the incidence of NAION in those who used the medication.

All participants in the study were 65 years or older, diagnosed with type 2 diabetes, and enrolled in Medicare, and needed to be prescribed an antidiabetic medication between 2007 and 2021 based on data from the Virtual Research Data Center of CMS. International Classification of Diseases, Ninth Revision, and International Statistical Classification of Disease and Related Health Problems, Tenth Edition, were used to determine diagnostic codes for type 2 diabetes and NAION.

Patients with optic neuritis or giant cell arteritis were excluded from the study, and patients using insulin or only metformin were excluded from the reference group to improve uniformity of glycemic control.

A total of 3,845,171 patients were included in this study who had type 2 diabetes. A total of 15.1% of the patients were prescribed GLP-1 RAs, 34.8% were prescribed metformin only, and 21.7% were prescribed insulin. NAION developed in 0.2% of the patients after a median (IQR) follow-up of 3.7 (1.9-5.9) years.

GLP-1 RAs were associated with an increased risk of NAION (HR, 1.15; 95% CI, 1.04-1.27) compared with other second-line medications, with the median time between initiation and NAION being 3.3 (1.6-5.4) years. Insulin was associated with an increased risk of NAION as well (HR, 1.43; 95% CI, 1.34-1.53) compared with metformin alone. Male sex, White race, rural residence, history of diabetic retinopathy, and use of amiodarone were all risk factors for NAION. Semaglutide (HR, 1.39; 95% CI, 1.13-1.72) and liraglutide (HR, 1.25; 95% CI, 1.08-1.45) were associated with an increased risk of NAION.

There were some limitations to this study. Using diagnostic codes may have limited the capture of NAION in patients. Also, the onset date for type 2 diabetes was not collected from patients, and all participants were 65 years or older, which limits generalizability.

The authors concluded that their results confirmed previous findings that GLP-1 RAs were associated with increased risk of NAION. “The risk of NAION warrants further research given the increasing use of GLP-1 RAs and the seriousness of NAION,” the authors concluded.

References

1. Fung KW, Baye F, Baik SH, McDonald MD. GLP-1 RAs and risk of nonarteritic anterior ischemic optic neuropathy in older patients with diabetes. JAMA Ophthalmol. Published online July 31, 2025. doi:10.1001/jamophthalmol.2025.2299

2. Wu KY, Evoy F. NAION: diagnosis and management. American Academy of Ophthalmology. August 1, 2022. Accessed August 5, 2025. https://www.aao.org/eyenet/article/naion-diagnosis-and-management

Treatment decisions based on a 7-gene molecular-based test, DCISionRT®, may more accurately risk stratify ipsilateral breast recurrence (IBR) in patients with ductal carcinoma in situ (DCIS) compared with clinicopathology alone, according to results from a multinational study published in the International Journal of Radiation Oncology, Biology, and Physics.¹

Findings from the study revealed that a mean of 57% (range, 51%-63%) of patients who were initially classified as decision score (DS) low risk were reclassified as DS high risk. The reclassified group experienced reduced IBR rates with radiation therapy vs without, with a mean HR of 0.30 (P <.001). Furthermore, among patients who met any low-risk clinicopathology criteria and were reclassified to high risk, the mean 10-year IBR rate was 21.4% without radiation and 6.4% with radiation. An independent external validation cohort showed that among patients reclassified as DS high risk from low-risk clinicopathology (mean, 54%), the IBR rate was significantly reduced with radiotherapy at a mean HR of 0.32 (P < .001).

Among patients initially classified as high risk by clinicopathology, a mean of 28% (range, 22%-33%) were reclassified as DS low risk; however, IBR rates did not significantly differ with or without radiation, and p-values across clinicopathology criteria ranged from 0.26 to 0.70. Furthermore, patients who were reclassified to low risk after a high-risk clinicopathology classification experienced a mean 10-year IBR rate of 5.0% without radiation and 5.2% with radiation. In an independent external validation cohort, a mean of 33% of patients were reclassified from high-risk CP to DS low risk, with an IBR rate that was not significantly reduced by radiotherapy (P = .33).

“This observational study further supports optimizing de-escalation and escalation treatment strategies using DCISionRT,” study author Patrick Borgen, MD, chair of the Department of Surgery at Maimonides Medical Center, said in a news release on the study findings.² “The national randomized clinical trial (NRG CC-016) will soon be underway to further define the utility of DCISionRT to identify important subsets of patients with low recurrence risk and minimal to no benefit from radiation therapy.”

A total of 926 patients with low-risk DCIS after breast conserving surgery were included in the study. Women were classified as DS low risk, with a DS of no more than 2.8 and no residual risk subtype (RRt), or DS high risk, with a DS of more than 2.8 with or without RRt. The RRt does not include CP factors but combines a subset of similar molecular biomarkers.

Biosignature testing was conducted on archived tissue samples. Validation of the 7-gene biosignature defined the optimal threshold of a DS of 2.8 to stratify DS low-risk patients who had minimal radiotherapy benefit from those who had a significant reduction from radiation, defined as a DS greater than 2.8. Clinicopathology factors included age, grade, size of tumor, and margin status as well as VNPI-, MSKCC-, DCIS nomogram-, ECOG 5194-, and RTOG 9804-based criteria.

Clinicopathology low- and high-risk groups were further stratified into dichotomous DS low- and high-risk groups, with risk group distributions determined based on patients meeting various clinicopathology criteria. Kaplan Meier survival analyses were used to calculate IBR rates for patients treated with or without postoperative radiotherapy.

A total of 69% of evaluable patients received postoperative radiotherapy, and 34% received postoperative endocrine therapy; 73% of those prescribed endocrine therapy received radiation. The median follow-up for the study population was 8.5 years (IQR, 5.8-10.2), and a total of 92 ipsilateral breast events were recorded.

“The study underscores the utility of DCISionRT to enhance shared decision-making and deliver more personalized [radiotherapy] guidance in the management of DCIS,” first study author Frank Vicini, MD, radiation oncologist at Michigan Healthcare Professionals, said in the news release.²

References

1. Vicini F, Shah C, Mittal K, et al. Limitations in the application of clinicopathologic factors alone in predicting radiation benefit for women with low-risk ductal carcinoma in situ after breast conserving surgery: the impact of a 7-gene biosignature based on 10-year ipsilateral breast recurrence (IBR) rates. Int J Radiat Oncol Biol Phys. 2025;18:S0360-3016(25)06007-9. doi:10.1016/j.ijrobp.2025.07.1411
2. PreludeDx study demonstrates superiority of DCISionRT® over clinicopathology factors and criteria for DCIS treatment management. News release. PreludeDx. July 31, 2025. Accessed August 5, 2025. https://tinyurl.com/unwea7up