TY - JOUR
T1 - Variation in detection of ductal carcinoma in situ during screening mammography
T2 - a survey within the International Cancer Screening Network
AU - Lynge, Elsebeth
AU - Ponti, Antonio
AU - James, Ted
AU - Májek, Ondřej
AU - von Euler-Chelpin, My
AU - Anttila, Ahti
AU - Fitzpatrick, Patricia
AU - Frigerio, Alfonso
AU - Kawai, Masaaki
AU - Scharpantgen, Astrid
AU - Broeders, Mireille
AU - Hofvind, Solveig
AU - Vidal, Carmen
AU - Ederra, Maria
AU - Salas, Dolores
AU - Bulliard, Jean-Luc
AU - Tomatis, Mariano
AU - Kerlikowske, Karla
AU - Taplin, Stephen
AU - ICSN DCIS Working group
N1 - Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.
PY - 2014/1
Y1 - 2014/1
N2 - BACKGROUND: There is concern about detection of ductal carcinoma in situ (DCIS) in screening mammography. DCIS accounts for a substantial proportion of screen-detected lesions but its effect on breast cancer mortality is debated. The International Cancer Screening Network conducted a comparative analysis to determine variation in DCIS detection.PATIENTS AND METHODS: Data were collected during 2004-2008 on number of screening examinations, detected breast cancers, DCIS cases and Globocan 2008 breast cancer incidence rates derived from national or regional cancer registers. We calculated screen-detection rates for breast cancers and DCIS.RESULTS: Data were obtained from 15 screening settings in 12 countries; 7,176,050 screening examinations; 29,605 breast cancers and 5324 DCIS cases. The ratio between highest and lowest breast cancer incidence was 2.88 (95% confidence interval (CI) 2.76-3.00); 2.97 (95% CI 2.51-3.51) for detection of breast cancer; and 3.49 (95% CI 2.70-4.51) for detection of DCIS.CONCLUSIONS: Considerable international variation was found in DCIS detection. This variation could not be fully explained by variation in incidence nor in breast cancer detection rates. It suggests the potential for wide discrepancies in management of DCIS resulting in overtreatment of indolent DCIS or undertreatment of potentially curable disease. Comprehensive cancer registration is needed to monitor DCIS detection. Efforts to understand discrepancies and standardise management may improve care.
AB - BACKGROUND: There is concern about detection of ductal carcinoma in situ (DCIS) in screening mammography. DCIS accounts for a substantial proportion of screen-detected lesions but its effect on breast cancer mortality is debated. The International Cancer Screening Network conducted a comparative analysis to determine variation in DCIS detection.PATIENTS AND METHODS: Data were collected during 2004-2008 on number of screening examinations, detected breast cancers, DCIS cases and Globocan 2008 breast cancer incidence rates derived from national or regional cancer registers. We calculated screen-detection rates for breast cancers and DCIS.RESULTS: Data were obtained from 15 screening settings in 12 countries; 7,176,050 screening examinations; 29,605 breast cancers and 5324 DCIS cases. The ratio between highest and lowest breast cancer incidence was 2.88 (95% confidence interval (CI) 2.76-3.00); 2.97 (95% CI 2.51-3.51) for detection of breast cancer; and 3.49 (95% CI 2.70-4.51) for detection of DCIS.CONCLUSIONS: Considerable international variation was found in DCIS detection. This variation could not be fully explained by variation in incidence nor in breast cancer detection rates. It suggests the potential for wide discrepancies in management of DCIS resulting in overtreatment of indolent DCIS or undertreatment of potentially curable disease. Comprehensive cancer registration is needed to monitor DCIS detection. Efforts to understand discrepancies and standardise management may improve care.
KW - Aged
KW - Breast Neoplasms
KW - Carcinoma, Ductal, Breast
KW - Carcinoma, Intraductal, Noninfiltrating
KW - Data Collection
KW - Early Detection of Cancer
KW - Europe
KW - Female
KW - Humans
KW - Mammography
KW - Middle Aged
KW - United States
U2 - 10.1016/j.ejca.2013.08.013
DO - 10.1016/j.ejca.2013.08.013
M3 - Journal article
C2 - 24041876
VL - 50
SP - 185
EP - 192
JO - European Journal of Cancer, Supplement
JF - European Journal of Cancer, Supplement
SN - 0959-8049
IS - 1
ER -