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Eur J Cancer. 2014 Oct;50(15):2695-704. doi: 10.1016/j.ejca.2014.07.019. Epub 2014 Aug 19.

International variation in management of screen-detected ductal carcinoma in situ of the breast.

Author information

1
CPO Piemonte, AOU Città della Salute e della Scienza, Torino, Italy. Electronic address: antonio.ponti@cpo.it.
2
Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
3
Department of Surgery, University of Vermont, Burlington, VT, USA.
4
Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic.
5
Mass Screening Registry, Finnish Cancer Registry, Helsinki, Finland.
6
National Cancer Screening Service, Dublin, Ireland.
7
CPO Piemonte, AOU Città della Salute e della Scienza, Torino, Italy.
8
Department of Surgical Oncology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
9
Programme Mammographie, Direction de la Santé, Luxembourg.
10
Erasmus Medical Centre, Rotterdam, The Netherlands.
11
The Cancer Registry of Norway, Oslo, Norway.
12
Cancer Detection and Control Programme, Catalan Institute of Oncology, Barcelona, Spain.
13
Breast Cancer Screening Programme, Instituto de Salud Pública, Navarra, Spain.
14
General Directorate Research and Public Health and Centre for Public Health Research, Valencia, Spain.
15
Lausanne University Hospital, Lausanne, Switzerland.
16
Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
17
Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA.

Abstract

BACKGROUND:

Ductal carcinoma in situ (DCIS) incidence has grown with the implementation of screening and its detection varies across International Cancer Screening Network (ICSN) countries. The aim of this survey is to describe the management of screen-detected DCIS in ICSN countries and to evaluate the potential for treatment related morbidity.

METHODS:

We sought screen-detected DCIS data from the ICSN countries identified during 2004-2008. We adopted standardised data collection forms and analysis and explored DCIS diagnosis and treatment processes ranging from pre-operative diagnosis to type of surgery and radiotherapy.

RESULTS:

Twelve countries contributed data from a total of 15 screening programmes, all from Europe except the United States of America and Japan. Among women aged 50-69 years, 7,176,050 screening tests and 5324 screen-detected DCIS were reported. From 21% to 93% of DCIS had a pre-operative diagnosis (PO); 67-90% of DCIS received breast conservation surgery (BCS), and in 41-100% of the cases this was followed by radiotherapy; 6.4-59% received sentinel lymph node biopsy (SLNB) only and 0.8-49% axillary dissection (ALND) with 0.6% (range by programmes 0-8.1%) being node positive. Among BCS patients 35% received SLNB only and 4.8% received ALND. Starting in 2006, PO and SLNB use increased while ALND remained stable. SLNB and ALND were associated with larger size and higher grade DCIS lesions.

CONCLUSIONS:

Variation in DCIS management among screened women is wide and includes lymph node surgery beyond what is currently recommended. This indicates the presence of varying levels of overtreatment and the potential for its reduction.

KEYWORDS:

Axillary staging; Breast cancer; Cancer registration; Ductal carcinoma in situ (DCIS); Overtreatment; Screening mammography

PMID:
25149183
PMCID:
PMC4275301
DOI:
10.1016/j.ejca.2014.07.019
[Indexed for MEDLINE]
Free PMC Article

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