Format

Send to

Choose Destination
Lancet Oncol. 2016 Jan;17(1):109-14. doi: 10.1016/S1470-2045(15)00446-5. Epub 2015 Dec 5.

Screen detection of ductal carcinoma in situ and subsequent incidence of invasive interval breast cancers: a retrospective population-based study.

Author information

1
Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis, Queen Mary University of London, Wolfson Institute of Preventive Medicine, London, UK. Electronic address: s.w.duffy@qmul.ac.uk.
2
Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis, Queen Mary University of London, Wolfson Institute of Preventive Medicine, London, UK.
3
Centre for Cancer Prevention, Queen Mary University of London, Wolfson Institute of Preventive Medicine, London, UK.
4
East Midlands QARC, Nottingham University Hospital City Campus, Nottingham, UK.
5
East of England QARC, Histon, Cambridge, UK.
6
London QARC, London, UK.
7
Yorkshire and Humber QARC, Newcastle upon Tyne, UK.
8
North West QARC, Albert St, Hollinwood, Oldham, UK.
9
Northern Ireland QARC, Belfast, UK.
10
South Central QARC, Oxford, UK.
11
South East Coast QARC, Battle, East Sussex, UK.
12
South West QARC, Clifton, Bristol, UK.
13
Public Health Wales, Cardiff, UK.
14
West Midlands QARC, Public Health Building, University of Birmingham, Birmingham, UK.
15
National Cancer Screening Programmes, Sheffield, UK.

Abstract

BACKGROUND:

The value of screen detection and treatment of ductal carcinoma in situ (DCIS) is a matter of controversy. At present, the extent to which the diagnosis and treatment of DCIS could prevent the occurrence of invasive breast cancer in the future is not clear. We sought to estimate the association between detection of DCIS at screening and invasive interval cancers subsequent to the relevant screen.

METHODS:

We obtained aggregate data for screen-detected cancers from 84 local screening units within 11 regional Quality Assurance Reference Centres in England, Wales, and Northern Ireland from the National Health Service Breast Screening Programme. Data for DCIS diagnoses were obtained for women aged 50-64 years who were invited to and attended mammographic breast screening from April 1, 2003, to March 31, 2007 (4 screening years). Patient-level data for interval cancer arising in the 36 months after each of these were analysed by Poisson regression with invasive interval cancer screen detection rate as the outcome variable; DCIS detection frequencies were fitted first as a continuous and then as a categorical variable. We repeated this analysis after adjustment with both small size and high-grade invasive screen-detected cancers.

FINDINGS:

We analysed data for 5,243,658 women and on interval cancers occurring in the 36 months after the relevant screen. The average frequency of DCIS detected at screening was 1·60 per 1000 women screened (median 1·50 [unit range 0·54-3·56] [corrected to] per 1000 women). There was a significant negative association of screen-detected DCIS cases with the rate of invasive interval cancers (Poisson regression coefficient -0·084 [95% CI -0·13 to -0·03]; p=0·002). 90% of units had a DCIS detection frequency within the range of 1·00 to 2·22 per 1000 women; in these units, for every three screen-detected cases of DCIS, there was one fewer invasive interval cancer in the next 3 years. This association remained after adjustment for numbers of small screen-detected invasive cancers and for numbers of grade 3 invasive screen-detected cancers.

INTERPRETATION:

The association between screen-detected DCIS and subsequent invasive interval cancers suggests that detection and treatment of DCIS is worthwhile in prevention of future invasive disease.

FUNDING:

UK Department of Health Policy Research Programme and NHS Cancer Screening Programmes.

PMID:
26655422
PMCID:
PMC4691349
DOI:
10.1016/S1470-2045(15)00446-5
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Elsevier Science Icon for PubMed Central
Loading ...
Support Center