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Multicenter Study
. 2014 Jan;50(1):185-92.
doi: 10.1016/j.ejca.2013.08.013. Epub 2013 Sep 13.

Variation in detection of ductal carcinoma in situ during screening mammography: a survey within the International Cancer Screening Network

Elsebeth Lynge  1 , Antonio Ponti  2 , Ted James  3 , Ondřej Májek  4 , My von Euler-Chelpin  5 , Ahti Anttila  6 , Patricia Fitzpatrick  7 , Alfonso Frigerio  8 , Masaaki Kawai  9 , Astrid Scharpantgen  10 , Mireille Broeders  11 , Solveig Hofvind  12 , Carmen Vidal  13 , Maria Ederra  14 , Dolores Salas  15 , Jean-Luc Bulliard  16 , Mariano Tomatis  2 , Karla Kerlikowske  17 , Stephen Taplin  18 ; ICSN DCIS Working group
Affiliations
Multicenter Study

Variation in detection of ductal carcinoma in situ during screening mammography: a survey within the International Cancer Screening Network

Elsebeth Lynge et al. Eur J Cancer. 2014 Jan.

Abstract

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.

Keywords: Breast cancer; Cancer registration; Ductal carcinoma in situ (DCIS); Screening mammography.

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Conflict of interest statement

Conflict of interest statement

No authors have declared a conflict of interest.

Figures

Figure 1
Figure 1
Age-standardized breast cancer incidence rate, detection rate of invasive breast cancer, and detection rate of DCIS per 1000 women aged 50–69 years.
Figure 2
Figure 2
Detection rate of invasive breast cancer versus detection rate of DCIS both per 1000 women aged 50–69 years.
See this image and copyright information in PMC

References

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