Screen detection of ductal carcinoma in situ and subsequent incidence of invasive interval breast cancers: a retrospective population-based study - 24/12/15
, Amanda Dibden, MSc a, Dimitrios Michalopoulos, MSc b, Judith Offman, PhD b, Dharmishta Parmar, BA a, Jacquie Jenkins, MSc c, Beverley Collins, BA d, Tony Robson, DipHE e, Suzanne Scorfield, BSc f, Kathryn Green, BA g, Clare Hall, HND h, Xiao-Hui Liao, MPH i, Michael Ryan, MSc j, Fiona Johnson k, Guy Stevens, BA l, Olive Kearins, MSc m, Sarah Sellars, MSc n, Julietta Patnick, ProfCBE nSummary |
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] 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.
Le texte complet de cet article est disponible en PDF.Plan
Vol 17 - N° 1
P. 109-114 - janvier 2016 Retour au numéro
Article précédent
- S-1 plus leucovorin versus S-1 plus leucovorin and oxaliplatin versus S-1 plus cisplatin in patients with advanced gastric cancer: a randomised, multicentre, open-label, phase 2 trial
- Shuichi Hironaka, Naotoshi Sugimoto, Kensei Yamaguchi, Toshikazu Moriwaki, Yoshito Komatsu, Tomohiro Nishina, Akihito Tsuji, Takako Eguchi Nakajima, Masahiro Gotoh, Nozomu Machida, Hideaki Bando, Taito Esaki, Yasunori Emi, Takashi Sekikawa, Shigemi Matsumoto, Masahiro Takeuchi, Narikazu Boku, Hideo Baba, Ichinosuke Hyodo
- Effect of continuous deep sedation on survival in patients with advanced cancer (J-Proval): a propensity score-weighted analysis of a prospective cohort study
- Isseki Maeda, Tatsuya Morita, Takuhiro Yamaguchi, Satoshi Inoue, Masayuki Ikenaga, Yoshihisa Matsumoto, Ryuichi Sekine, Takashi Yamaguchi, Takeshi Hirohashi, Tsukasa Tajima, Ryohei Tatara, Hiroaki Watanabe, Hiroyuki Otani, Chizuko Takigawa, Yoshinobu Matsuda, Hiroka Nagaoka, Masanori Mori, Yo Tei, Ayako Kikuchi, Mika Baba, Hiroya Kinoshita
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?