Antonio Ponti1, Elsebeth Lynge2, Ted James3, Ondřej Májek4, My von Euler-Chelpin2, Ahti Anttila5, Patricia Fitzpatrick6, Maria Piera Mano7, Masaaki Kawai8, Astrid Scharpantgen9, Jacques Fracheboud10, Solveig Hofvind11, Carmen Vidal12, Nieves Ascunce13, Dolores Salas14, Jean-Luc Bulliard15, Nereo Segnan7, Karla Kerlikowske16, Stephen Taplin17. 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.
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.
Authors: Virginia L Ernster; Rachel Ballard-Barbash; William E Barlow; Yingye Zheng; Donald L Weaver; Gary Cutter; Bonnie C Yankaskas; Robert Rosenberg; Patricia A Carney; Karla Kerlikowske; Stephen H Taplin; Nicole Urban; Berta M Geller Journal: J Natl Cancer Inst Date: 2002-10-16 Impact factor: 13.506
Authors: M J Silverstein; R J Rosser; E D Gierson; J R Waisman; P Gamagami; R S Hoffman; A G Fingerhut; B S Lewinsky; W Colburn; N Handel Journal: Cancer Date: 1987-05-15 Impact factor: 6.860
Authors: M J M Broeders; A Scharpantgen; N Ascunce; B Gairard; A H Olsen; P Mantellini; T Cerdá Mota; E Van Limbergen; B Séradour; A Ponti; L Salas Trejo; L Nyström Journal: Eur J Cancer Prev Date: 2005-04 Impact factor: 2.497
Authors: Robert E Mansel; Lesley Fallowfield; Mark Kissin; Amit Goyal; Robert G Newcombe; J Michael Dixon; Constantinos Yiangou; Kieran Horgan; Nigel Bundred; Ian Monypenny; David England; Mark Sibbering; Tholkifl I Abdullah; Lester Barr; Utheshtra Chetty; Dudley H Sinnett; Anne Fleissig; Dayalan Clarke; Peter J Ell Journal: J Natl Cancer Inst Date: 2006-05-03 Impact factor: 13.506
Authors: Elsebeth Lynge; Antonio Ponti; Ted James; Ondřej Májek; My von Euler-Chelpin; Ahti Anttila; Patricia Fitzpatrick; Alfonso Frigerio; Masaaki Kawai; Astrid Scharpantgen; Mireille Broeders; Solveig Hofvind; Carmen Vidal; Maria Ederra; Dolores Salas; Jean-Luc Bulliard; Mariano Tomatis; Karla Kerlikowske; Stephen Taplin Journal: Eur J Cancer Date: 2013-09-13 Impact factor: 9.162
Authors: L N van Steenbergen; A C Voogd; J A Roukema; W J Louwman; L E M Duijm; J W W Coebergh; L V van de Poll-Franse Journal: Breast Date: 2013-12-02 Impact factor: 4.380
Authors: Gary H Lyman; Sarah Temin; Stephen B Edge; Lisa A Newman; Roderick R Turner; Donald L Weaver; Al B Benson; Linda D Bosserman; Harold J Burstein; Hiram Cody; James Hayman; Cheryl L Perkins; Donald A Podoloff; Armando E Giuliano Journal: J Clin Oncol Date: 2014-03-24 Impact factor: 44.544
Authors: Tracy Onega; Donald L Weaver; Paul D Frederick; Kimberly H Allison; Anna N A Tosteson; Patricia A Carney; Berta M Geller; Gary M Longton; Heidi D Nelson; Natalia V Oster; Margaret S Pepe; Joann G Elmore Journal: Eur J Cancer Date: 2017-05-20 Impact factor: 9.162