International variation in management of screen-detected ductal carcinoma in situ of the breast
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International variation in management of screen-detected ductal carcinoma in situ of the breast. / Ponti, Antonio; Lynge, Elsebeth; James, Ted; Májek, Ondřej; von Euler-Chelpin, My; Anttila, Ahti; Fitzpatrick, Patricia; Mano, Maria Piera; Kawai, Masaaki; Scharpantgen, Astrid; Fracheboud, Jacques; Hofvind, Solveig; Vidal, Carmen; Ascunce, Nieves; Salas, Dolores; Bulliard, Jean-Luc; Segnan, Nereo; Kerlikowske, Karla; Taplin, Stephen; ICSN DCIS Working group.
In: European journal of cancer (Oxford, England : 1990), Vol. 50, No. 15, 01.10.2014, p. 2695-704.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - International variation in management of screen-detected ductal carcinoma in situ of the breast
AU - Ponti, Antonio
AU - Lynge, Elsebeth
AU - James, Ted
AU - Májek, Ondřej
AU - von Euler-Chelpin, My
AU - Anttila, Ahti
AU - Fitzpatrick, Patricia
AU - Mano, Maria Piera
AU - Kawai, Masaaki
AU - Scharpantgen, Astrid
AU - Fracheboud, Jacques
AU - Hofvind, Solveig
AU - Vidal, Carmen
AU - Ascunce, Nieves
AU - Salas, Dolores
AU - Bulliard, Jean-Luc
AU - Segnan, Nereo
AU - Kerlikowske, Karla
AU - Taplin, Stephen
AU - ICSN DCIS Working group
N1 - Copyright © 2014 Elsevier Ltd. All rights reserved.
PY - 2014/10/1
Y1 - 2014/10/1
N2 - 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.
AB - 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.
KW - Aged
KW - Breast Neoplasms
KW - Carcinoma, Intraductal, Noninfiltrating
KW - Early Detection of Cancer
KW - Europe
KW - Female
KW - Humans
KW - International Agencies
KW - Japan
KW - Lymph Node Excision
KW - Mastectomy, Segmental
KW - Middle Aged
KW - Outcome Assessment (Health Care)
KW - Radiotherapy
KW - United States
U2 - 10.1016/j.ejca.2014.07.019
DO - 10.1016/j.ejca.2014.07.019
M3 - Journal article
C2 - 25149183
VL - 50
SP - 2695
EP - 2704
JO - European Journal of Cancer, Supplement
JF - European Journal of Cancer, Supplement
SN - 0959-8049
IS - 15
ER -
ID: 135653233