International variation in management of screen-detected ductal carcinoma in situ of the breast

Research output: Contribution to journalJournal articleResearchpeer-review

Antonio Ponti, Elsebeth Lynge, Ted James, Ondřej Májek, My von Euler-Chelpin, Ahti Anttila, Patricia Fitzpatrick, Maria Piera Mano, Masaaki Kawai, Astrid Scharpantgen, Jacques Fracheboud, Solveig Hofvind, Carmen Vidal, Nieves Ascunce, Dolores Salas, Jean-Luc Bulliard, Nereo Segnan, Karla Kerlikowske, Stephen Taplin, ICSN DCIS Working group

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.

Original languageEnglish
JournalEuropean journal of cancer (Oxford, England : 1990)
Volume50
Issue number15
Pages (from-to)2695-704
Number of pages10
ISSN0959-8049
DOIs
Publication statusPublished - 1 Oct 2014

    Research areas

  • Aged, Breast Neoplasms, Carcinoma, Intraductal, Noninfiltrating, Early Detection of Cancer, Europe, Female, Humans, International Agencies, Japan, Lymph Node Excision, Mastectomy, Segmental, Middle Aged, Outcome Assessment (Health Care), Radiotherapy, United States

ID: 135653233