Publication details

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

Authors	PONTI Antonio LYNGE Elsebeth JAMES Ted MÁJEK Ondřej EULER-CHELPIN My von 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
Year of publication	2014
Type	Article in Periodical
Magazine / Source	European Journal of Cancer
MU Faculty or unit	Faculty of Medicine
Citation
Doi	http://dx.doi.org/10.1016/j.ejca.2014.07.019
Field	Oncology and hematology
Keywords	Breast cancer; Ductal carcinoma in situ (DCIS); Screening mammography; Overtreatment; Axillary staging; Cancer registration
Description	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.