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Showing content from https://pubmed.ncbi.nlm.nih.gov/28274272/ below:

The method of detection of ductal carcinoma in situ has no therapeutic implications: results of a population-based cohort study

doi: 10.1186/s13058-017-0819-4. The method of detection of ductal carcinoma in situ has no therapeutic implications: results of a population-based cohort study

Affiliations

¹ Division of Molecular Pathology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands.
² Division of Psychosocial research and Epidemiology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands.
³ Department of Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands.
⁴ Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511, DT, Utrecht, The Netherlands.
⁵ Division of Molecular Pathology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands. j.wesseling@nki.nl.
⁶ Department of Pathology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands. j.wesseling@nki.nl.

PMID: 28274272
PMCID: PMC5343406
DOI: 10.1186/s13058-017-0819-4

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The method of detection of ductal carcinoma in situ has no therapeutic implications: results of a population-based cohort study

Lotte E Elshof et al. Breast Cancer Res. 2017.

doi: 10.1186/s13058-017-0819-4. Affiliations

¹ Division of Molecular Pathology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands.
² Division of Psychosocial research and Epidemiology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands.
³ Department of Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands.
⁴ Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511, DT, Utrecht, The Netherlands.
⁵ Division of Molecular Pathology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands. j.wesseling@nki.nl.
⁶ Department of Pathology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands. j.wesseling@nki.nl.

PMID: 28274272
PMCID: PMC5343406
DOI: 10.1186/s13058-017-0819-4

Item in Clipboard

Abstract

Background: Population screening with mammography has resulted in increased detection of ductal carcinoma in situ (DCIS). The aim of this population-based cohort study was to assess whether the method of detection should be considered when determining prognosis and treatment in women with DCIS.

Methods: This study includes 7042 women aged 49-75 years, who were surgically treated for primary DCIS between 1989 and 2004 in the Netherlands. We calculated cumulative incidences of ipsilateral and contralateral invasive breast cancer and all-cause mortality among women with screen-detected, interval, or non-screening-related DCIS, and assessed the association between method of detection and these outcomes, using multivariable Cox regression analyses.

Results: Compared with non-screening-related DCIS, women with screen-detected DCIS had a lower risk of developing ipsilateral invasive breast cancer (hazard ratio (HR) = 0.75, 95% CI = 0.59-0.96), but a similar risk of contralateral invasive breast cancer (HR = 0.86, 95% CI = 0.67-1.10). The absolute difference in risk of ipsilateral invasive breast cancer was 1% at 15 years. Screen detection was associated with lower all-cause mortality (HR = 0.85, 95% CI = 0.73-0.98); when we additionally accounted for the occurrence of invasive breast cancer the magnitude of this effect remained similar (HR = 0.86, 95% CI = 0.75-1.00).

Conclusions: Screen detection was associated with lower risk of ipsilateral invasive breast cancer and all-cause mortality. However, the absolute difference in risk of ipsilateral invasive breast cancer was very low and the lower all-cause mortality associated with screen-detected and interval DCIS might be explained by a healthy-user effect. Therefore, our findings do not justify different treatment strategies for women with screen-detected, interval, or non-screening-related DCIS.

Keywords: Detection; Ductal carcinoma in situ; Invasive breast cancer; Mammography; Mortality; Population-based cohort; Screening.

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Figures
Fig. 1

Method of detection by year…

Fig. 1

Method of detection by year of diagnosis of ductal carcinoma in situ (…

Fig. 1

Method of detection by year of diagnosis of ductal carcinoma in situ (DCIS)

Fig. 2

Cumulative incidence of ipsilateral (…

Fig. 2

Cumulative incidence of ipsilateral ( a ) and contralateral ( b ) invasive…

Fig. 2

Cumulative incidence of ipsilateral (a) and contralateral (b) invasive breast cancer by method of detection, with death analyzed as a competing risk. P values based on competing risk regression with time since diagnosis of ductal carcinoma in situ as the primary time scale, adjusted for age (continuous) [25]

Fig. 3

Kaplan-Meier curves for all-cause mortality…

Fig. 3

Kaplan-Meier curves for all-cause mortality by method of detection. P values based on…

Fig. 3

Kaplan-Meier curves for all-cause mortality by method of detection. P values based on Cox proportional hazards regression with time since diagnosis of ductal carcinoma in situ as the primary time scale, adjusted for age (continuous)