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Screen detection of ductal carcinoma in situ and subsequent incidence of invasive interval breast cancers: a retrospective population-based study

BACKGROUND: The value of screen detection and treatment of ductal carcinoma in situ (DCIS) is a matter of controversy. At present, the extent to which the diagnosis and treatment of DCIS could prevent the occurrence of invasive breast cancer in the future is not clear. We sought to estimate the asso...

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Autores principales: Duffy, Stephen W, Dibden, Amanda, Michalopoulos, Dimitrios, Offman, Judith, Parmar, Dharmishta, Jenkins, Jacquie, Collins, Beverley, Robson, Tony, Scorfield, Suzanne, Green, Kathryn, Hall, Clare, Liao, Xiao-Hui, Ryan, Michael, Johnson, Fiona, Stevens, Guy, Kearins, Olive, Sellars, Sarah, Patnick, Julietta
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lancet Pub. Group 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4691349/
https://www.ncbi.nlm.nih.gov/pubmed/26655422
http://dx.doi.org/10.1016/S1470-2045(15)00446-5
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author Duffy, Stephen W
Dibden, Amanda
Michalopoulos, Dimitrios
Offman, Judith
Parmar, Dharmishta
Jenkins, Jacquie
Collins, Beverley
Robson, Tony
Scorfield, Suzanne
Green, Kathryn
Hall, Clare
Liao, Xiao-Hui
Ryan, Michael
Johnson, Fiona
Stevens, Guy
Kearins, Olive
Sellars, Sarah
Patnick, Julietta
author_facet Duffy, Stephen W
Dibden, Amanda
Michalopoulos, Dimitrios
Offman, Judith
Parmar, Dharmishta
Jenkins, Jacquie
Collins, Beverley
Robson, Tony
Scorfield, Suzanne
Green, Kathryn
Hall, Clare
Liao, Xiao-Hui
Ryan, Michael
Johnson, Fiona
Stevens, Guy
Kearins, Olive
Sellars, Sarah
Patnick, Julietta
author_sort Duffy, Stephen W
collection PubMed
description BACKGROUND: The value of screen detection and treatment of ductal carcinoma in situ (DCIS) is a matter of controversy. At present, the extent to which the diagnosis and treatment of DCIS could prevent the occurrence of invasive breast cancer in the future is not clear. We sought to estimate the association between detection of DCIS at screening and invasive interval cancers subsequent to the relevant screen. METHODS: We obtained aggregate data for screen-detected cancers from 84 local screening units within 11 regional Quality Assurance Reference Centres in England, Wales, and Northern Ireland from the National Health Service Breast Screening Programme. Data for DCIS diagnoses were obtained for women aged 50–64 years who were invited to and attended mammographic breast screening from April 1, 2003, to March 31, 2007 (4 screening years). Patient-level data for interval cancer arising in the 36 months after each of these were analysed by Poisson regression with invasive interval cancer screen detection rate as the outcome variable; DCIS detection frequencies were fitted first as a continuous and then as a categorical variable. We repeated this analysis after adjustment with both small size and high-grade invasive screen-detected cancers. FINDINGS: We analysed data for 5 243 658 women and on interval cancers occurring in the 36 months after the relevant screen. The average frequency of DCIS detected at screening was 1·60 per 1000 women screened (median 1·50 [unit range 1·54–3·56] per 1000 women). There was a significant negative association of screen-detected DCIS cases with the rate of invasive interval cancers (Poisson regression coefficient −0·084 [95% CI −0·13 to −0·03]; p=0·002). 90% of units had a DCIS detection frequency within the range of 1·00 to 2·22 per 1000 women; in these units, for every three screen-detected cases of DCIS, there was one fewer invasive interval cancer in the next 3 years. This association remained after adjustment for numbers of small screen-detected invasive cancers and for numbers of grade 3 invasive screen-detected cancers. INTERPRETATION: The association between screen-detected DCIS and subsequent invasive interval cancers suggests that detection and treatment of DCIS is worthwhile in prevention of future invasive disease. FUNDING: UK Department of Health Policy Research Programme and NHS Cancer Screening Programmes.
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spelling pubmed-46913492016-01-29 Screen detection of ductal carcinoma in situ and subsequent incidence of invasive interval breast cancers: a retrospective population-based study Duffy, Stephen W Dibden, Amanda Michalopoulos, Dimitrios Offman, Judith Parmar, Dharmishta Jenkins, Jacquie Collins, Beverley Robson, Tony Scorfield, Suzanne Green, Kathryn Hall, Clare Liao, Xiao-Hui Ryan, Michael Johnson, Fiona Stevens, Guy Kearins, Olive Sellars, Sarah Patnick, Julietta Lancet Oncol Articles BACKGROUND: The value of screen detection and treatment of ductal carcinoma in situ (DCIS) is a matter of controversy. At present, the extent to which the diagnosis and treatment of DCIS could prevent the occurrence of invasive breast cancer in the future is not clear. We sought to estimate the association between detection of DCIS at screening and invasive interval cancers subsequent to the relevant screen. METHODS: We obtained aggregate data for screen-detected cancers from 84 local screening units within 11 regional Quality Assurance Reference Centres in England, Wales, and Northern Ireland from the National Health Service Breast Screening Programme. Data for DCIS diagnoses were obtained for women aged 50–64 years who were invited to and attended mammographic breast screening from April 1, 2003, to March 31, 2007 (4 screening years). Patient-level data for interval cancer arising in the 36 months after each of these were analysed by Poisson regression with invasive interval cancer screen detection rate as the outcome variable; DCIS detection frequencies were fitted first as a continuous and then as a categorical variable. We repeated this analysis after adjustment with both small size and high-grade invasive screen-detected cancers. FINDINGS: We analysed data for 5 243 658 women and on interval cancers occurring in the 36 months after the relevant screen. The average frequency of DCIS detected at screening was 1·60 per 1000 women screened (median 1·50 [unit range 1·54–3·56] per 1000 women). There was a significant negative association of screen-detected DCIS cases with the rate of invasive interval cancers (Poisson regression coefficient −0·084 [95% CI −0·13 to −0·03]; p=0·002). 90% of units had a DCIS detection frequency within the range of 1·00 to 2·22 per 1000 women; in these units, for every three screen-detected cases of DCIS, there was one fewer invasive interval cancer in the next 3 years. This association remained after adjustment for numbers of small screen-detected invasive cancers and for numbers of grade 3 invasive screen-detected cancers. INTERPRETATION: The association between screen-detected DCIS and subsequent invasive interval cancers suggests that detection and treatment of DCIS is worthwhile in prevention of future invasive disease. FUNDING: UK Department of Health Policy Research Programme and NHS Cancer Screening Programmes. Lancet Pub. Group 2016-01 /pmc/articles/PMC4691349/ /pubmed/26655422 http://dx.doi.org/10.1016/S1470-2045(15)00446-5 Text en © 2016 Duffy et al. Open Access article distributed under the terms of CC BY http://creativecommons.org/licenses/by/4.0/ This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Articles
Duffy, Stephen W
Dibden, Amanda
Michalopoulos, Dimitrios
Offman, Judith
Parmar, Dharmishta
Jenkins, Jacquie
Collins, Beverley
Robson, Tony
Scorfield, Suzanne
Green, Kathryn
Hall, Clare
Liao, Xiao-Hui
Ryan, Michael
Johnson, Fiona
Stevens, Guy
Kearins, Olive
Sellars, Sarah
Patnick, Julietta
Screen detection of ductal carcinoma in situ and subsequent incidence of invasive interval breast cancers: a retrospective population-based study
title Screen detection of ductal carcinoma in situ and subsequent incidence of invasive interval breast cancers: a retrospective population-based study
title_full Screen detection of ductal carcinoma in situ and subsequent incidence of invasive interval breast cancers: a retrospective population-based study
title_fullStr Screen detection of ductal carcinoma in situ and subsequent incidence of invasive interval breast cancers: a retrospective population-based study
title_full_unstemmed Screen detection of ductal carcinoma in situ and subsequent incidence of invasive interval breast cancers: a retrospective population-based study
title_short Screen detection of ductal carcinoma in situ and subsequent incidence of invasive interval breast cancers: a retrospective population-based study
title_sort screen detection of ductal carcinoma in situ and subsequent incidence of invasive interval breast cancers: a retrospective population-based study
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4691349/
https://www.ncbi.nlm.nih.gov/pubmed/26655422
http://dx.doi.org/10.1016/S1470-2045(15)00446-5
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