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

TitreInternational variation in management of screen-detected ductal carcinoma in situ of the breast.
Publication TypeJournal Article
Year of Publication2014
AuthorsPonti, A, Lynge, E, James, T, Májek, O, von Euler-Chelpin, M, Anttila, A, Fitzpatrick, P, Mano, MPiera, Kawai, M, Scharpantgen, A, Fracheboud, J, Hofvind, S, Vidal, C, Ascunce, N, Salas, D, Bulliard, J-L, Segnan, N, Kerlikowske, K, Taplin, S
Corporate AuthorsICSN DCIS Working group
JournalEuropean Journal of Cancer
Date Published10/2014
ISBN Number1879-0852 (Electronic)

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.


Publication types: Journal Article Publication Status: ppublish

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Alternate JournalEur. J. Cancer
Citation Key / SERVAL ID3604
Peer reviewRefereed
PubMed ID25149183
Grant ListU01CA63731 / CA / NCI NIH HHS / United States
U01CA63736 / CA / NCI NIH HHS / United States
U01CA63740 / CA / NCI NIH HHS / United States
U01CA69976 / CA / NCI NIH HHS / United States
U01CA70013 / CA / NCI NIH HHS / United States
U01CA70040 / CA / NCI NIH HHS / United States
U01CA86076 / CA / NCI NIH HHS / United States
U01CA86082 / CA / NCI NIH HHS / United States
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