The distribution of ductal carcinoma in situ DCIS grade in 4232 women and its impact on overdiagnosis in breast cancer screeningReportar como inadecuado




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Breast Cancer Research

, 18:47

First Online: 10 May 2016Received: 27 November 2015Accepted: 19 April 2016DOI: 10.1186-s13058-016-0705-5

Cite this article as: van Luijt, P.A., Heijnsdijk, E.A.M., Fracheboud, J. et al. Breast Cancer Res 2016 18: 47. doi:10.1186-s13058-016-0705-5

Abstract

BackgroundThe incidence of ductal carcinoma in situ DCIS has rapidly increased over time. The malignant potential of DCIS is dependent on its differentiation grade.

MethodsOur aim is to determine the distribution of different grades of DCIS among women screened in the mass screening programme, and women not screened in the mass screening programme, and to estimate the amount of overdiagnosis by grade of DCIS. We retrospectively included a population-based sample of 4232 women with a diagnosis of DCIS in the years 2007–2009 from the Nationwide network and registry of histopathology and cytopathology in the Netherlands. Excluded were women with concurrent invasive breast cancer, lobular carcinoma in situ and no DCIS, women recently treated for invasive breast cancer, no grade mentioned in the record, inconclusive record on invasion, and prevalent DCIS. The screening status was obtained via the screening organisations. The distribution of grades was incorporated in the well-established and validated microsimulation model MISCAN.

ResultsOverall, 17.7 % of DCIS were low grade, 31.4 % intermediate grade, and 50.9 % high grade. This distribution did not differ by screening status, but did vary by age. Older women were more likely to have low-grade DCIS than younger women. Overdiagnosis as a proportion of all cancers in women of the screening age was 61 % for low-grade, 57 % for intermediate-grade, 45 % for high-grade DCIS. For women age 50–60 years with a high-grade DCIS this overdiagnosis rate was 21–29 %, compared to 50–66 % in women age 60–75 years with high-grade DCIS.

ConclusionsAmongst the rapidly increasing numbers of DCIS diagnosed each year is a significant number of overdiagnosed cases. Tailoring treatment to the probability of progression is the next step to preventing overtreatment. The basis of this tailoring could be DCIS grade and age.

KeywordsBreast cancer Ductal carcinoma in situ Screening MISCAN Overdiagnosis AbbreviationsDCISductal carcinoma in situ

LCISlobular carcinoma in situ

MISCANMIcrosimulation SCreening ANalysis

PALGAthe nationwide network and registry of histopathology and cytopathology in the Netherlands

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Autor: P. A. van Luijt - E. A. M. Heijnsdijk - J. Fracheboud - L. I. H. Overbeek - M. J. M. Broeders - J. Wesseling - G. J.

Fuente: https://link.springer.com/







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