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

Antonio Ponti; Elsebeth Lynge; Ted James; Ondřej Májek; My von Euler-Chelpin; Ahti Anttila; Patricia Fitzpatrick; Maria Piera Mano; Masaaki Kawai; Astrid Scharpantgen; Jacques Fracheboud; Solveig Hofvind; Carmen Vidal; Nieves Ascunce; Dolores Salas; Jean-Luc Bulliard; Nereo Segnan; Karla Kerlikowske; Stephen Taplin; ICSN DCIS Working group

doi:10.1016/j.ejca.2014.07.019

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

Antonio Ponti, Elsebeth Lynge, Ted James, Ondřej Májek, My von Euler-Chelpin, Ahti Anttila, Patricia Fitzpatrick, Maria Piera Mano, Masaaki Kawai, Astrid Scharpantgen, Jacques Fracheboud, Solveig Hofvind, Carmen Vidal, Nieves Ascunce, Dolores Salas, Jean-Luc Bulliard, Nereo Segnan, Karla Kerlikowske, Stephen Taplin, ICSN DCIS Working group

27 Citations (Scopus)

Abstract

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.

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.

Original language	English
Journal	European journal of cancer (Oxford, England : 1990)
Volume	50
Issue number	15
Pages (from-to)	2695-704
Number of pages	10
ISSN	0959-8049
DOIs	https://doi.org/10.1016/j.ejca.2014.07.019
Publication status	Published - 1 Oct 2014

Keywords

Aged
Breast Neoplasms
Carcinoma, Intraductal, Noninfiltrating
Early Detection of Cancer
Europe
Female
Humans
International Agencies
Japan
Lymph Node Excision
Mastectomy, Segmental
Middle Aged
Outcome Assessment (Health Care)
Radiotherapy
United States

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.ejca.2014.07.019

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Ponti, A., Lynge, E., James, T., Májek, O., von Euler-Chelpin, M., Anttila, A., Fitzpatrick, P., Mano, M. P., Kawai, M., Scharpantgen, A., Fracheboud, J., Hofvind, S., Vidal, C., Ascunce, N., Salas, D., Bulliard, J.-L., Segnan, N., Kerlikowske, K., Taplin, S., & ICSN DCIS Working group (2014). International variation in management of screen-detected ductal carcinoma in situ of the breast. European journal of cancer (Oxford, England : 1990), 50(15), 2695-704. https://doi.org/10.1016/j.ejca.2014.07.019

Ponti, A, Lynge, E, James, T, Májek, O, von Euler-Chelpin, M, Anttila, A, Fitzpatrick, P, Mano, MP, Kawai, M, Scharpantgen, A, Fracheboud, J, Hofvind, S, Vidal, C, Ascunce, N, Salas, D, Bulliard, J-L, Segnan, N, Kerlikowske, K, Taplin, S & ICSN DCIS Working group 2014, 'International variation in management of screen-detected ductal carcinoma in situ of the breast', European journal of cancer (Oxford, England : 1990), vol. 50, no. 15, pp. 2695-704. https://doi.org/10.1016/j.ejca.2014.07.019

@article{e7c149f6c2ff45d382b4e72dd718248c,

title = "International variation in management of screen-detected ductal carcinoma in situ of the breast",

abstract = "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.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.",

keywords = "Aged, Breast Neoplasms, Carcinoma, Intraductal, Noninfiltrating, Early Detection of Cancer, Europe, Female, Humans, International Agencies, Japan, Lymph Node Excision, Mastectomy, Segmental, Middle Aged, Outcome Assessment (Health Care), Radiotherapy, United States",

author = "Antonio Ponti and Elsebeth Lynge and Ted James and Ond{\v r}ej M{\'a}jek and {von Euler-Chelpin}, My and Ahti Anttila and Patricia Fitzpatrick and Mano, {Maria Piera} and Masaaki Kawai and Astrid Scharpantgen and Jacques Fracheboud and Solveig Hofvind and Carmen Vidal and Nieves Ascunce and Dolores Salas and Jean-Luc Bulliard and Nereo Segnan and Karla Kerlikowske and Stephen Taplin and {ICSN DCIS Working group}",

year = "2014",

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doi = "10.1016/j.ejca.2014.07.019",

language = "English",

volume = "50",

pages = "2695--704",

journal = "European journal of cancer (Oxford, England : 1990)",

issn = "0959-8049",

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number = "15",

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TY - JOUR

T1 - International variation in management of screen-detected ductal carcinoma in situ of the breast

AU - Ponti, Antonio

AU - Lynge, Elsebeth

AU - James, Ted

AU - Májek, Ondřej

AU - von Euler-Chelpin, My

AU - Anttila, Ahti

AU - Fitzpatrick, Patricia

AU - Mano, Maria Piera

AU - Kawai, Masaaki

AU - Scharpantgen, Astrid

AU - Fracheboud, Jacques

AU - Hofvind, Solveig

AU - Vidal, Carmen

AU - Ascunce, Nieves

AU - Salas, Dolores

AU - Bulliard, Jean-Luc

AU - Segnan, Nereo

AU - Kerlikowske, Karla

AU - Taplin, Stephen

AU - ICSN DCIS Working group

PY - 2014/10/1

Y1 - 2014/10/1

N2 - 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.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.

AB - 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.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.

KW - Aged

KW - Breast Neoplasms

KW - Carcinoma, Intraductal, Noninfiltrating

KW - Early Detection of Cancer

KW - Europe

KW - Female

KW - Humans

KW - International Agencies

KW - Japan

KW - Lymph Node Excision

KW - Mastectomy, Segmental

KW - Middle Aged

KW - Outcome Assessment (Health Care)

KW - Radiotherapy

KW - United States

U2 - 10.1016/j.ejca.2014.07.019

DO - 10.1016/j.ejca.2014.07.019

M3 - Journal article

C2 - 25149183

SN - 0959-8049

VL - 50

SP - 2695

EP - 2704

JO - European journal of cancer (Oxford, England : 1990)

JF - European journal of cancer (Oxford, England : 1990)

IS - 15

ER -

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

Abstract

Keywords

UN SDGs

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