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Breast Cancer Research
Published in: Breast Cancer Research 1/2017

Open Access 01-12-2017 | Research article

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

Authors: Lotte E. Elshof, Michael Schaapveld, Emiel J. Rutgers, Marjanka K. Schmidt, Linda de Munck, Flora E. van Leeuwen, Jelle Wesseling

Published in: Breast Cancer Research | Issue 1/2017

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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.
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Metadata
Title
The method of detection of ductal carcinoma in situ has no therapeutic implications: results of a population-based cohort study
Authors
Lotte E. Elshof
Michael Schaapveld
Emiel J. Rutgers
Marjanka K. Schmidt
Linda de Munck
Flora E. van Leeuwen
Jelle Wesseling
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Breast Cancer Research / Issue 1/2017
Electronic ISSN: 1465-542X
DOI
https://doi.org/10.1186/s13058-017-0819-4

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