Detection Rates of Ductal Carcinoma in Situ with Biennial Digital Mammography Screening: Radiologic Findings Support Pathologic Model of Tumor Progression

Abstract

Purpose To compare detection rates of ductal carcinoma in situ (DCIS), classified according to nuclear grade, between the prevalence round (baseline screening) and two subsequent screening rounds of a population-based digital mammography screening program, to assess differences over time. Materials and Methods The cancer registry provided data for 1970 graded pure DCIS cases from 16 screening regions of the prevalence round (baseline screening, from 2005 to 2008), first subsequent round, and second subsequent round; the interval between all screening rounds was 22-30 months. Age-adjusted logistic regression analysis was performed to compare the grade-specific detection rates between the prevalence round (reference) and subsequent screening rounds. Results Over all screening rounds, cancer detection rates were lowest for low-grade DCIS (range, 0.11 [58 of 508 817 patients] to 0.25 [178 of 713 867 patients] per 1000 women screened) and highest for high-grade DCIS (range, 0.53[271 of 508 817 patients] to 0.59 [237 of 398 944 patients] per 1000 women screened). Detection rates for low-grade DCIS were significantly lower in the first (odds ratio [OR] = 0.45, P < .001) and second (OR = 0.57, P < .001) subsequent screening rounds compared with that in the prevalence round; the relative reduction of detection rates of intermediate-grade DCIS was less pronounced (OR = 0.79, P = .006 and OR = 0.76, P = .003, respectively). Conversely, the detection rate of high-grade DCIS remained at the high level found in the prevalence screening (OR = 0.89, P = .143 and OR = 0.97, P = .700, respectively). Conclusion The findings demonstrate persistently high detection rates of high-grade DCIS in two consecutive subsequent screening rounds compared with the prevalence round; conversely, rates of low-grade DCIS and, less markedly, intermediate-grade DCIS decreased in subsequent rounds. Grade-related changes of DCIS detection are suggestive of distinct dynamics of lesion progression. RSNA, 2017 An earlier incorrect version of this article appeared online. This article was corrected on November 10, 2017.

Which type of cancer is detected in breast screening programs? Review of the literature with focus on the most frequent histological features

“…Von Luijt et al 12 analyzed a cohort of 4232 women with screen detected DCIS: most DCIS were intermediate (32%) and high grade (52%). Similar data were obtained by Weigel et al 13 confirming the importance of screening in detecting high grade DCIS. Furthermore, Weigel et al 13 demonstrated that the incidence of high-grade DCIS remained high even in the second and subsequent screening rounds.…”

“…Similar data were obtained by Weigel et al 13 confirming the importance of screening in detecting high grade DCIS. Furthermore, Weigel et al 13 demonstrated that the incidence of high-grade DCIS remained high even in the second and subsequent screening rounds.…”

The cost-effectiveness of digital breast tomosynthesis in a population breast cancer screening program

“…As to limitations of the study, we point out that ductal carcinoma in situ is not included in this model. DCIS accounts for nearly 20% of the DM screen-detected tumours in the Dutch population and similar proportions are detected in other population screening programs [18,46]. However, previous studies have shown that DBT plus DM can increase invasive CDR without preferentially increasing the proportion of DCIS compared to DM alone [47].…”

Unresected screen-detected ductal carcinoma in situ: Outcomes of 311 women in the Forget-Me-Not 2 study

“…In the US National Cancer Database, delay in the surgical treatment of DCIS up to one year after diagnosis was an independent predictor of finding invasive cancer at surgical excision [9]. These effects are probably driven predominantly by the behaviour of high grade DCIS which has a higher rate of proliferation than lower grade disease [10,11].…”