Skip to main content
main-content

01.12.2017 | Research article | Ausgabe 1/2017 Open Access

Breast Cancer Research 1/2017

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

Zeitschrift:
Breast Cancer Research > Ausgabe 1/2017
Autoren:
Lotte E. Elshof, Michael Schaapveld, Emiel J. Rutgers, Marjanka K. Schmidt, Linda de Munck, Flora E. van Leeuwen, Jelle Wesseling
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s13058-017-0819-4) contains supplementary material, which is available to authorized users.

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.
Zusatzmaterial
Additional file 1: Time (days) between a first or subsequent screening examination by the Dutch breast cancer screening program and DCIS diagnosis in women with screen-detected DCIS (DCIS diagnostic period 1989–2004) (DOCX 17 kb)
13058_2017_819_MOESM1_ESM.docx
Additional file 2: Multivariable-adjusted Cox regression analysis of ipsilateral and contralateral invasive breast cancer in women aged 49–75 years at DCIS diagnosis (DCIS diagnostic period 1989–2004). Age was the primary time scale, time since DCIS diagnosis (0–5, 5–10, and ≥10 years) the secondary time scale, and DCIS treatment a time-varying covariable (DOCX 22 kb)
13058_2017_819_MOESM2_ESM.docx
Additional file 3: Multivariable-adjusted Cox regression analysis of overall mortality in women aged 49–75 years at DCIS diagnosis (DCIS diagnostic period 1989–2004). Age was the primary time scale and time since DCIS diagnosis (0–5, 5–10, and ≥10 years) the secondary time scale. Model 1 was adjusted for period of DCIS diagnosis, DCIS grade, and DCIS treatment (time-varying). Model 2 was adjusted for period of DCIS diagnosis, DCIS grade, DCIS treatment (time-varying), and the occurrence of ipsilateral and contralateral invasive breast cancer (time-varying) (DOCX 21 kb)
13058_2017_819_MOESM3_ESM.docx
Additional file 4: Kaplan-Meier curves for all-cause mortality by method of detection for patients aged 49–59 years at DCIS diagnosis (a), patients aged 60–69 years at DCIS diagnosis (b), and patients aged 70–75 years (c) at DCIS diagnosis (DCIS diagnostic period 1989–2004). P values based on Cox proportional hazards regression with time since DCIS diagnosis as the primary time scale, adjusted for age (continuous). (DOCX 52 kb)
13058_2017_819_MOESM4_ESM.docx
Additional file 5: Multivariable-adjusted Cox regression analysis of ipsilateral and contralateral invasive breast cancer in women aged 49–75 years at DCIS diagnosis: comparison between screen-detected and interval DCIS (DCIS diagnostic period 1999–2004 (screening implemented)). Age was the primary time scale and time since DCIS diagnosis (0–5, 5–10, and ≥10 years) the secondary time-scale. (DOCX 21 kb)
13058_2017_819_MOESM5_ESM.docx
Additional file 6: Multivariable-adjusted Cox regression analysis of overall mortality in women aged 49–75 years at DCIS diagnosis: comparison between screen-detected and interval DCIS (DCIS diagnostic period 1999–2004 (screening implemented)). Age was the primary time scale and time since DCIS diagnosis (0–5, 5–10, and ≥10 years) was the secondary time scale. Model 1 was adjusted for period of DCIS diagnosis, DCIS grade, and DCIS treatment (time-varying). Model 2 was adjusted for period of DCIS diagnosis, DCIS grade, DCIS treatment (time-varying), and the occurrence of ipsilateral and contralateral invasive breast cancer (time-varying). (DOCX 20 kb)
13058_2017_819_MOESM6_ESM.docx
Literatur
Über diesen Artikel

Weitere Artikel der Ausgabe 1/2017

Breast Cancer Research 1/2017 Zur Ausgabe

Neu im Fachgebiet Onkologie

Mail Icon II Newsletter

Bestellen Sie unseren kostenlosen Newsletter Update Onkologie und bleiben Sie gut informiert – ganz bequem per eMail.

Bildnachweise