title: The effect of DCIS grade on rate, type and time to recurrence after 15 years of follow-up of screen-detected DCIS.
abstract: BACKGROUND
  The incidence of ductal carcinoma in situ (DCIS) rose rapidly when the NHS Breast Screening Programme (NHSBSP) started in 1988. Some authorities consider that this represents both over-diagnosis and over-treatment. We report long-term follow-up of DCIS diagnosed in the first 10 years (April 1988 to March 1999) of the West Midlands NHSBSP.
  
  
  METHODS
  840 noninvasive breast cancers were recorded on the national breast screening computer system. Following exclusions, and thorough case note and pathology review, 700 DCIS cases were identified for follow-up.
  
  
  RESULTS
  After a median follow-up of 183 (range 133 to 259) months, 102 (14.6%) first local recurrences were identified, 49 (48%) were invasive. Median time to first noninvasive recurrence was 15 months, and 60 months for invasive recurrence. Median time to invasive recurrence was 76 months from initially high-grade DCIS, and 131 months from low/intermediate grade DCIS. For the seven women, presenting with metastasis as their first event, the median time was 82 (range 15 to 188) months. The cumulative proportion developing recurrence at 180 months was twice as high as at 60 months.
  
  
  CONCLUSIONS
  Short-term follow-up of patients diagnosed with DCIS will miss significant numbers of events, especially invasive local recurrences.
authors.affiliation: Cambridge Breast Unit and NIHR Cambridge Biomedical Research Unit, Box 97, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK. matthew.wallis@addenbrookes.nhs.uk
authors.forename: M G
authors.initials: MG
authors.lastname: Wallis
authors.forename: K
authors.initials: K
authors.lastname: Clements
authors.forename: O
authors.initials: O
authors.lastname: Kearins
authors.forename: G
authors.initials: G
authors.lastname: Ball
authors.forename: J
authors.initials: J
authors.lastname: Macartney
authors.forename: G M
authors.initials: GM
authors.lastname: Lawrence
mesh_terms: D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local