title: Variation in detection of ductal carcinoma in situ during screening mammography: a survey within the International Cancer Screening Network.
abstract: BACKGROUND
  There is concern about detection of ductal carcinoma in situ (DCIS) in screening mammography. DCIS accounts for a substantial proportion of screen-detected lesions but its effect on breast cancer mortality is debated. The International Cancer Screening Network conducted a comparative analysis to determine variation in DCIS detection.
  
  
  METHODS
  Data were collected during 2004-2008 on number of screening examinations, detected breast cancers, DCIS cases and Globocan 2008 breast cancer incidence rates derived from national or regional cancer registers. We calculated screen-detection rates for breast cancers and DCIS.
  
  
  RESULTS
  Data were obtained from 15 screening settings in 12 countries; 7,176,050 screening examinations; 29,605 breast cancers and 5324 DCIS cases. The ratio between highest and lowest breast cancer incidence was 2.88 (95% confidence interval (CI) 2.76-3.00); 2.97 (95% CI 2.51-3.51) for detection of breast cancer; and 3.49 (95% CI 2.70-4.51) for detection of DCIS.
  
  
  CONCLUSIONS
  Considerable international variation was found in DCIS detection. This variation could not be fully explained by variation in incidence nor in breast cancer detection rates. It suggests the potential for wide discrepancies in management of DCIS resulting in overtreatment of indolent DCIS or undertreatment of potentially curable disease. Comprehensive cancer registration is needed to monitor DCIS detection. Efforts to understand discrepancies and standardise management may improve care.
authors.affiliation: Department of Public Health, University of Copenhagen, Copenhagen, Denmark. Electronic address: elsebeth@sund.ku.dk.
authors.forename: Elsebeth
authors.initials: E
authors.lastname: Lynge
authors.affiliation: CPO Piemonte, AOU San Giovanni Battista, Torino, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Ponti
authors.affiliation: Department of Surgery, University of Vermont, Burlington, VT, USA.
authors.forename: Ted
authors.initials: T
authors.lastname: James
authors.affiliation: Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic.
authors.forename: Ondřej
authors.initials: O
authors.lastname: Májek
authors.affiliation: Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors.forename: My
authors.initials: M
authors.lastname: von Euler-Chelpin
authors.affiliation: Mass Screening Registry, Finnish Cancer Registry, Helsinki, Finland.
authors.forename: Ahti
authors.initials: A
authors.lastname: Anttila
authors.affiliation: National Cancer Screening Service, Dublin, Ireland.
authors.forename: Patricia
authors.initials: P
authors.lastname: Fitzpatrick
authors.affiliation: Regional Reference Centre for Breast Cancer Screening, Torino, Italy.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Frigerio
authors.affiliation: Department of Surgical Oncology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Kawai
authors.affiliation: Programme Mammographie, Direction de la Santé, Luxembourg.
authors.forename: Astrid
authors.initials: A
authors.lastname: Scharpantgen
authors.affiliation: National Expert and Training Centre for Breast Cancer Screening, Nijmegen, The Netherlands.
authors.forename: Mireille
authors.initials: M
authors.lastname: Broeders
authors.affiliation: The Cancer Registry of Norway, Oslo, Norway.
authors.forename: Solveig
authors.initials: S
authors.lastname: Hofvind
authors.affiliation: Cancer and Prevention Control Program, Catalan Institute of Oncology, Barcelona, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Vidal
authors.affiliation: Breast Cancer Screening Program, Instituto de Salud Pública, Navarra, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Ederra
authors.affiliation: General Directorate Research and Public Health and Centre for Public Health Research, Valencia, Spain.
authors.forename: Dolores
authors.initials: D
authors.lastname: Salas
authors.affiliation: Lausanne University Hospital, Epalinges, Switzerland.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Bulliard
authors.affiliation: CPO Piemonte, AOU San Giovanni Battista, Torino, Italy.
authors.forename: Mariano
authors.initials: M
authors.lastname: Tomatis
authors.affiliation: Department of Medicine and Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Karla
authors.initials: K
authors.lastname: Kerlikowske
authors.affiliation: Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Taplin
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D003625:Data Collection; D055088:Early Detection of Cancer / Q000379:methods; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods; D008875:Middle Aged; D014481:United States / Q000453:epidemiology
keywords: Breast cancer; Cancer registration; Ductal carcinoma in situ (DCIS); Screening mammography
references.citation: Ann Intern Med. 2011 Oct 18;155(8):493-502
references.pmid: 22007043
references.citation: Breast Cancer Res Treat. 2011 Aug;129(1):165-73
references.pmid: 21390494
references.citation: Br J Cancer. 2008 Feb 12;98(3):641-5
references.pmid: 18231108
references.citation: J Med Screen. 2004;11(3):117-25
references.pmid: 15333269
references.citation: J Natl Cancer Inst. 2010 Feb 3;102(3):170-8
references.pmid: 20071685
references.citation: J Natl Cancer Inst. 2010 Feb 3;102(3):161-9
references.pmid: 20071686
references.citation: J Cancer. 2011 May 01;2:232-61
references.pmid: 21552384
references.citation: Radiology. 2009 Nov;253(2):353-8
references.pmid: 19703851
references.citation: J Natl Cancer Inst. 2010 May 5;102(9):627-37
references.pmid: 20427430
references.citation: J Med Screen. 2006;13(1):34-40
references.pmid: 16569304
references.citation: Cancer. 2004 Oct 15;101(8):1745-59
references.pmid: 15386334
references.citation: Cancer Epidemiol. 2011 Oct;35(5):393-8
references.pmid: 21239242
references.citation: J Natl Cancer Inst Monogr. 2010;2010(41):193-6
references.pmid: 20956828
references.citation: Breast Cancer Res Treat. 2009 May;115(1):181-3
references.pmid: 18516674
references.citation: Breast. 2010 Dec;19(6):499-505
references.pmid: 21071225
references.citation: Eur J Cancer. 2005 May;41(7):1045-50
references.pmid: 15862754
references.citation: J Clin Oncol. 2009 Jan 10;27(2):279-88
references.pmid: 19064970
references.citation: J Natl Cancer Inst. 2002 Oct 16;94(20):1546-54
references.pmid: 12381707
references.citation: Pathol Res Pract. 2010 Oct 15;206(10):705-11
references.pmid: 20663616
references.citation: Eur J Cancer. 1997 May;33(6):903-6
references.pmid: 9291813
references.citation: J Clin Pathol. 2006 Feb;59(2):138-45
references.pmid: 16443727