title: International variation in management of screen-detected ductal carcinoma in situ of the breast.
abstract: BACKGROUND
  Ductal carcinoma in situ (DCIS) incidence has grown with the implementation of screening and its detection varies across International Cancer Screening Network (ICSN) countries. The aim of this survey is to describe the management of screen-detected DCIS in ICSN countries and to evaluate the potential for treatment related morbidity.
  
  
  METHODS
  We sought screen-detected DCIS data from the ICSN countries identified during 2004-2008. We adopted standardised data collection forms and analysis and explored DCIS diagnosis and treatment processes ranging from pre-operative diagnosis to type of surgery and radiotherapy.
  
  
  RESULTS
  Twelve countries contributed data from a total of 15 screening programmes, all from Europe except the United States of America and Japan. Among women aged 50-69 years, 7,176,050 screening tests and 5324 screen-detected DCIS were reported. From 21% to 93% of DCIS had a pre-operative diagnosis (PO); 67-90% of DCIS received breast conservation surgery (BCS), and in 41-100% of the cases this was followed by radiotherapy; 6.4-59% received sentinel lymph node biopsy (SLNB) only and 0.8-49% axillary dissection (ALND) with 0.6% (range by programmes 0-8.1%) being node positive. Among BCS patients 35% received SLNB only and 4.8% received ALND. Starting in 2006, PO and SLNB use increased while ALND remained stable. SLNB and ALND were associated with larger size and higher grade DCIS lesions.
  
  
  CONCLUSIONS
  Variation in DCIS management among screened women is wide and includes lymph node surgery beyond what is currently recommended. This indicates the presence of varying levels of overtreatment and the potential for its reduction.
authors.affiliation: CPO Piemonte, AOU Città della Salute e della Scienza, Torino, Italy. Electronic address: antonio.ponti@cpo.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Ponti
authors.affiliation: Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Elsebeth
authors.initials: E
authors.lastname: Lynge
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: CPO Piemonte, AOU Città della Salute e della Scienza, Torino, Italy.
authors.forename: Maria Piera
authors.initials: MP
authors.lastname: Mano
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: Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: Jacques
authors.initials: J
authors.lastname: Fracheboud
authors.affiliation: The Cancer Registry of Norway, Oslo, Norway.
authors.forename: Solveig
authors.initials: S
authors.lastname: Hofvind
authors.affiliation: Cancer Detection and Control Programme, Catalan Institute of Oncology, Barcelona, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Vidal
authors.affiliation: Breast Cancer Screening Programme, Instituto de Salud Pública, Navarra, Spain.
authors.forename: Nieves
authors.initials: N
authors.lastname: Ascunce
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, Lausanne, Switzerland.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Bulliard
authors.affiliation: CPO Piemonte, AOU Città della Salute e della Scienza, Torino, Italy.
authors.forename: Nereo
authors.initials: N
authors.lastname: Segnan
authors.affiliation: Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Department of 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 / Q000628:therapy*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000175:diagnosis / Q000628:therapy*; D055088:Early Detection of Cancer; D005060:Europe; D005260:Female; D006801:Humans; D007390:International Agencies; D007564:Japan; D008197:Lymph Node Excision / Q000379:methods / Q000706:statistics & numerical data*; D015412:Mastectomy, Segmental / Q000379:methods / Q000706:statistics & numerical data*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D011878:Radiotherapy / Q000379:methods / Q000706:statistics & numerical data*; D014481:United States
keywords: Axillary staging; Breast cancer; Cancer registration; Ductal carcinoma in situ (DCIS); Overtreatment; Screening mammography