title: The distribution of ductal carcinoma in situ (DCIS) grade in 4232 women and its impact on overdiagnosis in breast cancer screening.
abstract: The incidence of ductal carcinoma in situ (DCIS) has rapidly increased over time. The malignant potential of DCIS is dependent on its differentiation grade.
  
  
  
  Our aim is to determine the distribution of different grades of DCIS among women screened in the mass screening programme, and women not screened in the mass screening programme, and to estimate the amount of overdiagnosis by grade of DCIS. We retrospectively included a population-based sample of 4232 women with a diagnosis of DCIS in the years 2007-2009 from the Nationwide network and registry of histopathology and cytopathology in the Netherlands. Excluded were women with concurrent invasive breast cancer, lobular carcinoma in situ and no DCIS, women recently treated for invasive breast cancer, no grade mentioned in the record, inconclusive record on invasion, and prevalent DCIS. The screening status was obtained via the screening organisations. The distribution of grades was incorporated in the well-established and validated microsimulation model MISCAN.
  
  
  
  Overall, 17.7 % of DCIS were low grade, 31.4 % intermediate grade, and 50.9 % high grade. This distribution did not differ by screening status, but did vary by age. Older women were more likely to have low-grade DCIS than younger women. Overdiagnosis as a proportion of all cancers in women of the screening age was 61 % for low-grade, 57 % for intermediate-grade, 45 % for high-grade DCIS. For women age 50-60 years with a high-grade DCIS this overdiagnosis rate was 21-29 %, compared to 50-66 % in women age 60-75 years with high-grade DCIS.
  
  
  
  Amongst the rapidly increasing numbers of DCIS diagnosed each year is a significant number of overdiagnosed cases. Tailoring treatment to the probability of progression is the next step to preventing overtreatment. The basis of this tailoring could be DCIS grade and age.
authors.affiliation: Department of Public Health, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. p.vanluijt@erasmusmc.nl.|National Evaluation Team for Breast cancer screening in the Netherlands (NETB), Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Nijmegen, The Netherlands. p.vanluijt@erasmusmc.nl.
authors.forename: P A
authors.initials: PA
authors.lastname: van Luijt
authors.affiliation: Department of Public Health, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.|National Evaluation Team for Breast cancer screening in the Netherlands (NETB), Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Nijmegen, The Netherlands.
authors.forename: E A M
authors.initials: EA
authors.lastname: Heijnsdijk
authors.affiliation: Department of Public Health, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.|National Evaluation Team for Breast cancer screening in the Netherlands (NETB), Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Nijmegen, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Fracheboud
authors.affiliation: PALGA, the nationwide network and registry of histopathology and cytopathology in the Netherlands, Randhoeve 225 A, 3995 GA, Houten, The Netherlands.
authors.forename: L I H
authors.initials: LI
authors.lastname: Overbeek
authors.affiliation: National Evaluation Team for Breast cancer screening in the Netherlands (NETB), Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Nijmegen, The Netherlands.|Department of Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands.|National Expert and Training Centre for Breast Cancer Screening, Nijmegen, The Netherlands.
authors.forename: M J M
authors.initials: MJ
authors.lastname: Broeders
authors.affiliation: Divisions of Diagnostic Oncology and Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Wesseling
authors.affiliation: National Evaluation Team for Breast cancer screening in the Netherlands (NETB), Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Nijmegen, The Netherlands.|Department of Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands.|National Expert and Training Centre for Breast Cancer Screening, Nijmegen, The Netherlands.|Department of Radiology, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands.
authors.forename: G J
authors.initials: GJ
authors.lastname: den Heeten
authors.affiliation: Department of Public Health, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.|National Evaluation Team for Breast cancer screening in the Netherlands (NETB), Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Nijmegen, The Netherlands.
authors.forename: H J
authors.initials: HJ
authors.lastname: de Koning
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology*; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008403:Mass Screening; D000069342:Medical Overuse; D008875:Middle Aged; D060787:Neoplasm Grading; D009426:Netherlands / Q000453:epidemiology; D011159:Population Surveillance; D012042:Registries
keywords: Breast cancer; Ductal carcinoma in situ; MISCAN; Overdiagnosis; Screening