Duffy Stephen W, Dibden Amanda, Michalopoulos Dimitrios, Offman Judith, Parmar Dharmishta, Jenkins Jacquie, Collins Beverley, Robson Tony, Scorfield Suzanne, Green Kathryn, Hall Clare, Liao Xiao-Hui, Ryan Michael, Johnson Fiona, Stevens Guy, Kearins Olive, Sellars Sarah, Patnick Julietta
Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis, Queen Mary University of London, Wolfson Institute of Preventive Medicine, London, UK.
Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis, Queen Mary University of London, Wolfson Institute of Preventive Medicine, London, UK.
Lancet Oncol. 2016 Jan;17(1):109-14. doi: 10.1016/S1470-2045(15)00446-5. Epub 2015 Dec 5.
The value of screen detection and treatment of ductal carcinoma in situ (DCIS) is a matter of controversy. At present, the extent to which the diagnosis and treatment of DCIS could prevent the occurrence of invasive breast cancer in the future is not clear. We sought to estimate the association between detection of DCIS at screening and invasive interval cancers subsequent to the relevant screen.
We obtained aggregate data for screen-detected cancers from 84 local screening units within 11 regional Quality Assurance Reference Centres in England, Wales, and Northern Ireland from the National Health Service Breast Screening Programme. Data for DCIS diagnoses were obtained for women aged 50-64 years who were invited to and attended mammographic breast screening from April 1, 2003, to March 31, 2007 (4 screening years). Patient-level data for interval cancer arising in the 36 months after each of these were analysed by Poisson regression with invasive interval cancer screen detection rate as the outcome variable; DCIS detection frequencies were fitted first as a continuous and then as a categorical variable. We repeated this analysis after adjustment with both small size and high-grade invasive screen-detected cancers.
We analysed data for 5,243,658 women and on interval cancers occurring in the 36 months after the relevant screen. The average frequency of DCIS detected at screening was 1·60 per 1000 women screened (median 1·50 [unit range 0·54-3·56] [corrected to] per 1000 women). There was a significant negative association of screen-detected DCIS cases with the rate of invasive interval cancers (Poisson regression coefficient -0·084 [95% CI -0·13 to -0·03]; p=0·002). 90% of units had a DCIS detection frequency within the range of 1·00 to 2·22 per 1000 women; in these units, for every three screen-detected cases of DCIS, there was one fewer invasive interval cancer in the next 3 years. This association remained after adjustment for numbers of small screen-detected invasive cancers and for numbers of grade 3 invasive screen-detected cancers.
The association between screen-detected DCIS and subsequent invasive interval cancers suggests that detection and treatment of DCIS is worthwhile in prevention of future invasive disease.
UK Department of Health Policy Research Programme and NHS Cancer Screening Programmes.
导管原位癌（DCIS）的筛查检测及治疗价值存在争议。目前，DCIS的诊断和治疗在预防未来浸润性乳腺癌发生方面的作用程度尚不清楚。我们试图评估筛查时检测到DCIS与相关筛查后发生的浸润性间期癌之间的关联。
我们从英国国家医疗服务体系乳腺筛查计划中，获取了英格兰、威尔士和北爱尔兰11个地区质量保证参考中心内84个当地筛查单位的筛查发现癌症的汇总数据。获取了2003年4月1日至2007年3月31日（4个筛查年度）受邀参加乳腺钼靶筛查且年龄在50 - 64岁女性的DCIS诊断数据。以浸润性间期癌筛查检出率为结局变量，通过泊松回归分析这些筛查后36个月内发生的间期癌的患者层面数据；DCIS检测频率首先作为连续变量，然后作为分类变量进行拟合。在对筛查发现的小尺寸和高级别浸润性癌进行校正后，我们重复了这一分析。
我们分析了5243658名女性的数据以及相关筛查后36个月内发生的间期癌数据。筛查时检测到DCIS的平均频率为每1000名接受筛查的女性中有1.60例（中位数1.50[单位范围0.54 - 3.56][校正后]每1000名女性）。筛查发现的DCIS病例与浸润性间期癌的发生率之间存在显著的负相关（泊松回归系数 -0.084[95%置信区间 -0.13至 -0.03]；p = 0.002）。90%的单位DCIS检测频率在每1000名女性1.00至2.22例的范围内；在这些单位中，每筛查发现3例DCIS病例，接下来3年的浸润性间期癌就会减少1例。在对筛查发现的小尺寸浸润性癌数量和3级浸润性筛查发现癌数量进行校正后，这种关联仍然存在。
筛查发现的DCIS与随后的浸润性间期癌之间的关联表明，DCIS的检测和治疗对于预防未来的浸润性疾病是值得的。
英国卫生部政策研究计划和英国国家医疗服务体系癌症筛查计划。
