Faculty of Medicine and Health Sciences, Erasmus University, University Medical Centre, 's-Gravendijkwal 230, 3015CE, Rotterdam, The Netherlands.
Department of Breast Surgery, Amphia Hospital, Molengracht 21, 4818CK, Breda, The Netherlands.
Breast Cancer Res Treat. 2017 Nov;166(1):307-314. doi: 10.1007/s10549-017-4412-4. Epub 2017 Jul 26.
In a biennial screening mammography programme, we analysed the trends in incidence of screen-detected DCIS and invasive breast cancers in the era of screen-film mammography (SFM) screening, the period of the transition to full-field digital mammography (FFDM) screening and the period of FFDM screening. We also investigated a possible association between the incidence and grading of screen-detected DCIS and invasive breast cancer.
In the southern part of the Netherlands, FFDM screening gradually replaced SFM screening between May 2009 and April 2010. We included a consecutive series of 484, 422 screens obtained between July 2005 and July 2015 and divided these screens into three groups; SFM-only cohort, transition cohort and FFDM-only cohort.
A total of 3059 referred women were diagnosed with DCIS (n = 623) or invasive breast cancer (n = 2436). The majority of DCIS were high-grade (48.2%), whereas the majority of the invasive breast cancers were low-grade (45.4%) or intermediate-grade (41.6%). The cancer detection rate (CDR) per 1000 screened women showed the same distribution by grade in both groups. The transition to FFDM was characterised by an increased overall detection rate of invasive cancers.
Screening mammography detects mostly high-grade DCIS and low- or intermediate-grade invasive cancers. The grade distribution as well as the CDR in the years after the introduction of FFDM remained stable compared to the era of SFM screening. By diagnosing and treating high-grade DCIS, which otherwise may develop into high-grade invasive carcinoma, our findings provide new evidence for the beneficial value of screening mammography programmes.
在两年一次的筛查性乳房 X 光摄影计划中，我们分析了在屏片式乳房 X 光摄影（SFM）筛查时代、向全数字化乳腺 X 光摄影（FFDM）筛查过渡时期以及 FFDM 筛查时期，筛查出的导管原位癌（DCIS）和浸润性乳腺癌发病率的变化趋势。我们还调查了筛查出的 DCIS 和浸润性乳腺癌的发病率与分级之间可能存在的关联。
在荷兰南部，FFDM 筛查于 2009 年 5 月至 2010 年 4 月期间逐渐取代了 SFM 筛查。我们纳入了一个连续的 484、422 例 SFM 和 FFDM 筛查系列，这些筛查于 2005 年 7 月至 2015 年 7 月间进行，并将这些筛查分为三组：仅 SFM 组、过渡组和仅 FFDM 组。
共有 3059 名转诊女性被诊断为 DCIS（n=623）或浸润性乳腺癌（n=2436）。大多数 DCIS 为高级别（48.2%），而大多数浸润性乳腺癌为低级别（45.4%）或中级别（41.6%）。按分级计算，每 1000 例筛查女性的癌症检出率（CDR）在两组中分布相同。向 FFDM 的过渡以浸润性癌症整体检出率的增加为特征。
筛查性乳房 X 光摄影主要检测高级别 DCIS 和低级别或中级别浸润性癌症。与 SFM 筛查时代相比，FFDM 引入后的几年中，分级分布和 CDR 保持稳定。通过诊断和治疗可能发展为高级别浸润性癌的高级别 DCIS，我们的研究结果为筛查性乳房 X 光摄影计划的有益价值提供了新的证据。
