Institut national de santé publique du Québec, 945, Av. Wolfe, Quebec City, G1V 5B3, Canada.
Département de médecine sociale et préventive, Faculté de Médecine, Université Laval, Quebec City, Canada.
Breast Cancer Res Treat. 2019 Apr;174(2):525-535. doi: 10.1007/s10549-018-05095-7. Epub 2018 Dec 18.
Detection of ductal carcinoma in situ (DCIS) has increased with the mammography dissemination. Given the potential role of DCIS as a precursor of invasive breast cancer (IBC), we aimed to assess whether women's characteristics have a different effect on the DCIS compared to IBC detection rate.
This study included 3,609,569 screening mammograms performed from 2002 to 2015 in our organized breast cancer screening program, which actively invites women 50-69 years of age. The association between women's characteristics and the DCIS detection rate, the IBC detection rate and the odds ratio of DCIS among screen-detected cancers was assessed by logistic regression and generalized estimating equations with independent correlation matrix and sandwich estimator.
A total of 4173 DCIS and 15,136 IBC were screen-detected. Increasing women's age, current hormone replacement therapy use and higher body mass index were less associated with the DCIS than with IBC detection rates (p value for the odds of DCIS among screen-detected cancers of, respectively, < 0.0001, 0.0244 and < 0.0001). In contrast, having a previous breast aspiration or biopsy and increasing breast density were more strongly associated with DCIS than with IBC detection rates (p value of, respectively, 0.0050 and < 0.0001).
The results suggest that some women's characteristics could be playing a role in the initiation and other in the progression from in situ to invasive breast cancer. These characteristics can also affect the screening sensitivity, and this effect may differ depending on whether screen-detected cases were DCIS or IBC.
随着乳房 X 光摄影术的普及，导管原位癌（DCIS）的检出率有所增加。鉴于 DCIS 可能是浸润性乳腺癌（IBC）的前身，我们旨在评估女性特征对 DCIS 与 IBC 检出率的影响是否不同。
本研究纳入了我们组织的乳腺癌筛查计划在 2002 年至 2015 年期间进行的 3609569 例筛查性乳房 X 光检查，该计划积极邀请 50-69 岁的女性参加。通过逻辑回归和广义估计方程，评估女性特征与 DCIS 检出率、IBC 检出率以及筛查发现癌症中 DCIS 的比值比之间的关系，采用独立相关矩阵和夹心估计器。
共筛查出 4173 例 DCIS 和 15136 例 IBC。女性年龄增加、当前使用激素替代疗法和更高的体重指数与 DCIS 检出率的关联小于与 IBC 检出率的关联（分别为 DCIS 在筛查发现癌症中的比值比的 p 值<0.0001、0.0244 和<0.0001）。相比之下，有过乳房抽吸或活检史以及乳腺密度增加与 DCIS 检出率的关联大于与 IBC 检出率的关联（分别为 p 值为 0.0050 和<0.0001）。
研究结果表明，一些女性特征可能在原位癌向浸润性乳腺癌的发生和进展中发挥作用。这些特征还可能影响筛查的敏感性，并且这种影响可能因筛查发现的是 DCIS 还是 IBC 而有所不同。
