School of Public Health, Physiotherapy and Sports Science, 8797University College Dublin, Dublin, Ireland.
Department of Public Health HSE North East, Navan, Ireland.
J Med Screen. 2022 Sep;29(3):172-177. doi: 10.1177/09691413221090739. Epub 2022 Mar 28.
The purpose of this study was to evaluate the grade distribution of screen-detected ductal carcinoma in situ (DCIS) diagnosed in Ireland, in the context of the clinical trials currently underway to determine if active surveillance is a feasible management option for low-risk DCIS.
BreastCheck is the national breast screening programme in Ireland, offering screening to women aged 50 to 69 every two years.
This study was a secondary analysis of data collected by BreastCheck on all screen-detected DCIS diagnosed in the 12 years of nationwide screening. Incidence and detection rates were calculated. Descriptive analysis of the cases was performed and, for comparative analysis, grade of DCIS was analysed as a binary variable (high vs. low/intermediate) in keeping with the inclusion criteria for active surveillance trials. Analysis was performed in IBM Statistical Package for Social Sciences, version 26.
Between 2008 and 2020, 2240 women were diagnosed with DCIS through BreastCheck; 876 (39.1%) were low/intermediate-grade. The overall incidence rate has remained relatively stable during this period. Women with low/intermediate-grade DCIS were younger than women with high-grade DCIS (56 (interquartile range: 56-61) years v 57 (interquartile range: 53-61) years; p < 0.001). They were also more likely to have been diagnosed at an initial screening episode compared with those who had high-grade lesions (42.5% v 29.0%; p < 0.001).
If current clinical trials recommend active surveillance as a feasible option for DCIS, up to 40% of women with screen-detected DCIS may be eligible. These women are younger and often diagnosed on initial screening episode, so may require longer active follow-up.
本研究旨在评估爱尔兰通过筛查检出的导管原位癌（DCIS）的分级分布情况，以期为目前正在进行的临床试验提供参考，这些临床试验旨在确定主动监测是否是低危 DCIS 的可行管理选择。
BreastCheck 是爱尔兰的国家乳房筛查计划，为 50 至 69 岁的女性每两年提供一次筛查。
本研究对 BreastCheck 在全国范围内筛查的 12 年间发现的所有经筛查检出的 DCIS 病例进行了二次分析。计算了发病率和检出率。对病例进行了描述性分析，并根据纳入主动监测试验的标准，将 DCIS 的分级作为二分类变量（高 vs. 低/中）进行了比较分析。采用 IBM SPSS Statistics 26 版进行分析。
2008 年至 2020 年间，2240 名女性通过 BreastCheck 被诊断为 DCIS，其中 876 名（39.1%）为低/中级别。在此期间，总体发病率一直保持相对稳定。与高级别 DCIS 患者相比，低/中级别 DCIS 患者年龄更小（56（四分位距：56-61）岁比 57（四分位距：53-61）岁；p<0.001）。与高级别病变患者相比，这些患者更有可能在初次筛查时被诊断出（42.5%比 29.0%；p<0.001）。
如果当前的临床试验建议主动监测是 DCIS 的可行选择，那么多达 40%的经筛查检出的 DCIS 患者可能符合条件。这些女性年龄较小，且往往在初次筛查时被诊断出，因此可能需要更长时间的主动随访。
