Bucchi Lauro, Mancini Silvia, Biggeri Annibale, Vattiato Rosa, Giuliani Orietta, Ravaioli Alessandra, Baldacchini Flavia, Zamagni Federica, Falcini Fabio
Emilia-Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy.
Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.
Int J Epidemiol. 2025 Jun 11;54(4). doi: 10.1093/ije/dyaf102.
The increasing incidence of ductal carcinoma in situ (DCIS) of the breast is attributed to mammography screening, but the trend has so far been evaluated only descriptively.
We report an age-period-cohort modelling analysis of the incidence trend (1992-2017) observed among screening-aged women living in a region of northern Italy, where a mammography screening programme was implemented in 1996-98 (age 50-69 years) and 2010-14 (age 45-49 and 70-74 years).
The incidence of DCIS increased by an annual average of 9.1% (age 60-64 years) to 14.9% (age 70-74 years). The incidence peak followed a complex age-time pattern indicating an interaction between age and period, which suggested a cohort effect explained by the screening programme. In the age-period-cohort analysis, the birth cohort had a 2-fold effect. The nonlinear effect consisted of an increase in incidence for the generations of 1933-42 and 1943-52, targeted by screening since 1997, and of a second increase for the cohort of 1963-72, first invited in 2010. Taking into account the early excess incidence due to the introduction of the screening programme, the linear effect consisted of an annual 4.0% increase in the risk of DCIS for all successive birth cohorts or calendar periods, which was only partially attributable to the programme.
The increase in incidence rates resulted from an increased detection of DCIS through the screening programme and from an uptrend in the risk of diagnosis that can be attributed either to long-term changes in diagnostic scrutiny independent of the programme or to an increased exposure to risk factors.
乳腺导管原位癌（DCIS）发病率的上升归因于乳腺钼靶筛查，但迄今为止，这一趋势仅得到了描述性评估。
我们报告了一项针对居住在意大利北部某地区的筛查年龄女性（1992 - 2017年）中观察到的发病趋势的年龄 - 时期 - 队列建模分析，该地区于1996 - 1998年（年龄50 - 69岁）和2010 - 2014年（年龄45 - 49岁和70 - 74岁）实施了乳腺钼靶筛查项目。
DCIS的发病率平均每年上升9.1%（年龄60 - 64岁）至14.9%（年龄70 - 74岁）。发病高峰呈现出复杂的年龄 - 时间模式，表明年龄与时期之间存在相互作用，这提示了筛查项目所导致的队列效应。在年龄 - 时期 - 队列分析中，出生队列有2倍的影响。非线性效应包括1933 - 1942年和1943 - 1952年这几代人的发病率上升，自1997年起这些人群成为筛查对象，以及1963 - 1972年队列的发病率再次上升，该队列于2010年首次被邀请参加筛查。考虑到筛查项目引入导致的早期发病率过高，线性效应包括所有连续出生队列或日历时期中DCIS风险每年增加4.0%，这仅部分归因于该项目。
发病率的上升是由于通过筛查项目对DCIS的检测增加，以及诊断风险的上升趋势，这一趋势可能归因于与项目无关的诊断检查的长期变化，或者是危险因素暴露的增加。
