Quantifying the potential problem of overdiagnosis of ductal carcinoma in situ in breast cancer screening

M. F. Yen, L. Tabár, B. Vitak, R. A. Smith, H. H. Chen, S. W. Duffy

研究成果: 雜誌貢獻文章

108 引文 (Scopus)

摘要

The relevance of detection of ductal carcinoma in situ (DCIS) in a breast cancer screening programme, and the extent of overdiagnosis of non-progressive lesions, remains controversial. It was the purpose of this paper to estimate the incidence of non-progressive, 'overdiagnosed' DCIS. We defined non-progressive DCIS (DCIS0) as DCIS which could not have progressed to invasive disease if left untreated. Progressive DCIS (DCIS1) was defined as DCIS which has the propensity to progress to invasive disease. We fitted a Markov process model of the incidence of progressive and non-progressive DCIS, the transition of the former to preclinical invasive disease and the subsequent progression to clinical symptomatic cancer. We used data from the Swedish Two-County Trial and from service screening programmes in the UK, Netherlands, Australia and the USA to estimate the incidence of progressive and non-progressive DCIS, and the detection rates of each at the first and subsequent screening. Average incidence of non-progressive DCIS was 1.11 per 100 000 per year. Average incidence of progressive DCIS was 2.1 per 1000 per year. At prevalence screen, 37% of DCIS cases were estimated to be non-progressive. A woman attending prevalence screen has a 19 times greater chance of having a progressive DCIS or an invasive tumour diagnosed than of having a non-progressive DCIS diagnosed. At incidence screen, only 4% of DCIS cases were estimated to be non-progressive. A woman attending an incidence screen has a 166 times higher probability of having a progressive DCIS or invasive lesion diagnosed than of having a non-progressive DCIS diagnosed. There is an element of overdiagnosis of DCIS in breast cancer screening, but the phenomenon is small in both relative and absolute terms.
原文英語
頁(從 - 到)1746-1754
頁數9
期刊European Journal of Cancer
39
發行號12
DOIs
出版狀態已發佈 - 八月 2003
對外發佈Yes

指紋

Carcinoma, Intraductal, Noninfiltrating
Early Detection of Cancer
Breast Neoplasms
Incidence
Medical Overuse
Markov Chains

ASJC Scopus subject areas

  • Cancer Research
  • Hematology
  • Oncology

引用此文

Quantifying the potential problem of overdiagnosis of ductal carcinoma in situ in breast cancer screening. / Yen, M. F.; Tabár, L.; Vitak, B.; Smith, R. A.; Chen, H. H.; Duffy, S. W.

於: European Journal of Cancer, 卷 39, 編號 12, 08.2003, p. 1746-1754.

研究成果: 雜誌貢獻文章

Yen, M. F. ; Tabár, L. ; Vitak, B. ; Smith, R. A. ; Chen, H. H. ; Duffy, S. W. / Quantifying the potential problem of overdiagnosis of ductal carcinoma in situ in breast cancer screening. 於: European Journal of Cancer. 2003 ; 卷 39, 編號 12. 頁 1746-1754.
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abstract = "The relevance of detection of ductal carcinoma in situ (DCIS) in a breast cancer screening programme, and the extent of overdiagnosis of non-progressive lesions, remains controversial. It was the purpose of this paper to estimate the incidence of non-progressive, 'overdiagnosed' DCIS. We defined non-progressive DCIS (DCIS0) as DCIS which could not have progressed to invasive disease if left untreated. Progressive DCIS (DCIS1) was defined as DCIS which has the propensity to progress to invasive disease. We fitted a Markov process model of the incidence of progressive and non-progressive DCIS, the transition of the former to preclinical invasive disease and the subsequent progression to clinical symptomatic cancer. We used data from the Swedish Two-County Trial and from service screening programmes in the UK, Netherlands, Australia and the USA to estimate the incidence of progressive and non-progressive DCIS, and the detection rates of each at the first and subsequent screening. Average incidence of non-progressive DCIS was 1.11 per 100 000 per year. Average incidence of progressive DCIS was 2.1 per 1000 per year. At prevalence screen, 37{\%} of DCIS cases were estimated to be non-progressive. A woman attending prevalence screen has a 19 times greater chance of having a progressive DCIS or an invasive tumour diagnosed than of having a non-progressive DCIS diagnosed. At incidence screen, only 4{\%} of DCIS cases were estimated to be non-progressive. A woman attending an incidence screen has a 166 times higher probability of having a progressive DCIS or invasive lesion diagnosed than of having a non-progressive DCIS diagnosed. There is an element of overdiagnosis of DCIS in breast cancer screening, but the phenomenon is small in both relative and absolute terms.",
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AB - The relevance of detection of ductal carcinoma in situ (DCIS) in a breast cancer screening programme, and the extent of overdiagnosis of non-progressive lesions, remains controversial. It was the purpose of this paper to estimate the incidence of non-progressive, 'overdiagnosed' DCIS. We defined non-progressive DCIS (DCIS0) as DCIS which could not have progressed to invasive disease if left untreated. Progressive DCIS (DCIS1) was defined as DCIS which has the propensity to progress to invasive disease. We fitted a Markov process model of the incidence of progressive and non-progressive DCIS, the transition of the former to preclinical invasive disease and the subsequent progression to clinical symptomatic cancer. We used data from the Swedish Two-County Trial and from service screening programmes in the UK, Netherlands, Australia and the USA to estimate the incidence of progressive and non-progressive DCIS, and the detection rates of each at the first and subsequent screening. Average incidence of non-progressive DCIS was 1.11 per 100 000 per year. Average incidence of progressive DCIS was 2.1 per 1000 per year. At prevalence screen, 37% of DCIS cases were estimated to be non-progressive. A woman attending prevalence screen has a 19 times greater chance of having a progressive DCIS or an invasive tumour diagnosed than of having a non-progressive DCIS diagnosed. At incidence screen, only 4% of DCIS cases were estimated to be non-progressive. A woman attending an incidence screen has a 166 times higher probability of having a progressive DCIS or invasive lesion diagnosed than of having a non-progressive DCIS diagnosed. There is an element of overdiagnosis of DCIS in breast cancer screening, but the phenomenon is small in both relative and absolute terms.

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