Skip to main content

Advertisement

SpringerLink
Log in

Characterizing the impact of 25 years of DCIS treatment

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

The significant increase in the detection and treatment of ductal carcinoma in situ (DCIS) since the introduction of screening mammography has not been accompanied by the anticipated reduction in invasive breast cancer (IBC) incidence. The prevalence of DCIS requires a reexamination of the population level effects of detecting and treating DCIS. To further our understanding of the possible impact of DCIS diagnosis and treatment on IBC incidence in the U.S., we simulated breast cancer incidence over 25 years under various assumptions regarding the baseline incidence of IBC and the progression of DCIS to IBC. The simulations demonstrate a tradeoff between the expected increased incidence of IBC absent any DCIS detection and treatment and the rate of progression of DCIS to IBC. Our analyses indicate that a high progression of DCIS to IBC implies a significant increase in incidence of IBC over what is observed had we not detected and treated DCIS. Conversely, if we assume that there would not have been a significant increase over and above the observed incidence evident in SEER, then our model indicates that the rate of DCIS progression to clinically significant IBC is low. Given the tradeoff illustrated by our model, we must reevaluate the assumption that DCIS is a short-term obligate precursor of invasive cancer and instead focus on further exploration of the true natural history of DCIS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Peto J et al (2004) The cervical cancer epidemic that screening has prevented in the UK. Lancet 364(9430):249–256

    Article  PubMed  Google Scholar 

  2. McCredie MR et al (2008) Natural history of cervical neoplasia and risk of invasive cancer in women with cervical intraepithelial neoplasia 3: a retrospective cohort study. Lancet Oncol 9(5):425–434

    Article  PubMed  Google Scholar 

  3. Winawer SJ et al (1993) Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med 329(27):1977–1981

    Article  PubMed  CAS  Google Scholar 

  4. Ries L et al (2008) SEER cancer statistics review. National Cancer Institute, Bethesda

    Google Scholar 

  5. Pignone M et al (2002) Screening for colorectal cancer in adults at average risk: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 137(2):132–141

    PubMed  Google Scholar 

  6. Janicek MF, Averette HE (2001) Cervical cancer: prevention diagnosis, and therapeutics. CA Cancer J Clin 51(2):92–114 (quiz 115–118)

    Article  PubMed  CAS  Google Scholar 

  7. Ravdin PM et al (2007) The decrease in breast-cancer incidence in 2003 in the United States. N Engl J Med 356(16):1670–1674

    Article  PubMed  CAS  Google Scholar 

  8. Kerlikowske K et al (2007) Declines in invasive breast cancer and use of postmenopausal hormone therapy in a screening mammography population. JNCI 99(17):1335–1339

    PubMed  Google Scholar 

  9. Glass AG et al (2007) Breast cancer incidence, 1980–2006: combined roles of menopausal hormone therapy, screening mammography, and estrogen receptor status. J Natl Cancer Inst 99(15):1152–1161

    Article  PubMed  Google Scholar 

  10. Simon JA et al (2010) The breast cancer “plunge” after initial publication of the WHI results: an alternative explanation. Maturitas 66(3):277–284

    Article  PubMed  Google Scholar 

  11. Welch HG, Black WC (2010) Overdiagnosis in cancer. J Natl Cancer Inst 102(9):605–613

    Article  PubMed  Google Scholar 

  12. Jorgensen KJ, Gotzsche PC (2009) Overdiagnosis in publicly organised mammography screening programmes: systematic review of incidence trends. BMJ 339:b2587

    Article  PubMed  Google Scholar 

  13. Esserman L, Shieh Y, Thompson I (2009) Rethinking screening for breast cancer and prostate cancer. JAMA 302(15):1685–1692

    Article  PubMed  CAS  Google Scholar 

  14. U.S. Preventive services task force (2009) Screening for breast cancer: U.S. Preventive services task force recommendation statement. Ann Intern Med 151(10): 716–26, W-236

    Google Scholar 

  15. Sanders ME et al (2005) The natural history of low-grade ductal carcinoma in situ of the breast in women treated by biopsy only revealed over 30 years of long-term follow-up. Cancer 103(12):2481–2484

    Article  PubMed  Google Scholar 

  16. Collins LC et al (2005) Outcome of patients with ductal carcinoma in situ untreated after diagnostic biopsy: results from the Nurses’ Health Study. Cancer 103(9):1778–1784

    Article  PubMed  Google Scholar 

  17. Warnberg F, Yuen J, Holmberg L (2000) Risk of subsequent invasive breast cancer after breast carcinoma in situ. Lancet 355(9205):724–725

    Article  PubMed  CAS  Google Scholar 

  18. Fisher ER et al (1999) Pathologic findings from the National Surgical Adjuvant Breast Project (NSABP) eight-year update of Protocol B-17: intraductal carcinoma. Cancer 86(3):429–438

    Article  PubMed  CAS  Google Scholar 

  19. Baxter NN et al (2004) Trends in the treatment of ductal carcinoma in situ of the breast. J Natl Cancer Inst 96(6):443–448

    Article  PubMed  Google Scholar 

  20. Claus EB et al (2003) The risk of a contralateral breast cancer among women diagnosed with ductal and lobular breast carcinoma in situ: data from the Connecticut Tumor Registry. Breast 12(6):451–456

    Article  PubMed  Google Scholar 

  21. Morrell S et al (2010) Estimates of overdiagnosis of invasive breast cancer associated with screening mammography. Cancer Causes Control 21(2):275–282

    Article  PubMed  Google Scholar 

  22. Welch HG (2004) Should I be tested for cancer?: maybe not and here’s why. University of California Press, Berkeley, p 224

    Google Scholar 

  23. SEER, SEER*Stat Database (2009) Incidence - SEER 9 Regs Limited-Use, Nov 2008 Sub (1973–2006) <Katrina/Rita Population Adjustment> -Linked To County Attributes - Total U.S., 1969–2006 Counties, National Cancer Institute, DCCPS. Surveillance Research Program, Cancer Statistics

    Google Scholar 

  24. Miller BA, Feuer EJ, Hankey BF (1994) The significance of the rising incidence of breast cancer in the United States. Important Adv Oncol 193–207

  25. Devesa SS, Silverman DT (1978) Cancer incidence and mortality trends in the United States: 1935–74. J Natl Cancer Inst 60(3):545–571

    PubMed  CAS  Google Scholar 

  26. Zhang SM et al (2007) Alcohol consumption and breast cancer risk in the Women’s Health Study. Am J Epidemiol 165(6):667–676

    Article  PubMed  Google Scholar 

  27. Silvera SA et al (2006) Energy balance and breast cancer risk: a prospective cohort study. Breast Cancer Res Treat 97(1):97–106

    Article  PubMed  Google Scholar 

  28. Eliassen AH et al (2010) Physical activity and risk of breast cancer among postmenopausal women. Arch Intern Med 170(19):1758–1764

    Article  PubMed  Google Scholar 

  29. Peplonska B et al (2008) Adulthood lifetime physical activity and breast cancer. Epidemiology 19(2):226–236

    Article  PubMed  Google Scholar 

  30. Zahl PH, Maehlen J, Welch HG (2008) The natural history of invasive breast cancers detected by screening mammography. Arch Intern Med 168(21):2311–2316

    Article  PubMed  Google Scholar 

  31. Welch HG, Black WC (2010) Overdiagnosis in cancer. J Natl Cancer Inst 102(9):605–613

    Google Scholar 

  32. Mandelblatt J et al (2006) The SPECTRUM population model of the impact of screening and treatment on U.S. breast cancer trends from 1975 to 2000: principles and practice of the model methods. J Natl Cancer Inst Monogr 36:47–55

    PubMed  Google Scholar 

  33. Fryback DG et al (2006) The Wisconsin breast cancer epidemiology simulation model. J Natl Cancer Inst Monogr 36:37–47

    PubMed  Google Scholar 

  34. Lagios MD et al (1989) Mammographically detected duct carcinoma in situ: frequency of local recurrence following tylectomy and prognostic effect of nuclear grade on local recurrence. Cancer 63:616–624

    Article  Google Scholar 

  35. Welch HG, Black WC (1997) Using autopsy series to estimate the disease “reservoir” for ductal carcinoma in situ of the breast: how much more breast cancer can we find? Ann Intern Med 127(11):1023–1028

    PubMed  CAS  Google Scholar 

  36. Hughes LL et al (2009) Local excision alone without irradiation for ductal carcinoma in situ of the breast: a trial of the Eastern Cooperative Oncology Group. J Clin Oncol 27(32):5319–5324

    Article  PubMed  Google Scholar 

  37. Solin LJ et al (2005) Long-term outcome after breast-conservation treatment with radiation for mammographically detected ductal carcinoma in situ of the breast. Cancer 103(6):1137–1146

    Article  PubMed  Google Scholar 

  38. Friebel TM et al (2007) Bilateral prophylactic oophorectomy and bilateral prophylactic mastectomy in a prospective cohort of unaffected BRCA1 and BRCA2 mutation carriers. Clin Breast Cancer 7(11):875–882

    Article  PubMed  Google Scholar 

  39. Hartmann LC et al (2005) Benign breast disease and the risk of breast cancer. N Engl J Med 353(3):229–237

    Article  PubMed  CAS  Google Scholar 

  40. Degnim AC et al (2007) Stratification of breast cancer risk in women with atypia: a Mayo cohort study. J Clin Oncol 25(19):2671–2677

    Article  PubMed  Google Scholar 

  41. Esserman L et al (2004) Applying the neoadjuvant paradigm to ductal carcinoma in situ. Ann Surg Oncol 11(1 Suppl):28S–36S

    Article  PubMed  Google Scholar 

  42. van’t Veer LJ et al (2009) Evaluation of the effect of screening on the detection of good and poor prognosis breast cancers. Am Soc Clin Oncol 27 (abstr 1525)

  43. Jensen RA, P DL (2003) Ductal carcinoma in situ of the breast: impact of pathology on therapeutic decisions. Am J Surg Pathol 27(6):828–831

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, 101 Merrimac St., 10th Floor, Boston, MA, 02114, USA

    Elissa M. Ozanne & Colleen Bouzan

  2. University of California, San Francisco, CA, USA

    Yiwey Shieh

  3. University of Illinois, Chicago, IL, USA

    James Barnes

  4. Department of Surgery, University of California, San Francisco, CA, USA

    E. Shelley Hwang

  5. Department of Surgery and Radiology, University of California, San Francisco, CA, USA

    Laura J. Esserman

Authors
  1. Elissa M. Ozanne
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yiwey Shieh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. James Barnes
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Colleen Bouzan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. E. Shelley Hwang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Laura J. Esserman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elissa M. Ozanne.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ozanne, E.M., Shieh, Y., Barnes, J. et al. Characterizing the impact of 25 years of DCIS treatment. Breast Cancer Res Treat 129, 165–173 (2011). https://doi.org/10.1007/s10549-011-1430-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-011-1430-5

Keywords

Search

Navigation