Incidence of and treatment for ductal carcinoma in situ of the breast

V. L. Ernster, J. Barclay, K. Kerlikowske, D. Grady and C. Henderson
Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, 94143-0560, USA.

OBJECTIVE: To describe trends in incidence and treatment for ductal carcinoma in situ (DCIS) of the breast in the United States between 1973 and 1992 and to estimate total numbers of in situ cases diagnosed and numbers treated by mastectomy since 1983, when screening mammography for breast cancer began to become widespread. DESIGN: Analysis of population-based breast cancer incidence data collected by the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program since 1973 and treatment data collected by the SEER program since 1983. STUDY POPULATION: All women in the geographic areas af the United States included in the SEER program. MAIN OUTCOME MEASURES: Annual age-adjusted and age-specific incidence rates for DCIS; time trends in distribution of cases by type of treatment; percentage of cases treated by mastectomy by geographic area; and estimated numbers for the entire United States of DCIS cases, mastectomies for DCIS, and cases attributable to mammography. RESULTS: There was a marked increase in DCIS incidence beginning in the early 1980s. Average annual increases in rates between 1973 and 1983 and between 1983 and 1992 changed from 0.3% to 12.0% among women aged 30 to 39 years, from 0.4% to 17.4% among women aged 40 to 49, and from 5.2% to 18.1% among women aged 50 years or older. The total estimated number of DCIS cases in the United States in 1992 (23,368) was 200% higher than expected based on 1983 rates and trends between 1973 and 1983. Between 1983 and 1992, there was a marked decline in the proportion of DCIS cases treated by mastectomy (from 71% to 43.8%) and an increase in those treated by lumpectomy (from 25.6% to 53.3%). In 1992, 23.3% of cases were treated by lumpectomy and radiation, 30.2% by lumpectomy alone, and 2.6% with no surgery. Treatment patterns varied substantially by geographic area, with 57.7% of cases in New Mexico treated by mastectomy in 1992 compared with 28.8% in Connecticut. Despite the decline in the proportion of cases treated by mastectomy, the increased DCIS incidence rates resulted in an increase in the absolute number of cases treated by mastectomy until 1990 (n=10,657); in 1992, there were an estimated 10,242 DCIS cases treated by mastectomy. CONCLUSIONS: Incidence rates of DCIS of the breast have increased dramatically since 1983. This increase correlates with the widespread adoption of modern mammographic screening. While early detection of invasive breast cancer is beneficial, the value of DCIS detection is currently unknown. There is cause for concern about the large number of DCIS cases that are being diagnosed as a consequence of screening mammography, most of which are treated by some form of surgery. In addition, the proportion of cases treated by mastectomy may be inappropriately high, particularly in some areas of the United States.

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Trentham-Dietz et al.
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Kinkel et al.
Am. J. Roentgenol. 2000;175:35-43.
ABSTRACT | FULL TEXT  

US women's attitudes to false positive mammography results and detection of ductal carcinoma in situ: cross sectional survey
Schwartz et al.
BMJ 2000;320:1635-1640.
ABSTRACT | FULL TEXT  

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Ernster et al.
Arch Intern Med 2000;160:953-958.
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Waldman et al.
JNCI J Natl Cancer Inst 2000;92:313-320.
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Morrow and Schnitt
JAMA 2000;283:453-455.
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Vicini et al.
JCO 2000;18:296-296.
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The p53 Tumor Suppressor Gene in Ductal Carcinoma in Situ of the Breast
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Kerlikowske et al.
JAMA 1999;282:2156-2163.
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Hrung et al.
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Foucar et al.
JAMA 1999;282:938-939.
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Xiao et al.
Proc. Natl. Acad. Sci. USA 1999;96:3700-3705.
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Stages of Adopting Regular Screening Mammography: Do Women Differ in Decisional Balance Within Stages?
Clark et al.
J Health Psychol 1998;3:491-506.
ABSTRACT  

Ductal Carcinoma In Situ of the Breast: Controversial Issues
Silverstein
The Oncologist 1998;3:94-103.
ABSTRACT | FULL TEXT  

Current Management of Patients with Ductal Carcinoma-in-Situ
Chabner et al.
The Oncologist 1997;2:76-82.
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Breast cancer screening in women aged under 50
Fletcher
BMJ 1997;314:764-764.
FULL TEXT  

Questions about the Value of Early Intervention
Welch
NEJM 1996;334:1472-1473.
FULL TEXT  

Ductal Carcinoma in Situ: Are We Doing Too Much?
JWatch Women's Health 1996;1996:12-12.
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CHANGING STRATEGIES FOR DUCTAL CARCINOMA IN SITU
JWatch General 1996;1996:1-1.
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Case 41: Ductal Carcinoma in Situ
Harris
Radiology 2001;221:770-773.
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