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Low-grade screen-detected ductal carcinoma in situ progresses more slowly than high-grade lesions: evidence from an international multi-centre study

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Abstract

Purpose

Nuclear grade is an important indicator of the biological behaviour of ductal carcinoma in situ (DCIS). De-escalation of treatment has been suggested for low-grade DCIS. Our aim is to estimate the relative rate of progression of DCIS by nuclear grade by analysing the distribution of nuclear grade by detection at initial or subsequent screening.

Methods

We asked International Cancer Screening Network sites to complete, based on their screening and clinical databases, an aggregated data file on DCIS detection, diagnosis and treatment.

Results

Eleven screening programs reported 5068 screen-detected pure DCIS in nearly 7 million screening tests in women 50–69 years of age. For all programs combined, low-grade DCIS were 20.1% (range 11.4–31.8%) of graded DCIS, intermediate grade 31.0% and high grade 48.9%. Detection rates decreased more steeply from initial to subsequent screening in low compared to high-grade DCIS: the ratios of subsequent to initial detection rates were 0.39 for low grade, 0.51 for intermediate grade, and 0.75 for high grade (p < 0.001).

Conclusions

These results suggest that the duration of the preclinical detectable phase is longer for low than for high-grade DCIS. The findings from this large multi-centre, international study emphasize that the management of low-grade DCIS should be carefully scrutinized in order to minimize overtreatment of screen-detected slow-growing or indolent lesions. The high variation by site in the proportion of low grade suggests that further pathology standardization and training would be beneficial.

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Acknowledgements

The authors thank the members of the ICSN DCIS Working group, the national and regional screening programs coordinators, and all professionals involved in breast cancer screening and treatment in participating centres for their contribution to this study.

Funding

No specific funding was made available for this study, but the US National Cancer Institute (NCI) provided co-ordination of the project and secretarial support. The content of this paper is solely the responsibility of the authors and does not represent the official view of the NCI or the National Institutes of Health.

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Author notes

  1. Co-senior authors: Nereo Segnan and Stephen Taplin

Authors and Affiliations

  1. CPO Piemonte, AOU Città della Salute e della Scienza, Via Cavour 31, 10123, Torino, Italy

    Antonio Ponti, Guglielmo Ronco, Mariano Tomatis & Nereo Segnan

  2. Department of Public Health, University of Copenhagen, Copenhagen, Denmark

    Elsebeth Lynge

  3. Mass Screening Registry, Finnish Cancer Registry, Helsinki, Finland

    Ahti Anttila

  4. Breast Cancer Screening Program, Public Health and Labour Institute of Navarra, Pamplona, Spain

    Nieves Ascunce

  5. Dutch Expert Centre for Screening and Radboud University Medical Centre, Nijmegen, The Netherlands

    Mireille Broeders

  6. Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland

    Jean-Luc Bulliard

  7. Unit of Pathology, Department of Medical Sciences, University of Torino, Torino, Italy

    Isabella Castellano

  8. National Screening Service, Dublin, Ireland

    Patricia Fitzpatrick

  9. Breast Cancer Screening Reference Centre, AOU Città della Salute e della Scienza, Torino, Italy

    Alfonso Frigerio

  10. The Cancer Registry of Norway, Oslo, Norway

    Solveig Hofvind

  11. Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic

    Ondřej Májek

  12. Centre for Global Health, National Cancer Institute, Rockville, MD, USA

    Stephen Taplin

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  1. Antonio Ponti
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  2. Guglielmo Ronco
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  14. Nereo Segnan
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  15. Stephen Taplin
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the ICSN DCIS Working Group

Corresponding author

Correspondence to Antonio Ponti.

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All authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Ponti, A., Ronco, G., Lynge, E. et al. Low-grade screen-detected ductal carcinoma in situ progresses more slowly than high-grade lesions: evidence from an international multi-centre study. Breast Cancer Res Treat 177, 761–765 (2019). https://doi.org/10.1007/s10549-019-05333-6

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  • DOI: https://doi.org/10.1007/s10549-019-05333-6

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