© 2002 by Oxford University Press
Journal of the National Cancer Institute, Vol. 94, No. 20, 1546-1554,
October 16, 2002
© 2002 Oxford University Press
ARTICLE |
Detection of Ductal Carcinoma In Situ in Women Undergoing Screening Mammography
Affiliations of authors: V. L. Ernster, Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco; R. Ballard-Barbash, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD; W. E. Barlow, Center for Health Studies, Group Health Cooperative, Seattle, WA, and Department of Biostatistics, University of Washington, Seattle; Y. Zheng, Department of Biostatistics, University of Washington; D. L. Weaver, (Department of Pathology), B. M. Geller (Health Promotion Research), University of Vermont, College of Medicine, Burlington, VT; G. Cutter, Center for Research Design and Statistical Methods, University of Nevada, Reno; B. C. Yankaskas, Department of Radiology, University of North Carolina, Chapel Hill; R. Rosenberg, Department of Radiology, University of New Mexico, Albuquerque; P. A. Carney, Norris Cotton Cancer Center/Dartmouth-Hitchcock Medical Center/Department of Community and Family Medicine, Dartmouth Medical School, Lebanon, NH; K. Kerlikowske, Department of Epidemiology and Biostatistics, School of Medicine, and General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco; S. H. Taplin, Center for Health Studies, Group Health Cooperative, Seattle; N. Urban, Fred Hutchinson Cancer Research Center, Division of Public Health, Seattle.
Correspondence to: Rachel Ballard-Barbash, M.D., M.P.H., Applied Research Program, National Cancer Institute, EPN 4005, 6130 Executive Blvd., MSC 7344, Bethesda, MD 20892-7344 (e-mail: barbashr{at}mail.nih.gov).
Background: With the large number of women having mammography—an estimated 28.4 million U.S. women aged 40 years and older in 1998—the percentage of cancers detected as ductal carcinoma in situ (DCIS), which has an uncertain prognosis, has increased. We pooled data from seven regional mammography registries to determine the percentage of mammographically detected cancers that are DCIS and the rate of DCIS per 1000 mammograms. Methods: We analyzed data on 653 833 mammograms from 540 738 women between 40 and 84 years of age who underwent screening mammography at facilities participating in the National Cancer Institute’s Breast Cancer Surveillance Consortium (BCSC) throughout 1996 and 1997. Mammography results were linked to population-based cancer and pathology registries. We calculated the percentage of screen-detected breast cancers that were DCIS, the rate of screen-detected DCIS per 1000 mammograms by age and by previous mammography status, and the sensitivity of screening mammography. Statistical tests were two-sided. Results: A total of 3266 cases of breast cancer were identified, 591 DCIS and 2675 invasive breast cancer. The percentage of screen-detected breast cancers that were DCIS decreased with age (from 28.2% [95% confidence interval (CI) = 23.9% to 32.5%] for women aged 40–49 years to 16.0% [95% CI = 13.3% to 18.7%] for women aged 70–84 years). However, the rate of screen-detected DCIS cases per 1000 mammograms increased with age (from 0.56 [95% CI = 0.41 to 0.70] for women aged 40–49 years to 1.07 [95% CI = 0.87 to 1.27] for women aged 70–84 years). Sensitivity of screening mammography in all age groups combined was higher for detecting DCIS (86.0% [95% CI = 83.2% to 88.8%]) than it was for detecting invasive breast cancer (75.1% [95% CI = 73.5% to 76.8%]). Conclusions: Overall, approximately 1 in every 1300 screening mammography examinations leads to a diagnosis of DCIS. Given uncertainty about the natural history of DCIS, the clinical significance of screen-detected DCIS needs further investigation.
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