International variation in management of screen-detected ductal carcinoma in situ of the breast
Identifieur interne : 002974 ( Main/Exploration ); précédent : 002973; suivant : 002975International variation in management of screen-detected ductal carcinoma in situ of the breast
Auteurs : Antonio Ponti [Italie] ; Elsebeth Lynge [Danemark] ; Ted James [États-Unis] ; Ond Ej Májek [République tchèque] ; My Von Euler-Chelpin [Danemark] ; Ahti Anttila [Finlande] ; Patricia Fitzpatrick [Irlande (pays)] ; Maria Piera Mano [Italie] ; Masaaki Kawai [Japon] ; Astrid Scharpantgen [Luxembourg (pays)] ; Jacques Fracheboud [Pays-Bas] ; Solveig Hofvind [Norvège] ; Carmen Vidal [Espagne] ; Nieves Ascunce [Espagne] ; Dolores Salas [Espagne] ; Jean-Luc Bulliard [Suisse] ; Nereo Segnan [Italie] ; Karla Kerlikowske [États-Unis] ; Stephen Taplin [États-Unis]Source :
- European journal of cancer (Oxford, England : 1990) [ 0959-8049 ] ; 2014.
Abstract
Ductal carcinoma in situ (DCIS) incidence has grown with the implementation of screening and its detection varies across International Cancer Screening Network (ICSN) countries. The aim of this survey is to describe the management of screen-detected DCIS in ICSN countries and to evaluate the potential for treatment related morbidity.
We sought screen-detected DCIS data from the ICSN countries identified during 2004–2008. We adopted standardised data collection forms and analysis and explored DCIS diagnosis and treatment processes ranging from pre-operative diagnosis to type of surgery and radiotherapy.
Twelve countries contributed data from a total of 15 screening programmes, all from Europe except the United States of America and Japan. Among women aged 50–69 years, 7,176,050 screening tests and 5324 screen-detected DCIS were reported. From 21% to 93% of DCIS had a pre-operative diagnosis (PO); 67–90% of DCIS received breast conservation surgery (BCS), and in 41–100% of the cases this was followed by radiotherapy; 6.4–59% received sentinel lymph node biopsy (SLNB) only and 0.8–49% axillary dissection (ALND) with 0.6% (range by programmes 0–8.1%) being node positive. Among BCS patients 35% received SLNB only and 4.8% received ALND. Starting in 2006, PO and SLNB use increased while ALND remained stable. SLNB and ALND were associated with larger size and higher grade DCIS lesions.
Variation in DCIS management among screened women is wide and includes lymph node surgery beyond what is currently recommended. This indicates the presence of varying levels of overtreatment and the potential for its reduction.
Url:
DOI: 10.1016/j.ejca.2014.07.019
PubMed: 25149183
PubMed Central: 4275301
Affiliations:
- Danemark, Espagne, Finlande, Irlande (pays), Italie, Japon, Luxembourg (pays), Norvège, Pays-Bas, République tchèque, Suisse, États-Unis
- Canton de Vaud, Catalogne, Hollande-Méridionale, Hovedstaden, Moravie, Piémont, Østlandet
- Barcelone, Brno, Copenhague, Lausanne, Oslo, Rotterdam, Turin
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Le document en format XML
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<author><name sortKey="Ascunce, Nieves" sort="Ascunce, Nieves" uniqKey="Ascunce N" first="Nieves" last="Ascunce">Nieves Ascunce</name>
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<author><name sortKey="Salas, Dolores" sort="Salas, Dolores" uniqKey="Salas D" first="Dolores" last="Salas">Dolores Salas</name>
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<country xml:lang="fr">Espagne</country>
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</author>
<author><name sortKey="Bulliard, Jean Luc" sort="Bulliard, Jean Luc" uniqKey="Bulliard J" first="Jean-Luc" last="Bulliard">Jean-Luc Bulliard</name>
<affiliation wicri:level="3"><nlm:aff id="A14">Lausanne University Hospital, Lausanne, Switzerland</nlm:aff>
<country xml:lang="fr">Suisse</country>
<wicri:regionArea>Lausanne University Hospital, Lausanne</wicri:regionArea>
<placeName><settlement type="city">Lausanne</settlement>
<region nuts="3" type="region">Canton de Vaud</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Segnan, Nereo" sort="Segnan, Nereo" uniqKey="Segnan N" first="Nereo" last="Segnan">Nereo Segnan</name>
<affiliation wicri:level="3"><nlm:aff id="A1">CPO Piemonte, AOU Città della Salute e della Scienza, Torino, Italy</nlm:aff>
<country xml:lang="fr">Italie</country>
<wicri:regionArea>CPO Piemonte, AOU Città della Salute e della Scienza, Torino</wicri:regionArea>
<placeName><settlement type="city">Turin</settlement>
<region type="région" nuts="2">Piémont</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Kerlikowske, Karla" sort="Kerlikowske, Karla" uniqKey="Kerlikowske K" first="Karla" last="Kerlikowske">Karla Kerlikowske</name>
<affiliation wicri:level="1"><nlm:aff id="A15">Department of Medicine, University of California San Francisco, San Francisco, CA, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Department of Medicine, University of California San Francisco, San Francisco, CA</wicri:regionArea>
<wicri:noRegion>CA</wicri:noRegion>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="A16">Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA</wicri:regionArea>
<wicri:noRegion>CA</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Taplin, Stephen" sort="Taplin, Stephen" uniqKey="Taplin S" first="Stephen" last="Taplin">Stephen Taplin</name>
<affiliation wicri:level="1"><nlm:aff id="A17">Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD</wicri:regionArea>
<wicri:noRegion>MD</wicri:noRegion>
</affiliation>
</author>
</analytic>
<series><title level="j">European journal of cancer (Oxford, England : 1990)</title>
<idno type="ISSN">0959-8049</idno>
<idno type="eISSN">1879-0852</idno>
<imprint><date when="2014">2014</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc><textClass></textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en"><sec id="S1"><title>Background</title>
<p id="P1">Ductal carcinoma in situ (DCIS) incidence has grown with the implementation of screening and its detection varies across International Cancer Screening Network (ICSN) countries. The aim of this survey is to describe the management of screen-detected DCIS in ICSN countries and to evaluate the potential for treatment related morbidity.</p>
</sec>
<sec id="S2"><title>Methods</title>
<p id="P2">We sought screen-detected DCIS data from the ICSN countries identified during 2004–2008. We adopted standardised data collection forms and analysis and explored DCIS diagnosis and treatment processes ranging from pre-operative diagnosis to type of surgery and radiotherapy.</p>
</sec>
<sec id="S3"><title>Results</title>
<p id="P3">Twelve countries contributed data from a total of 15 screening programmes, all from Europe except the United States of America and Japan. Among women aged 50–69 years, 7,176,050 screening tests and 5324 screen-detected DCIS were reported. From 21% to 93% of DCIS had a pre-operative diagnosis (PO); 67–90% of DCIS received breast conservation surgery (BCS), and in 41–100% of the cases this was followed by radiotherapy; 6.4–59% received sentinel lymph node biopsy (SLNB) only and 0.8–49% axillary dissection (ALND) with 0.6% (range by programmes 0–8.1%) being node positive. Among BCS patients 35% received SLNB only and 4.8% received ALND. Starting in 2006, PO and SLNB use increased while ALND remained stable. SLNB and ALND were associated with larger size and higher grade DCIS lesions.</p>
</sec>
<sec id="S4"><title>Conclusions</title>
<p id="P4">Variation in DCIS management among screened women is wide and includes lymph node surgery beyond what is currently recommended. This indicates the presence of varying levels of overtreatment and the potential for its reduction.</p>
</sec>
</div>
</front>
</TEI>
<affiliations><list><country><li>Danemark</li>
<li>Espagne</li>
<li>Finlande</li>
<li>Irlande (pays)</li>
<li>Italie</li>
<li>Japon</li>
<li>Luxembourg (pays)</li>
<li>Norvège</li>
<li>Pays-Bas</li>
<li>République tchèque</li>
<li>Suisse</li>
<li>États-Unis</li>
</country>
<region><li>Canton de Vaud</li>
<li>Catalogne</li>
<li>Hollande-Méridionale</li>
<li>Hovedstaden</li>
<li>Moravie</li>
<li>Piémont</li>
<li>Østlandet</li>
</region>
<settlement><li>Barcelone</li>
<li>Brno</li>
<li>Copenhague</li>
<li>Lausanne</li>
<li>Oslo</li>
<li>Rotterdam</li>
<li>Turin</li>
</settlement>
</list>
<tree><country name="Italie"><region name="Piémont"><name sortKey="Ponti, Antonio" sort="Ponti, Antonio" uniqKey="Ponti A" first="Antonio" last="Ponti">Antonio Ponti</name>
</region>
<name sortKey="Mano, Maria Piera" sort="Mano, Maria Piera" uniqKey="Mano M" first="Maria Piera" last="Mano">Maria Piera Mano</name>
<name sortKey="Segnan, Nereo" sort="Segnan, Nereo" uniqKey="Segnan N" first="Nereo" last="Segnan">Nereo Segnan</name>
</country>
<country name="Danemark"><region name="Hovedstaden"><name sortKey="Lynge, Elsebeth" sort="Lynge, Elsebeth" uniqKey="Lynge E" first="Elsebeth" last="Lynge">Elsebeth Lynge</name>
</region>
<name sortKey="Von Euler Chelpin, My" sort="Von Euler Chelpin, My" uniqKey="Von Euler Chelpin M" first="My" last="Von Euler-Chelpin">My Von Euler-Chelpin</name>
</country>
<country name="États-Unis"><noRegion><name sortKey="James, Ted" sort="James, Ted" uniqKey="James T" first="Ted" last="James">Ted James</name>
</noRegion>
<name sortKey="Kerlikowske, Karla" sort="Kerlikowske, Karla" uniqKey="Kerlikowske K" first="Karla" last="Kerlikowske">Karla Kerlikowske</name>
<name sortKey="Kerlikowske, Karla" sort="Kerlikowske, Karla" uniqKey="Kerlikowske K" first="Karla" last="Kerlikowske">Karla Kerlikowske</name>
<name sortKey="Taplin, Stephen" sort="Taplin, Stephen" uniqKey="Taplin S" first="Stephen" last="Taplin">Stephen Taplin</name>
</country>
<country name="République tchèque"><region name="Moravie"><name sortKey="Majek, Ond Ej" sort="Majek, Ond Ej" uniqKey="Majek O" first="Ond Ej" last="Májek">Ond Ej Májek</name>
</region>
</country>
<country name="Finlande"><noRegion><name sortKey="Anttila, Ahti" sort="Anttila, Ahti" uniqKey="Anttila A" first="Ahti" last="Anttila">Ahti Anttila</name>
</noRegion>
</country>
<country name="Irlande (pays)"><noRegion><name sortKey="Fitzpatrick, Patricia" sort="Fitzpatrick, Patricia" uniqKey="Fitzpatrick P" first="Patricia" last="Fitzpatrick">Patricia Fitzpatrick</name>
</noRegion>
</country>
<country name="Japon"><noRegion><name sortKey="Kawai, Masaaki" sort="Kawai, Masaaki" uniqKey="Kawai M" first="Masaaki" last="Kawai">Masaaki Kawai</name>
</noRegion>
</country>
<country name="Luxembourg (pays)"><noRegion><name sortKey="Scharpantgen, Astrid" sort="Scharpantgen, Astrid" uniqKey="Scharpantgen A" first="Astrid" last="Scharpantgen">Astrid Scharpantgen</name>
</noRegion>
</country>
<country name="Pays-Bas"><region name="Hollande-Méridionale"><name sortKey="Fracheboud, Jacques" sort="Fracheboud, Jacques" uniqKey="Fracheboud J" first="Jacques" last="Fracheboud">Jacques Fracheboud</name>
</region>
</country>
<country name="Norvège"><region name="Østlandet"><name sortKey="Hofvind, Solveig" sort="Hofvind, Solveig" uniqKey="Hofvind S" first="Solveig" last="Hofvind">Solveig Hofvind</name>
</region>
</country>
<country name="Espagne"><region name="Catalogne"><name sortKey="Vidal, Carmen" sort="Vidal, Carmen" uniqKey="Vidal C" first="Carmen" last="Vidal">Carmen Vidal</name>
</region>
<name sortKey="Ascunce, Nieves" sort="Ascunce, Nieves" uniqKey="Ascunce N" first="Nieves" last="Ascunce">Nieves Ascunce</name>
<name sortKey="Salas, Dolores" sort="Salas, Dolores" uniqKey="Salas D" first="Dolores" last="Salas">Dolores Salas</name>
</country>
<country name="Suisse"><region name="Canton de Vaud"><name sortKey="Bulliard, Jean Luc" sort="Bulliard, Jean Luc" uniqKey="Bulliard J" first="Jean-Luc" last="Bulliard">Jean-Luc Bulliard</name>
</region>
</country>
</tree>
</affiliations>
</record>
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