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


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2019-06-28

AUTHORS

Antonio Ponti, Guglielmo Ronco, Elsebeth Lynge, Mariano Tomatis, Ahti Anttila, Nieves Ascunce, Mireille Broeders, Jean-Luc Bulliard, Isabella Castellano, Patricia Fitzpatrick, Alfonso Frigerio, Solveig Hofvind, Ondřej Májek, Nereo Segnan, Stephen Taplin

ABSTRACT

PurposeNuclear 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.MethodsWe 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.ResultsEleven 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).ConclusionsThese 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. More... »

PAGES

761-765

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s10549-019-05333-6

DOI

http://dx.doi.org/10.1007/s10549-019-05333-6

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1117604517

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/31250357


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23 schema:description PurposeNuclear 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.MethodsWe 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.ResultsEleven 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).ConclusionsThese 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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30 schema:keywords ConclusionsThese results
31 DCI
32 DCIS
33 DCIS detection
34 MethodsWe
35 age
36 aim
37 behavior
38 biological behavior
39 carcinoma
40 clinical database
41 data files
42 database
43 detectable phase
44 detection
45 detection rate
46 diagnosis
47 distribution
48 ductal carcinoma
49 duration
50 evidence
51 files
52 findings
53 grade
54 high grade
55 high variation
56 high-grade DCIS
57 high-grade lesions
58 important indicator
59 indicators
60 indolent lesions
61 initial detection rate
62 intermediate grade
63 international multi-centre study
64 international studies
65 lesions
66 low grade
67 low-grade DCIS
68 management
69 multi-center study
70 network sites
71 nuclear grade
72 order
73 overtreatment
74 phase
75 preclinical detectable phase
76 program
77 progression
78 proportion
79 pure DCIS
80 rate
81 ratio
82 relative rates
83 results
84 screen-detected ductal carcinoma
85 screening
86 screening program
87 screening test
88 sites
89 situ
90 standardization
91 study
92 subsequent screening
93 test
94 training
95 treatment
96 variation
97 women 50
98 years
99 years of age
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