• Elsebeth Lynge, Antonio Ponti, Ted James, Ondřej Májek, My von Euler-Chelpin, Ahti Anttila, Patricia Fitzpatrick, Alfonso Frigerio, Masaaki Kawai, Astrid Scharpantgen, Mireille Broeders, Solveig Hofvind, Carmen Vidal, Maria Ederra, Dolores Salas, Jean-Luc Bulliard, Mariano Tomatis, Karla Kerlikowske, Stephen Taplin, and ICSN DCIS Working group.
• Department of Public Health, University of Copenhagen, Copenhagen, Denmark. Electronic address: elsebeth@sund.ku.dk.
• Eur. J. Cancer. 2014 Jan 1; 50 (1): 185-92.

BackgroundThere is concern about detection of ductal carcinoma in situ (DCIS) in screening mammography. DCIS accounts for a substantial proportion of screen-detected lesions but its effect on breast cancer mortality is debated. The International Cancer Screening Network conducted a comparative analysis to determine variation in DCIS detection.Patients And MethodsData were collected during 2004-2008 on number of screening examinations, detected breast cancers, DCIS cases and Globocan 2008 breast cancer incidence rates derived from national or regional cancer registers. We calculated screen-detection rates for breast cancers and DCIS.ResultsData were obtained from 15 screening settings in 12 countries; 7,176,050 screening examinations; 29,605 breast cancers and 5324 DCIS cases. The ratio between highest and lowest breast cancer incidence was 2.88 (95% confidence interval (CI) 2.76-3.00); 2.97 (95% CI 2.51-3.51) for detection of breast cancer; and 3.49 (95% CI 2.70-4.51) for detection of DCIS.ConclusionsConsiderable international variation was found in DCIS detection. This variation could not be fully explained by variation in incidence nor in breast cancer detection rates. It suggests the potential for wide discrepancies in management of DCIS resulting in overtreatment of indolent DCIS or undertreatment of potentially curable disease. Comprehensive cancer registration is needed to monitor DCIS detection. Efforts to understand discrepancies and standardise management may improve care.Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

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