Abstract
BackgroundThe incidence of ductal carcinoma in situ (DCIS) has increased substantially since the introduction of mammography screening. Nevertheless, little is known about the natural history of preclinical DCIS in the absence of biopsy or complete excision.MethodsTwo well-established population models evaluated six possible DCIS natural history submodels. The submodels assumed 30%, 50%, or 80% of breast lesions progress from undetectable DCIS to preclinical screen-detectable DCIS; each model additionally allowed or prohibited DCIS regression. Preclinical screen-detectable DCIS could also progress to clinical DCIS or invasive breast cancer (IBC). Applying US population screening dissemination patterns, the models projected age-specific DCIS and IBC incidence that were compared to Surveillance, Epidemiology, and End Results data. Models estimated mean sojourn time (MST) in the preclinical screen-detectable DCIS state, overdiagnosis, and the risk of progression from preclinical screen-detectable DCIS.ResultsWithout biopsy and surgical excision, the majority of DCIS (64–100%) in the preclinical screen-detectable state progressed to IBC in submodels assuming no DCIS regression (36–100% in submodels allowing for DCIS regression). DCIS overdiagnosis differed substantially between models and submodels, 3.1–65.8%. IBC overdiagnosis ranged 1.3–2.4%. Submodels assuming DCIS regression resulted in a higher DCIS overdiagnosis than submodels without DCIS regression. MST for progressive DCIS varied between 0.2 and 2.5 years.ConclusionsOur findings suggest that the majority of screen-detectable but unbiopsied preclinical DCIS lesions progress to IBC and that the MST is relatively short. Nevertheless, due to the heterogeneity of DCIS, more research is needed to understand the progression of DCIS by grades and molecular subtypes.
Highlights
With the introduction of mammographic screening, the incidence of ductal carcinoma in situ (DCIS) has increased rapidly due to the ability of mammography to identify associated microcalcifications
Model D showed higher DCIS incidence in later years when regression was allowed compared to no regression, except for submodel 3 where the incidence was similar regardless of DCIS regression
Our modeling work showed that several different natural history models fit the observed trends, making any firm conclusions about the DCIS natural history based on observation data difficult
Summary
With the introduction of mammographic screening, the incidence of ductal carcinoma in situ (DCIS) has increased rapidly due to the ability of mammography to identify associated microcalcifications. In the USA, DCIS incidence rate among women older than 40 years increased from 5.6 per 100, 000 women in 1990–1994 to 31.6 per 100,000 women in 2010–2014 [1]. The detection of DCIS has increased substantially relative to detection of invasive breast cancer, its natural history remains poorly understood. The incidence of ductal carcinoma in situ (DCIS) has increased substantially since the introduction of mammography screening. Little is known about the natural history of preclinical DCIS in the absence of biopsy or complete excision
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