Invasive Breast Cancer and Mortality Risks after Non-Screen Detected Ductal Carcinoma In Situ: A 28-Year Cohort Study in England

This study, published in BMJ in 2024, investigates the long-term risks of invasive breast cancer and breast cancer mortality following a diagnosis of non-screen detected ductal carcinoma in situ (DCIS) in England from 1990 to 2018. The researchers conducted a population-based cohort study using data from 27,543 women diagnosed with non-screen detected DCIS. They found that these women had a significantly higher risk of developing invasive breast cancer and dying from breast cancer compared to the general population. Specifically, by 2018, 3,651 women had developed invasive breast cancer, and 908 perished from breast cancer, rates four times higher than expected based on national cancer incidence and death rates.

The study revealed that the risk of invasive breast cancer and breast cancer death remained elevated for at least 25 years post-diagnosis. The risk was exceptionally high in women diagnosed before the age of 45 or after 70, who are not typically included in breast screening programs. The study also compared women with non-screen-detected DCIS to those with screen-detected DCIS, finding that the former had slightly higher risks of invasive breast cancer and death.

Regarding treatment, women who underwent mastectomy had a lower risk of invasive breast cancer compared to those who had breast-conserving surgery, regardless of radiotherapy. However, this difference in treatment did not translate into a lower rate of breast cancer deaths.

These findings suggest a need for extended surveillance and tailored management strategies for women diagnosed with non-screen detected DCIS, particularly for younger patients. The study emphasizes the importance of considering the detection mode in treatment decisions and highlights the need for ongoing research to optimize management strategies for DCIS.

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[Source: The BMJ, January 24th, 2024]