Incidence of and treatment for ductal carcinoma in situ of the breast
Incidence of and treatment for ductal carcinoma in situ of the breast
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DOI：
10.1001/jama.275.12.913
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发表时间：
1996-03-27
影响因子：
120.7
通讯作者：
Henderson, IC
中科院分区：
文献类型：
--
作者：
Ernster, VL;Barclay, J;Henderson, IC
客观。-描述1973年至1992年美国乳腺导管原位癌（DCIS）的发病率和治疗趋势，并估计自1983年以来诊断的原位病例总数和乳房切除术治疗的人数，当时乳腺癌的筛查性乳房X线摄影术开始普及。分析自1973年以来由国家癌症研究所的监测，流行病学和最终结果（SEER）计划收集的基于人群的乳腺癌发病率数据和自1983年以来由SEER计划收集的治疗数据。所有妇女在美国的地理区域包括在SEER程序。主要结果测量。DCIS的年年龄调整和年龄特异性发病率;按治疗类型划分的病例分布的时间趋势;按地理区域划分的乳房切除术治疗病例的百分比;以及整个美国DCIS病例、DCIS乳房切除术和乳腺X线检查病例的估计数量。从20世纪80年代初开始，DCIS的发病率显著增加。1973至1983年和1983至1992年期间，30至39岁妇女的平均年增长率为0.3%至12.0%，40至49岁妇女的增长率为0.4%至17.4%，50岁或50岁以上妇女的增长率为5.2%至18.1%。根据1983年的发病率和1973年至1983年的趋势，1992年美国DCIS病例的估计总数（23368例）比预期高出200%。通过乳房切除术治疗的DCIS病例比例显著下降，（从71%增加到43.8%），而接受肿块切除术的患者增加（从25.6%增加到53.3%）。1992年，23.3%的病例接受乳房肿瘤切除术和放射治疗，30.2%仅接受乳房肿瘤切除术，2.6%不接受手术。治疗模式因地理区域而异，1992年新墨西哥州有57.7%的病例接受乳房切除术治疗，而康涅狄格州为28.8%。尽管接受乳房切除术治疗的病例比例下降，DCIS发病率的增加导致了乳腺切除术治疗的绝对病例数的增加，直到1990年（n= 10657）;在1992年，估计有10242例DCIS病例接受了乳腺切除术治疗。这一增长与现代乳腺X线筛查的广泛采用有关。虽然浸润性乳腺癌的早期检测是有益的，但DCIS检测的价值目前尚不清楚。值得关注的是，大量的DCIS病例是通过筛查性乳房X光检查诊断出来的，其中大多数都是通过某种形式的手术治疗的。此外，通过乳房切除术治疗的病例比例可能过高，特别是在美国的一些地区。
Objective.-To describe trends in incidence and treatment for ductal carcinoma in situ (DCIS) of the breast in the United States between 1973 and 1992 and to estimate total numbers of in situ cases diagnosed and numbers treated by mastectomy since 1983, when screening mammography for breast cancer began to become widespread.Design.-Analysis of population-based breast cancer incidence data collected by the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program since 1973 and treatment data collected by the SEER program since 1983.Study Population.-All women in the geographic areas of the United States included in the SEER program.Main Outcome Measures.-Annual age-adjusted and age-specific incidence rates for DCIS; time trends in distribution of cases by type of treatment; percentage of cases treated by mastectomy by geographic area; and estimated numbers for the entire United States of DCIS cases, mastectomies for DCIS, and cases attributable to mammography.Results.-There was a marked increase in DCIS incidence beginning in the early 1980s. Average annual increases in rates between 1973 and 1983 and between 1983 and 1992 changed from 0.3% to 12.0% among women aged 30 to 39 years, from 0.4% to 17.4% among women aged 40 to 49 years, and from 5.2% to 18.1% among women aged 50 years or older. The total estimated number of DCIS cases in the United States in 1992 (23 368) was 200% higher than expected based on 1983 rates and trends between 1973 and 1983, Between 1983 and 1992, there was a marked decline in the proportion of DCIS cases treated by mastectomy (from 71% to 43.8%) and an increase in those treated by lumpectomy (from 25.6% to 53.3%). In 1992, 23.3% of cases were treated by lumpectomy and radiation, 30.2% by lumpectomy alone, and 2.6% with no surgery, Treatment patterns varied substantially by geographic area, with 57.7% of cases in New Mexico treated by mastectomy in 1992 compared with 28.8% in Connecticut, Despite the decline in the proportion of cases treated by mastectomy, the increased DCIS incidence rates resulted in an increase in the absolute number of cases treated by mastectomy until 1990 (n=10 657); in 1992, there were an estimated 10 242 DCIS cases treated by mastectomy.Conclusions-Incidence rates of DCIS of the breast have increased dramatically since 1983. This increase correlates with the widespread adoption of modern mammographic screening. While early detection of invasive breast cancer is beneficial, the value of DCIS detection is currently unknown. There is cause for concern about the large number of DCIS cases that are being diagnosed as a consequence of screening mammography, most of which are treated; by some form of surgery. In addition, the proportion of cases treated by mastectomy may be inappropriately high, particularly in some areas of the United States.