BCSC Model Predicts Risk of Screen-Detected DCIS According to Clinical Risk Factors and Mammography Screening Interval
New BCSC study will inform policymakers’ discussions of screening strategies
Detection of ductal carcinoma in situ (DCIS) by mammography screening is a controversial outcome with potential benefits and harms. Because DCIS can be a precursor to invasive breast cancer, the detection and treatment of DCIS may reduce the risk of subsequent invasive disease; yet there is also concern that a substantial fraction of screen-detected DCIS may never have led to invasive cancer if left untreated (“overdiagnosis”). A new study from the BCSC sought to develop a 6-year risk prediction model for screen-detected DCIS according to mammography screening interval and women’s risk factors. Using data from over 3 million mammography screening exams, the authors developed a well-calibrated model to predict cumulative 6-year risk of screen-detected DCIS after 6 annual, 3 biennial, or 2 triennial screening exams. The authors found that cumulative 6-year screen-detected DCIS risk increased with age and shorter screening interval. Compared with women undergoing biennial mammography, those undergoing annual mammography had a 40% to 45% higher 6-year cumulative risk of screen-detected DCIS, whereas those undergoing triennial mammography had lower risk. DCIS risk also varied substantially by menopausal status, race and ethnicity, family history of breast cancer, benign breast biopsy history, breast density, body mass index, age at first birth, and false-positive mammography history.
The results of this study demonstrate wide variation in the probability of DCIS detection over a 6-year period according to screening interval and clinical risk factors. This new BCSC risk model permits estimation of the probability of screen-detected DCIS during a 6-year time horizon according to mammography screening frequency and women’s risk factors. The findings can be used by policy makers assessing the balance of benefits and harms of different screening strategies, in conjunction with existing risk models for other screening outcomes, such as advanced cancers and false-positive mammography results. The risk model can also be used by women and healthcare providers to estimate the probability of DCIS detection for an individual woman under different screening regimens.
Sprague BL, Chen S, Miglioretti DL, Gard CC, Tice JA, Hubbard RA, Aiello Bowles EJ, Kaufman PA, Kerlikowske K. Cumulative 6-Year Risk of Screen-Detected Ductal Carcinoma In Situ by Screening Frequency. JAMA Netw Open. 2023 Feb 1;6(2):e230166. PMC9941892. [Link]
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Posted by: Brian Sprague