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A new study published in The BMJ reveals that women diagnosed with ductal carcinoma in situ (DCIS) outside the NHS breast screening program face a significantly higher risk of developing invasive breast cancer and dying from breast cancer compared to the general population. The increased risk persists for at least 25 years after diagnosis, indicating the potential need for extended monitoring. DCIS is characterized by malignant breast cells within the milk ducts, posing a future risk of invasive breast cancer. While NHS breast screening typically identifies DCIS, some cases occur outside the program.
Researchers utilized data from the National Disease Registration Service to assess the rates of invasive breast cancer and breast cancer-related deaths after non-screen detected DCIS. The study involved 27,543 women in England diagnosed with DCIS outside the NHS screening program between 1990 and 2018. Findings indicated that 3651 women developed invasive breast cancer, a rate more than four times higher than expected from national rates. Additionally, 908 women died from breast cancer, nearly four times the expected number. The elevated risk persisted for at least 25 years post-DCIS diagnosis.
While the study is observational and has limitations related to lifestyle and health-related behavior data, the researchers emphasize the high quality of the data supporting their conclusions. Currently, women diagnosed with DCIS receive yearly mammograms for the initial five years, with those aged 50-70 entering the NHS screening program afterward. The study suggests that the increased risk of invasive disease and breast cancer death following a DCIS diagnosis lasts for at least 25 years. The findings prompt considerations for surveillance frequency and duration, particularly for women diagnosed at younger ages.
In a linked editorial, researchers inquire about the possibility of risk-based screening and follow-up after a DCIS diagnosis, highlighting the importance of a more personalized approach, especially for younger women. Factors such as family history and genetic variants should be considered, and the study’s relevance lies in shedding light on the risks of non-screen detected DCIS amid ongoing discussions about overdiagnosis and overtreatment. The results also suggest the potential recommendation for longer follow-up after DCIS diagnosis, contributing essential information for the development of personalized risk-based screening strategies.
