Correlating Screening and Ductal Carcinoma in Situ Incidence Rates in the US
*Biqi Zhang1, *Tawakalitu S. Oseni2, Suzanne B. Coopey2, *Michele A. Gadd2, *Kevin S. Hughes2, *David C. Chang2
1Harvard Medical School, Boston, MA; 2Massachusetts General Hospital, Boston, MA
The rising incidence of DCIS since widespread mammography screening has been documented in the general US population. Patterns across women of different age and racial/ethnic groups have not been well described.
A retrospective cohort study of the Surveillance, Epidemiology, and End Results (SEER) dataset from 1990-2014 was performed. SEER data were linked to screening information from the Centers for Disease Control and Prevention.
All women aged >40 years and diagnosed with DCIS were included. Age group (40-49, 50-64, >65) and race/ethnicity—mutually exclusive categories of non-Hispanic white (white), non-Hispanic black (black), and Hispanic—were determined.
Main Outcome Measure(s)
Annual incidence rates were calculated and compared by age and race/ethnicity. The relationship between incidence and screening rates was tested after adjusting for patient characteristics.
201,574 women aged >40 years with DCIS were identified. Screening compliance and incidence rates increased across all ages and ethnicities (Figure 1). Between 1990 and 2014, DCIS incidence increased from 12.5 to 31.8 per 100,000 individuals for women aged >40 years, representing a 254% increase (269% for 40-49, 243% for 50-64, 224% for >65). On adjusted analysis, incidence was found to increase by 0.9 per 100,000 individuals (95% confidence interval 0.7-1.0) with each additional percent of women receiving a mammogram.
Between 1990 and 2014, DCIS incidence rose significantly across all ethnic groups for women aged >40 years, with the greatest magnitude of increase seen for women aged 40-49 years. Incidence was significantly correlated with increased mammography screening.