%0 Journal Article
%T Overdiagnosis and overtreatment of breast cancer: Rates of ductal carcinoma in situ: a US perspective
%A Anjali S Kumar
%A Vinona Bhatia
%A I Craig Henderson
%J Breast Cancer Research
%D 2005
%I BioMed Central
%R 10.1186/bcr1346
%X The incidence of breast ductal carcinoma in situ (DCIS) has increased steadily in all countries as the use of screening mammography has increased [1]. In the USA the incidence of DCIS remained below 5 per 100,000 and DCIS constituted 2.8 to 3.8% of breast cancers diagnosed between 1973 and 1984 [2]. It now exceeds 30 per 100,000 and constitutes 18.6% [3]. During this time the percentage of American women aged 50 years and over who reported having a recent mammogram increased from 27% in 1987 to 69% in 1998 [4]. Cancers detected by screening are more likely to be DCIS, ranging from 18 to 33% in various studies [5].DCIS with comedo histology is one of the subtypes most likely to recur with an invasive histology [6]. From 1992 to 1999, when the overall incidence of DCIS in the USA increased by 73%, there was no increase in the incidence of comedo histology [7,8]. Several explanations have been suggested for this, the most plausible being that DCIS found in women undergoing screening mammography is more likely to be the non-comedo variety [7].Although the correlation between increased DCIS with increased use of mammography seems to be universal, the frequency of DCIS is still higher in the USA than in other countries with similar mammography use (Table 1). The incidence of carcinoma in situ (ductal plus lobular) had increased in the USA, England and Switzerland by 1990 [8-10]. However, DCIS incidence in the USA was about thrice that in England and Switzerland. For the early dates, mammography rates might account for the difference in the incidence of DCIS between America and Europe. That is less true today.Recommendations for screening in the USA and UK are quite different. In the USA there is no national policy, but most organizations, such as the American Cancer Society, recommend mammograms every 1 or 2 years for women more than 50 years old and many recommend initiating yearly mammograms at the age of 40 years [11]. In the UK, it is national policy to obtain mammogr
%U http://breast-cancer-research.com/content/7/6/271