Objective To evaluate the long term risks of invasive breast cancer and death from breast cancer after ductal carcinoma in situ (DCIS) diagnosed through breast screening. Design Population based observational cohort study. Setting Data from the NHS Breast Screening Programme and the National Cancer Registration and Analysis Service. Participants All 35 024 women in England diagnosed as having DCIS by the NHS Breast Screening Programme from its start in 1988 until March 2014. Main outcome measures Incident invasive breast cancer and death from breast cancer. Results By December 2014, 13 606 women had been followed for up to five years, 10 998 for five to nine years, 6861 for 10-14 years, 2620 for 15-19 years, and 939 for at least 20 years. Among these women, 2076 developed invasive breast cancer, corresponding to an incidence rate of 8.82 (95% confidence interval 8.45 to 9.21) per 1000 women per year and more than double that expected from national cancer incidence rates (ratio of observed rate to expected rate 2.52, 95% confidence interval 2.41 to 2.63). The increase started in the second year after diagnosis of DCIS and continued until the end of follow-up. In the same group of women, 310 died from breast cancer, corresponding to a death rate of 1.26 (1.13 to 1.41) per 1000 women per year and 70% higher than that expected from national breast cancer mortality rates (observed:expected ratio 1.70, 1.52 to 1.90). During the first five years after diagnosis of DCIS, the breast cancer death rate was similar to that expected from national mortality rates (observed:expected ratio 0.87, 0.69 to 1.10), but it then increased, with values of 1.98 (1.65 to 2.37), 2.99 (2.41 to 3.70), and 2.77 (2.01 to 3.80) in years five to nine, 10-14, and 15 or more after DCIS diagnosis. Among 29 044 women with unilateral DCIS undergoing surgery, those who had more intensive treatment (mastectomy, radiotherapy for women who had breast conserving surgery, and endocrine treatment in oestrogen receptor positive disease) and those with larger final surgical margins had lower rates of invasive breast cancer. Conclusions To date, women with DCIS detected by screening have, on average, experienced higher long term risks of invasive breast cancer and death from breast cancer than women in the general population during a period of at least two decades after their diagnosis. More intensive treatment and larger final surgical margins were associated with lower risks of invasive breast cancer.

中文翻译：

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1988-2014 年英国参加乳腺筛查的女性中浸润性乳腺癌和导管原位癌后乳腺癌死亡率：基于人群的观察性队列研究。


目的 评估通过乳腺筛查诊断出导管原位癌（DCIS）后发生浸润性乳腺癌和乳腺癌死亡的长期风险。设计基于人群的观察性队列研究。设置来自 NHS 乳腺筛查计划和国家癌症登记和分析服务的数据。参与者 NHS 乳腺筛查计划从 1988 年启动到 2014 年 3 月期间，共有 35 024 名英格兰女性被诊断为 DCIS。主要结果指标是浸润性乳腺癌发生率和乳腺癌死亡率。结果 截至 2014 年 12 月，13 606 名女性接受了长达 5 年的随访，10 998 名女性接受了 5 至 9 年的随访，6 861 名女性接受了 10-14 年的随访，2 620 名女性接受了 15-19 年的随访，939 名女性接受了至少 20 年的随访。在这些女性中，有 2076 人罹患浸润性乳腺癌，相应的发病率为每年每 1000 名女性 8.82 例（95% 置信区间为 8.45 至 9.21），是全国癌症发病率预期（观察率与预期率之比）的两倍多2.52，95% 置信区间 2.41 至 2.63）。这种增加从诊断 DCIS 后的第二年开始，一直持续到随访结束。在同一组女性中，有 310 人死于乳腺癌，相当于每年每 1000 名女性中有 1.26 人（1.13 至 1.41 人）的死亡率，比全国乳腺癌死亡率的预期高出 70%（观察值：预期比 1.70， 1.52 至 1.90）。在诊断为 DCIS 后的前五年内，乳腺癌死亡率与全国死亡率的预期相似（观察值：预期比 0.87、0.69 至 1.10），但随后有所上升，值为 1.98（1.65 至 2.37） DCIS 诊断后第 5 至 9 年、10-14 年和 15 年或更长时间为 2.99（2.41 至 3.70）和 2.77（2.01 至 3.80）。 在 29 044 名接受手术的单侧 DCIS 女性中，那些接受更强化治疗（乳房切除术、对进行保乳手术的女性进行放射治疗、对雌激素受体阳性疾病进行内分泌治疗）和最终手术切缘较大的女性，浸润性乳腺发生率较低癌症。结论 迄今为止，通过筛查发现的 DCIS 女性在诊断后至少 20 年内，平均患浸润性乳腺癌和乳腺癌死亡的长期风险高于普通人群的女性。更强化的治疗和更大的最终手术切缘与更低的浸润性乳腺癌风险相关。