Objectives To evaluate the long term risks of invasive breast cancer and death related to breast cancer after non-screen detected ductal carcinoma in situ. Risks for women in the general population and for women diagnosed with ductal carcinoma in situ via the screening programme were compared. Design Population based cohort study. Setting Data from the National Disease Registration Service. Participants All 27 543 women in England who were diagnosed with ductal carcinoma in situ, outside the NHS breast screening programme, during 1990 to 2018. Main outcome measures Incident invasive breast cancer and death caused by breast cancer. Results By 31 December 2018, 3651 women with non-screen detected ductal carcinoma in situ had developed invasive breast cancer, more than four times higher than expected from national cancer incidence rates (ratio of observed to expected rate was 4.21 (95% conference interval 4.07 to 4.35)). The ratio of observed to expected rate of developing invasive breast cancer remained increased throughout follow-up among women aged <45-70 years. The 25 year cumulative risks of invasive breast cancer by age at diagnosis of ductal carcinoma in situ were 27.3% for <45 years, 25.2% for 45-49 years, 21.7% for 50-59 years, and 20.8% for 60-70 years. 908 women died of breast cancer, almost four times higher than that expected from breast cancer death rates in the general population (ratio of observed to expected rate 3.83 (3.59 to 4.09)). The ratio of observed to expected rate of mortality attributed to breast cancer remained increased throughout follow-up. The 25 year cumulative risks of breast cancer death by age at ductal carcinoma in situ diagnosis were 7.6% for <45 years, 5.8% for 45-49 years, 5.9% for 50-59 years, and 6.2% for 60-70 years. Among women aged 50-64 years, and therefore eligible for breast screening by the NHS, the ratio of observed to expected rate of invasive breast cancer in women with non-screen detected compared with screen detected ductal carcinoma in situ was 1.26 (95% conference interval 1.17 to 1.35), while the ratio for mortality from breast cancer was 1.37 (1.17 to 1.60). Among 22 753 women with unilateral ductal carcinoma in situ undergoing surgery, those who had mastectomy rather than breast conserving surgery had a lower 25 year cumulative rate of ipsilateral invasive breast cancer (mastectomy 8.2% (95% conference interval 7.0% to 9.4%), breast conserving surgery with radiotherapy 19.8% (16.2% to 23.4%), and breast conserving surgery with no radiotherapy recorded 20.6% (18.7% to 22.4%)). However, reductions did not translate into a lower 25 year cumulative rate of deaths attributable to breast cancer (mastectomy 6.5% (4.9% to 10.9%), breast conserving surgery with radiotherapy 8.6% (5.9% to 15.5%), breast conserving surgery with no radiotherapy recorded 7.8% (6.3% to 11.5%)). Conclusions For at least 25 years after their diagnosis, women with non-screen detected ductal carcinoma in situ had higher long term risks of invasive breast cancer and breast cancer death than women in the general population. Additionally, they had higher long term risks than women with screen detected ductal carcinoma in situ. Mastectomy was associated with lower risks of invasive breast cancer than breast conserving surgery, even when accompanied by radiotherapy. However, risks of breast cancer death appeared similar for mastectomy, breast conserving surgery with radiotherapy, and breast conserving surgery with no radiotherapy recorded. De-personalised study data may be made available on request to accredited researchers who submit a proposal that is approved by NHS Digital’s Data Access Request Service.

中文翻译：

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1990 年至 2018 年英格兰浸润性乳腺癌和非筛查检测到导管原位癌后乳腺癌死亡：基于人群的队列研究


目的 评估未筛查检测到导管原位癌后浸润性乳腺癌和乳腺癌相关死亡的长期风险。比较了普通人群中女性和通过筛查计划诊断为导管原位癌的女性的风险。设计 基于人群的队列研究。设置来自国家疾病登记局的数据。参与者 1990 年至 2018 年期间，英格兰所有 27 543 名被诊断出患有导管原位癌的女性，这些女性在 NHS 乳房筛查计划之外。主要结局指标 浸润性乳腺癌的发病率和乳腺癌引起的死亡。结果截至 2018 年 12 月 31 日，3651 名未筛查检测到导管原位癌的女性已发展为浸润性乳腺癌，比全国癌症发病率预期的高出四倍多（观察率与预期率之比为 4.21 （95% 会议间隔 4.07 至 4.35））。在整个随访过程中，<45-70 岁女性的浸润性乳腺癌发生率与预期发病率之比保持增加。按诊断为导管原位癌的年龄划分的 25 年浸润性乳腺癌累积风险为 <45 年 27.3%，45-49 岁 25.2%，50-59 岁 21.7%，60-70 岁 20.8%。908 名女性死于乳腺癌，几乎是普通人群乳腺癌死亡率预期死亡率的四倍（观察到的死亡率与预期死亡率之比 3.83（3.59 至 4.09））。在整个随访过程中，归因于乳腺癌的观察死亡率与预期死亡率的比率保持增加。导管原位癌诊断时按年龄划分的乳腺癌死亡 25 年累积风险为 <45 年 7.6%，45-49 岁为 5.8%，50-59 岁为 5.9%，60-70 岁为 6.2%。 在 50-64 岁且因此有资格接受 NHS 乳房筛查的女性中，与筛查检测到的导管原位癌相比，未筛查检测到的女性浸润性乳腺癌的观察率与预期发病率之比为 1.26（95% 会议区间为 1.17 至 1.35），而乳腺癌死亡率为 1.37（1.17 至 1.60）。在 22 753 例接受手术的单侧导管原位癌女性中，接受乳房切除术而非保乳手术的同侧浸润性乳腺癌 25 年累积发生率较低 （乳房切除术 8.2% （95% 会议间隔 7.0% 至 9.4%），保乳手术联合放疗 19.8% （16.2% 至 23.4%），保乳手术无放疗记录为 20.6% （18.7% 至 22.4%））。然而，减少并未转化为较低的 25 年乳腺癌累积死亡率（乳房切除术 6.5%（4.9% 至 10.9%），保乳手术联合放疗 8.6%（5.9% 至 15.5%），无放疗保乳手术记录 7.8%（6.3% 至 11.5%））。结论 在诊断后至少 25 年内，未筛查检测到导管原位癌的女性比普通人群中的女性具有更高的浸润性乳腺癌和乳腺癌死亡的长期风险。此外，与筛查检测到导管原位癌的女性相比，她们的长期风险更高。与保乳手术相比，乳房切除术与浸润性乳腺癌的风险较低相关，即使伴有放疗也是如此。然而，乳房切除术、放疗保乳手术和无放疗记录的保乳手术的乳腺癌死亡风险似乎相似。 非个性化的研究数据可应要求提供给经认证的研究人员，这些研究人员提交的提案已获得 NHS Digital 的数据访问请求服务批准。