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Low-grade screen-detected ductal carcinoma in situ progresses more slowly than high-grade lesions: evidence from an international multi-centre study



Nuclear grade is an important indicator of the biological behaviour of ductal carcinoma in situ (DCIS). De-escalation of treatment has been suggested for low-grade DCIS. Our aim is to estimate the relative rate of progression of DCIS by nuclear grade by analysing the distribution of nuclear grade by detection at initial or subsequent screening.


We asked International Cancer Screening Network sites to complete, based on their screening and clinical databases, an aggregated data file on DCIS detection, diagnosis and treatment.


Eleven screening programs reported 5068 screen-detected pure DCIS in nearly 7 million screening tests in women 50–69 years of age. For all programs combined, low-grade DCIS were 20.1% (range 11.4–31.8%) of graded DCIS, intermediate grade 31.0% and high grade 48.9%. Detection rates decreased more steeply from initial to subsequent screening in low compared to high-grade DCIS: the ratios of subsequent to initial detection rates were 0.39 for low grade, 0.51 for intermediate grade, and 0.75 for high grade (p < 0.001).


These results suggest that the duration of the preclinical detectable phase is longer for low than for high-grade DCIS. The findings from this large multi-centre, international study emphasize that the management of low-grade DCIS should be carefully scrutinized in order to minimize overtreatment of screen-detected slow-growing or indolent lesions. The high variation by site in the proportion of low grade suggests that further pathology standardization and training would be beneficial.

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The authors thank the members of the ICSN DCIS Working group, the national and regional screening programs coordinators, and all professionals involved in breast cancer screening and treatment in participating centres for their contribution to this study.


No specific funding was made available for this study, but the US National Cancer Institute (NCI) provided co-ordination of the project and secretarial support. The content of this paper is solely the responsibility of the authors and does not represent the official view of the NCI or the National Institutes of Health.

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Correspondence to Antonio Ponti.

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Ponti, A., Ronco, G., Lynge, E. et al. Low-grade screen-detected ductal carcinoma in situ progresses more slowly than high-grade lesions: evidence from an international multi-centre study. Breast Cancer Res Treat 177, 761–765 (2019).

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  • Breast cancer screening
  • Ductal carcinoma in situ
  • Low-grade DCIS
  • Overtreatment