Published 9 March 2009, doi:10.1136/bmj.b957
Cite this as: BMJ 2009;338:b957

Letters

Breast screening

Will ductal carcinoma in situ defeat breast cancer screening?

The first 150 words of the full text of this article appear below.

Gøtzsche and colleagues focus on the inadequacy of patient information leaflets in the NHS breast screening programme.1

The failure to disclose information on ductal carcinoma in situ has aptly been described by a patient representative as a "closely guarded state secret." Ductal carcinoma in situ constitutes up to a fifth of screen detected cancers but only 2-5% of symptomatic tumours before national screening.2 Its occurrence in 15-39% of routine autopsy studies suggests that some non-invasive lesions detected mammographically and subsequently excised would have been of no clinical consequence during their lifetime.3 4

This non-obligate progression (especially of non-high grade lesions) poses a dilemma in clinical management of non-invasive disease.5 Once ductal carcinoma in situ has been detected, treatment must be offered, which mandates mastectomy in about 30% of cases and often radiotherapy in cases amenable to breast conservation. Undoubtedly some patients with low grade lesions undergo surgery for a condition which . . . [Full text of this article]

John R Benson, consultant breast surgeon1

1 Addenbrooke’s Hospital, Cambridge CB2 0QQ

john.benson@addenbrookes.nhs.uk


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Relevant Article

Breast screening: the facts—or maybe not
Peter C Gøtzsche, Ole J Hartling, Margrethe Nielsen, John Brodersen, and Karsten Juhl Jørgensen
BMJ 2009 338: b86. [Extract] [Full Text]

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