DCIS (ductal carcinoma in situ) is the most common form of non-invasive breast cancer and is considered stage 0 cancer. Even though DCIS is always considered stage 0, it can be any size and be located in any number of areas inside the breast. While DCIS isn’t considered life threatening, it does increase the risk of developing invasive breast cancer later in life.
There are three grades of DCIS: low, or grade I; moderate, or grade II; and high, or grade III. The lower the grade, the more closely the cancer cells resemble normal breast cells and the more slowly they grow. Low-grade DCIS cells look very similar to normal cells. Moderate-grade DCIS cells grow faster than normal cells and look less like them. High-grade DCIS cells tend to grow more quickly and look much different from healthy breast cells. People with high-grade DCIS have a higher risk of invasive cancer, either when the DCIS is diagnosed or at some point in the future. They also have a higher risk of the cancer coming back earlier -- within the first 5 years rather than after 5 years.
A study has found that as women age, digital mammograms are better at finding high-grade DCIS.
The research was published online on Oct. 27, 2015 by the journal Radiology. Read the abstract of “Digital Mammography Screening: Does Age Influence the Detection Rates of Low-, Intermediate-, and High-Grade Ductal Carcinoma in Situ?”
This study was a retrospective study, which means the researchers analyzed information that was collected before the study was designed.
The researchers looked at the records of 733,905 women aged 50 to 69 who were participating in a breast cancer screening program for the first time in 2005 to 2008. The women were divided into 5-year age groups.
The researchers then figured out how many cases of DCIS were found by mammogram and whether the mammogram could distinguish between high-grade, moderate-grade, and low-grade DCIS.
Overall, there were 989 DCIS diagnoses among the women:
- 419 were high-grade
- 388 were moderate-grade
- 182 were low-grade
DCIS detection rates were higher for women who were older. DCIS detection rates by age group were:
- 50-54 years: 1.15%
- 55-59 years: 1.23%
- 60-64 years: 1.34%
- 65-69 years: 1.17%
"The detection rate of high-grade DCIS in our collective showed a statistically significant increase with age, with a maximum rate at the oldest assessed age group of 65 to 69 years," said the study's lead author, Stefanie Weigel, M.D., of the University Hospital Muenster in Muenster, Germany.
According to Dr. Weigel, the results underscore the need for more research on the effectiveness of standard DCIS treatments in women older than 60, a group for which there is little information.
Doctors need to weigh the risk of potentially overtreating DCIS that might not develop into invasive disease with the very real possibility that high-grade DCIS is more likely to come back and or progress to invasive breast cancer.
"Adequate therapy of non-symptomatic high-grade DCIS detected at screening needs further evaluation, as there is the chance to prevent aggressive invasive breast cancer, which could be life-threatening even in older age groups," said Dr. Weigel. "In terms of overdiagnosis and overtreatment, there is need for more detailed prognostic characterization of DCIS lesions and weighting them in the context of age."
These results also add more information to the debate over breast cancer screening in older women. Most groups recommend that women get screened as long as they are healthy. On the other hand, the U.S. Preventive Services Task Force recommends that screening stop at age 74.
At Breastcancer.org, we believe that ALL women should have mammograms annually starting at age 40 and should continue having them as long as they would want to be treated for any invasive breast cancer or DCIS that is found.
There's only one of you and you deserve the best care possible. Don't let any obstacles get in the way of your regular screening mammograms.
- If you're worried about cost, talk to your doctor, a local hospital social worker, or staff members at a mammogram center. Ask about free programs in your area.
- If you're having problems scheduling a mammogram, call the National Cancer Institute (800-4-CANCER) or the American College of Radiology (800-227-5463) to find certified mammogram providers near you.
- If you find mammograms painful, ask the mammography center staff members how the experience can be as easy and as comfortable as possible for you.
- If you’re concerned about unknown results or being called back for more testing, talk to your doctor about what happens when mammogram results are unclear, as well as what to expect if you’re called back for more testing.
For more information on mammograms and other tests to detect and diagnose breast cancer, visit the Breastcancer.org Screening and Testing section.