Abstract PS16-08: Trends in LCIS Incidence from 2000-2020 Mirror USPSTF Screening Guidelines: A SEER Registry Analysis

Anna C. Beck; Madhuchhanda Roy; Ashley A. Woodfin; Benjamin W. Weber; Meeghan A. Lautner; Nicci Owusu-Brackett; Laura Bozzuto; Heather Neuman; Lee G. Wilke; Mai A. Elezaby

doi:10.1158/1557-3265.SABCS24-PS16-08

Introduction: Lobular carcinoma in situ (LCIS) is a proliferative breast lesion that is associated with an increased risk of developing breast cancer. The United States Preventative Task Force (USPSTF) screening mammography guidelines have had a significant impact on screening practice. This is especially true for women aged 40-49 who were recommended screening in the 2002-2009 guidelines but not in the 2009 guideline. The incidence and population level impact of LCIS has not been characterized in association with imaging utilization, specifically changes in the USPSTF screening mammography guidelines. We sought to determine if variations in the incidence of LCIS in the US population correlated with changes in mammographic screening guidelines. Methods: Utilizing the Surveillance, Epidemiology and End Results (SEER) 22 Registries 2000-2020, we identified all diagnoses of LCIS from 2000-2020 using the ICD-0-3 Hist/behave code 8520/2. Patients <20 years of age and those with a prior breast cancer diagnosis were excluded. Age adjusted incidence per 100,000 was analyzed for trends over the study period. Simple linear regression models were used to determine significance in trend with set at 0.05. Joinpoint version 5.0 was utilized to evaluate the average annual percent change (APC) in age-adjusted incidence over time. Inflection points were set at the years USPSTF screening mammography guidelines changed (2002 and 2009) to evaluate temporal trends before and after the change in guidelines. Results: 71,588 documented cases of LCIS were identified within the SEER database between 2000-2020. Since 2000, the age-adjusted incidence of LCIS increased from 2.8 per 100,000 to 3.0 per 100,000 in 2020 (p=0.006), with the highest incidence recorded in 2009 at a rate of 3.7 per 100,000. Between 2002 and 2009, during which time USPSTF guidelines recommended starting screening mammography at age 40, joinpoint analysis identified a significantly increased rate of LCIS diagnosis with an APC of 3.6 (confidence interval [CI] 2.2-4.7, p<0.01). Prior to this change in guidelines, from 2000-2002, APC of LCIS incidence was 0.06 (CI -5.5-2.8, p=0.84). Following 2009, when the USPSTF guidelines recommended against routine screening for women ages 40–49 and the reduced screening frequency for women ≥50, APC was -1.2 (CI –[1.8-0.31], p<0.01). Subset analysis was performed separating patients by age group given the differences in screening recommendations by age over the study period. From 2002-2009, the incidence of LCIS was found to increase the greatest in women age 40-49 (APC 5.6, CI 4.8-7.1, p<0.01), although the incidence also increased in women age 50-59 (APC 2.5, CI 1.1-3.3, p<0.01) and those aged 60-69 (APC 0.65, CI -0.01-1.6, p=0.052). From 2009-2020, however, the incidence of LCIS declined in women age 50-59 (APC -1.5, CI –[2.1-0.51], p<0.01) and age 60-69 (APC -2.0, CI –[2.5-1.7], p<0.01), while the incidence of LCIS was unchanged in women age 40-49 (APC -0.39, CI -1.1-0.28, p=0.22). Conclusions: Incidence of LCIS has increased from 2000 to 2020 with rate of change mirroring changes in USPSTF screening guidelines, with higher incidence identified when guidelines recommended initiating screening at age 40. This suggests that early initiation of screening may lead to diagnosis of LCIS at a younger age, which may allow for earlier initiation of risk-reducing interventions. Given the recent USPSTF guideline changes recommending screening mammography initiation at age 40, we anticipate a future increase in the incidence of LCIS diagnoses in screened populations and subsequently increased opportunity and demand for education, tailored supplemental screening, and risk management for these individuals with LCIS. Citation Format: Anna C Beck, Madhuchhanda Roy, Ashley A Woodfin, Benjamin W Weber, Meeghan A Lautner, Nicci Owusu-Brackett, Laura Bozzuto, Heather Neuman, Lee G Wilke, Mai A Elezaby. Trends in LCIS Incidence from 2000-2020 Mirror USPSTF Screening Guidelines: A SEER Registry Analysis [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr PS16-08.

Abstract PS16-08: Trends in LCIS Incidence from 2000-2020 Mirror USPSTF Screening Guidelines: A SEER Registry Analysis

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