Table 2.
Detection mechanism of DCIS in the CISNET models.
| Model | Clinical detection mechanism | Screen detection mechanism | Detection mechanism DCIS vs. invasive cancer |
|---|---|---|---|
| D | Some DCIS progress to clinical DCIS with symptoms - this rate matches age-specific incidence rate of DCIS in pre-screening era | Sensitivity varying by screening modality, age, calendar year | Same mechanism for DCIS and invasive cancer by test sensitivity |
| E | Some DCIS progress to clinical DCIS with symptoms - this rate matches age-specific incidence rate of DCIS in pre-screening era | Sensitivity varying by calendar year | DCIS is detected by test sensitivity; invasive disease is detected using a threshold diameter |
| GE | Progressive DCIS are clinically detected the same as more advanced lesions. Non-progressive DCIS are NEVER clinically detected. | Sensitivity varying by screening modality, age, calendar year | Same mechanism for DCIS and invasive cancer by test sensitivity |
| M | Model M makes no explicit mechanism assumptions regarding DCIS detection. | ||
| W | Some DCIS are clinically diagnosed similarly as more advanced lesions. Clinical detection probability is an increasing function of tumor size and varies by age and calendar year. Clinical detection probabilities are in general smaller than screen detection probabilities; therefore a tumor is less likely to be detected via clinical surfacing than by screening. | Sensitivity varying by is tumor size, age, calendar year | Detection probability is an increasing function of tumor size, thus because in situ are small by definition, likelihood of detection of DCIS is less than that for invasive cancer |
Model D: Dana-Farber Cancer Institute, Boston, Massachusetts. Model E: Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands. Model GE: Georgetown University Medical Center, Washington, DC, and Albert Einstein College of Medicine, Bronx, New York. Model M: MD Anderson Cancer Center, Houston, Texas. Model W: University of Wisconsin-Madison, Madison, Wisconsin, and Harvard Medical School, Boston, Massachusetts.