Long-term effects of the interruption of the Dutch breast cancer screening program due to COVID-19:A modelling study

Due to COVID-19, the Dutch breast cancer screening program was interrupted for three months with uncertain long-term effects. The aim of this study was to estimate the long-term impact of this interruption on delay in detection, tumour size of screen-detected breast cancers, and interval cancer rate. After validation, the micro-simulation model SiMRiSc was used to calculate the effects of interruption of the breast cancer screening program for three months and for hypothetical interruptions of six and twelve months. A scenario without interruption was used as reference. Outcomes considered were tumour size of screen-detected breast cancers and interval cancer rate. Women of 55–59 and 60–64 years old at time of interruption were considered. Uncertainties were estimated using a sensitivity analysis. The three-month interruption had no clinically relevant long-term effect on the tumour size of screen-detected breast cancers. A 19% increase in interval cancer rate was found between last screening before and first screening after interruption compared to no interruption. Hypothetical interruptions of six and twelve months resulted in larger increases in interval cancer rate of 38% and 78% between last screening before and first screening after interruption, respectively, and an increase in middle-sized tumours in first screening after interruption of 26% and 47%, respectively. In conclusion, the interruption of the Dutch screening program is not expected to result in a long-term delay in detection or clinically relevant change in tumour size of screen-detected cancers, but only affects the interval cancer rate between last screening before and first screening after interruption

Cost-effectiveness of abbreviated-protocol MRI screening for women with mammographically dense breasts in a national breast cancer screening program

INTRODUCTION: Magnetic resonance imaging (MRI) has shown the potential to improve the screening effectiveness among women with dense breasts. The introduction of fast abbreviated protocols (AP) makes MRI more feasible to be used in a general population. We aimed to investigate the cost-effectiveness of AP-MRI in women with dense breasts (heterogeneously/extremely dense) in a population-based screening program. METHODS: A previously validated model (SiMRiSc) was applied, with parameters updated for women with dense breasts. Breast density was assumed to decrease with increased age. The base scenarios included six biennial AP-MRI strategies, with biennial mammography from age 50–74 as reference. Fourteen alternative scenarios were performed by varying screening interval (triennial and quadrennial) and by applying a combined strategy of mammography and AP-MRI. A 3% discount rate for both costs and life years gained (LYG) was applied. Model robustness was evaluated using univariate and probabilistic sensitivity analyses. RESULTS: The six biennial AP-MRI strategies ranged from 132 to 562 LYG per 10,000 women, where more frequent application of AP-MRI was related to higher LYG. The optimal strategy was biennial AP-MRI screening from age 50–65 for only women with extremely dense breasts, producing an incremental cost-effectiveness ratio of € 18,201/LYG. At a threshold of € 20,000/LYG, the probability that the optimal strategy was cost-effective was 79%. CONCLUSION: Population-based biennial breast cancer screening with AP-MRI from age 50–65 for women with extremely dense breasts might be a cost-effective alternative to mammography, but is not an option for women with heterogeneously dense breasts

C++ Annotations

This document is intended for knowledgable users of C who would like to make the transition to C++. It is a guide for `our' programming courses, which are given yearly at the State University of Groningen. As such, this document is not a complete C/C++ handbook, but rather serves as an addition to other documentation sources

C++ Annotations

Created by Frank B. Brokken of the Computing Center at the University of Groningen, this document is intended for âknowledgeable users of C (or any other language using a C-like grammar, like Perl or Java) who would like to know more about, or make the transition to, C++.â Topics included are IO-streams, classes, memory allocation, and polymorphism. Also, the final chapter gives a number of concrete examples of C++ programs, classes, and templates which illustrate the concepts covered in the web page. This is an excellent site for students looking to learn C++ or for educators in computer programming

Integrated Reporting in Multidimensional Personality Questionnaires

In individual applications, in which the client is the primary audience for the outcome of a personality assessment, integrated reporting is needed in communicating the result. With multidimensional questionnaires, the usual reporting in terms of a profile of separate scale scores is insufficient from that communicative point of view. We present a procedure for finding integral characterizations, consisting of a set of markers for the rotated factor defined by the individual's score vector. For illustrations, we refer to the Five-Factor Personality Inventory (FFPI-III; see Hendriks et al., 2019)