Prognosis of screen-detected breast cancers: results of a population based study

BACKGROUND: The reduced mortality rate from breast carcinoma among women offered screening mammography is demonstrated after 15–20 years of follow-up. However, the assessment of 5-year overall and event-free survival could represent an earlier measure of the efficacy of mammography screening program (MSP). METHODS: All cases of breast cancer diagnosed in the Province of Modena between years 1996 and 2000 in women aged 50 to 69 years, were identified through the Modena Cancer Registry (MCR). Stage of disease and treatment information were obtained from clinical records. All the events occurring up to June 30, 2003 were retrieved by experienced monitors. Five-year overall and event-free survival were the principal end-points of the study. RESULTS: During a 5-year period, 587 primary breast cancers were detected by the MSP and 471 primary breast cancers were diagnosed out of the MSP. The screen-detected breast cancers were smaller, more likely node negative, with low histological grade, low proliferative activity and positive receptors status. Furthermore, the breast cancer diagnosed through the MSP more frequently received a conservative surgery. The 5-year survival rate was 94% in the screen-detected group, versus 84% in the other group (p = 0.0001). The rate of 5-year event-free survival was 89% and 75% for the MSP participants and not participants, respectively (p = 0.0001). CONCLUSIONS: Our data confirm a favourable outcome of screen-detected breast cancers in terms of five-year overall and event-free survival, which reflect the good quality assurance parameters of the MSP. Finally, a cancer registry should be implemented in every area covered by screening programs

Breast cancer screening in women at increased risk according to different family histories: an update of the Modena Study Group experience

BACKGROUND: Breast cancer (BC) detection in women with a genetic susceptibility or strong family history is considered mandatory compared with BC screening in the general population. However, screening modalities depend on the level of risk. Here we present an update of our screening programs based on risk classification. METHODS: We defined different risk categories and surveillance strategies to identify early BC in 1325 healthy women recruited by the Modena Study Group for familial breast and ovarian cancer. Four BC risk categories included BRCA1/2 carriers, increased, intermediate, and slightly increased risk. Women who developed BC from January 1, 1994, through December 31, 2005 (N = 44) were compared with the number of expected cases matched for age and period. BRCA1/2 carriers were identified by mutational analysis. Other risk groups were defined by different levels of family history for breast or ovarian cancer (OC). The standardized incidence ratio (SIR) was used to evaluate the observed and expected ratio among groups. All statistical tests were two-sided. RESULTS: After a median follow-up of 55 months, there was a statistically significant difference between observed and expected incidence [SIR = 4.9; 95% confidence interval (CI) = 1.6 to 7.6; p < 0.001]. The incidence observed among BRCA carriers (SIR = 20.3; 95% CI = 3.1 to 83.9; P < 0.001), women at increased (SIR = 4.5; 95% CI = 1.5 to 8.3; P < 0.001) or intermediate risk (SIR = 7.0, 95% CI = 2.0 to 17.1; P = 0.0018) was higher than expected, while the difference between observed and expected among women at slightly increased risk was not statistically significant (SIR = 2.4, 95% CI = 0.9 to 8.3; P = .74). CONCLUSION: The rate of cancers detected in women at high risk according to BRCA status or strong family history, as defined according to our operational criteria, was significantly higher than expected in an age-matched general population. However, we failed to identify a greater incidence of BC in the slightly increased risk group. These results support the effectiveness of the proposed program to identify and monitor individuals at high risk, whereas prospective trials are needed for women belonging to families with sporadic BC or OC

The efficacy of a training that combines activities on working memory and metacognition: transfer and maintenance effects in children with ADHD and typical development

Introduction: It has been demonstrated that children with attention deficit and hyperactivity disorder (ADHD) have impairments in working memory (WM), and particularly its visuospatial component, responsible for academic underachievement. Furthermore, children with ADHD have difficulty in metacognition, and consequently use inappropriate strategies to control attention and impulsive behavior. The aim of the present study was to devise a training that combined individual exercises on visuospatial WM and group metacognitive activities capable of helping children with ADHD to ameliorate their performance in executive functioning tasks, and to contain their inattentive and hyperactive/impulsive behavior. Method: A combined training that focused on visuospatial WM and metacognition was administered to 12 children with a diagnosis of ADHD and 15 typically-developing children. Tasks on executive functions and questionnaires for parents and teachers were administered before and at the end of the training, and one month after the post-test. Specific short- and long-term training gains and transfer effects were examined. Effects of the training on parents\u2019 and teachers\u2019 ratings were also considered. Results: Specific gains and transfer effects were found at the post-test and long-term assessments in both typically-developing children and those with ADHD. Parents\u2019 and teachers\u2019 ratings also indicated an improvement in the symptomatic behavior of children with ADHD. Conclusion: The results of this study have clinical and educational implications. A training that combines individual computerized visuospatial WM activities with metacognitive group reflection about useful strategies seems to produce promising results, helping children with ADHD to improve their executive functioning and behavioral problem

Estimating Activity Start Timestamps in the Presence of Waiting Times via Process Simulation

Process Mining aims to analyze and improve processes to enable organizations to provide better services or products. The starting point of Process Mining is an event log that is extracted from the organization’s information systems that support the process’ executions. Several techniques require event logs to record the timestamp when process’ activities have started and been completed. Unfortunately, information systems do not always record the timestamps when process activities start, preventing the application of these techniques. This paper reports on a technique based on process simulation that aims to estimate the start event timestamps when missing. In a nutshell, the idea is to build an accurate process model from the initial event log without start timestamps, to simulate it with alternative activity-duration profiles, and to select the model with the profile that generates the runs that are the closest to the initial log. This activity-duration profile is used to add the missing, start timestamps to the initial log. Experiments were conducted with two event logs with start timestamps, and aimed at their rediscovery: the results show our estimation of the start event timestamps is more accurate than the state of the art

L'incidenza dei tumori nella provincia di Modena: previsioni per il periodo 2002-2006

Obiettivo: previsioni di incidenza tumorale in provincia di Modena per ilperiodo 2002-2006 secondo l'utilizzo di una metodologia APC (Age Period Cohort) bayesiani.Disegno: studio su base dipopolazione.Setting: pazienti con diagnosi di neoplasia primaria registrati dal Registro Tumori di Modena tra il 1988 e il 2001.Outcome principali: numero di casi, tassi d'incidenza grezzi e standardizzati.Risultati: complessivamente, nel periodo 2002-2006, è previsto un aumento dei casi di tumore per entrambi i sessi a eccezione dei tumori dello stomaco e dei tumori polmonari maschili, per i quali è previsto un calo. Il numero di casi previsti per il 2002 si discosta dal dato osservato dello 0,7%.Conclusione: le stime risultano attendibili per la maggior parte delle sedi, anche se deve essere usata cautela nel loro utilizzo. In modo particolare le proiezioni di incidenza per i tumori della mammella e della prostata sono risultate chiaramente sovrastimate, a causa dell'effetto di anticipazione diagnostica che provoca un aumento del numero di casi diagnosticati negli ultimi anni

A Framework to Improve the Accuracy of Process Simulation Models

Business process simulation is a methodology that enables analysts to run the process in different scenarios, compare the performances and consequently provide indications into how to improve a business process. Process simulation requires one to provide a simulation model, which should accurately reflect reality to ensure the reliability of the simulation findings. This paper proposes a framework to assess the extent to which a simulation model reflects reality and to pinpoint how to reduce the distance. The starting point is a business simulation model, along with a real event log that records actual executions of the business process being simulated and analyzed. In a nutshell, the idea is to simulate the process, thus obtaining a simulation log, which is subsequently compared with the real event log. A decision tree is built, using the vector of features that represent the behavioral characteristics of log traces. The tree aims to classify traces as belonging to the real and simulated event logs, and the discriminating features encode the difference between reality, represented in the real event log, and the simulation model, represented in the simulated event logs. These features provide actionable insights into how to repair simulation models to become closer to reality. The technique has been assessed on a real-life process for which the literature provides a real event log and a simulation model. The results of the evaluation show that our framework increases the accuracy of the given initial simulation model to better reflect reality

I tumori in provincia di Modena nel 2001

Monografia sui dati di incidenza e sopravvivenza delle neoplasie nella provincia di Moden

I tumori in Provincia di Modena nel 2000.

Monografia sui dati di incidenza e sopravvivenza delle neoplasie nella provincia di Moden

I tumori in provincia di Modena nel 2004

Monografia sui dati di incidenza e sopravvivenza delle neoplasie nella provincia di Moden

I tumor in provincia di Modena nel 2002

Monografia sui dati di incidenza e sopravvivenza delle neoplasie nella provincia di Moden