Interest in breast cancer genetic testing among Icelandic women

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenObjective: It is estimated that 6-10% of all breast cancers in Iceland can be attributed to inherited mutations in newly identified breast cancer susceptibility genes (BRCA1 and BRCA2). Before genetic testing becomes widely available in Iceland it is important to understand what motivates women s interest in undergoing testing as that will provide the data necessary for designing effective counseling interventions. Therefore, the aim of this population-based study was to examine interest in and predictors of interest in genetic testing among Icelandic women. Material and methods: A randomly selected sample of 534 Icelandic women, who had not been previously diagnosed with breast cancer, completed questionnaires assessing, demographic/medical variables, interest in genetic testing, perceived risk of carrying mutations in BRCA1/2 genes, cancer-specific distress and perceived benefits and barriers of genetic testing. The mean age was 53.8 years and 197 of the women had at least one first degree-relative that had been diagnosed with breast cancer. Results: Interest in testing was high with 74% of the women indicating that they were interested in testing. Family history of breast cancer was unrelated to interest in testing whereas perceived risk of being a mutation carrier was significantly and positively related to interest in testing. Interest in testing was also significantly higher among younger women and among women with higher levels of cancer-specific distress. The most commonly cited reasons for wanting to be tested were to increase use of mammography screening and to learn if one s children were at risk for developing cancer. The most commonly citied reasons against being tested were fear of being mutation carrier and worry that test results would not stay confidential. Conclusions: These results suggest that demand for genetic testing, once it becomes commercially available, among Icelandic women may be high even among women without family history of breast cancer. The results also suggest that genetic counseling needs to address women s breast cancer worries as that may increase the probability that the decision to undergo testing is based on knowledge rather than driven by breast cancer fear and distress.Tilgangur: Áætlað er að um 6-10% brjóstakrabbameinstilfella á Íslandi megi rekja til arfgengra stökkbreytinga á tveimur erfðaefnum sem nýlega hafa verið einangruð (BRCA1 og BRCA2). Greina má tilvist þeirra með erfðaprófum. Mikilvægt er að greina hvað ýtir undir áhuga kvenna á að fara í slíkt próf til að tryggja að erfðaráðgjöf beri tilætlaðan árangur. Þess vegna var markmið þessarar þýðisbundnu rannsóknar að kanna áhuga á og kanna forspárþætti fyrir áhuga íslenskra kvenna á að mæta í erfðapróf. Efniviður og aðferðir: Handahófsúrtak 534 íslenskra kvenna, sem ekki höfðu greinst með brjóstakrabbamein, svaraði spurningalista með lýðfræðilegum þáttum/fjölskyldusögu um brjóstakrabbamein, áhuga á að mæta í erfðapróf, mati á líkum á að vera með brjóstakrabbameinserfðaefni, sértækum krabbameinsótta og mælikvarða á hindranir og hvatningu fyrir mætingu í erfðapróf. Meðalaldur var 53,8 ár og 197 konur áttu að minnsta kosti einn ættingja sem fengið hafði brjóstakrabbamein. Niðurstöður: Áhugi á erfðaprófi var mikill þar sem um 74% kvenna höfðu áhuga á að mæta í slíkt próf. Fjölskyldusaga um brjóstakrabbamein tengdist ekki áhuga á erfðaprófi, en mat á líkum á að hafa brjóstakrabbameinserfðaefni tengdist marktækt og jákvætt áhuga á prófinu. Áhugi á erfðaprófi var einnig meiri hjá yngri konum og hjá konum sem óttuðust brjóstakrabbamein. Helstu kostir erfðaprófa voru taldir að þau gæfu vísbendingu um hvort fara ætti oftar í brjóstamyndatöku og til að vita hvort börn þátttakenda væru í aukinni áhættu fyrir brjóstakrabbameini. Helstu ókostir erfðaprófa voru ótti við að greinast með stökkbreytingar og áhyggjur af ónógri persónuvernd. Ályktanir: Þessar niðurstöður gefa til kynna að kröfur íslenskra kvenna um að fá að fara í erfðapróf, þegar þau eru orðin almenn hér á landi verði miklar, jafnvel hjá konum sem ekki hafa ættarsögu um brjóstakrabbamein. Niðurstöður rannsóknarinnar gefa einnig til kynna að erfðaráðgjöf þurfi að taka mið af ótta kvenna við brjóstakrabbamein því það gæt

Predictors of mammography adherence among Icelandic women

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenObjective: In Iceland, breast cancer is a second only to lung cancer as a cause of women s cancer related deaths. Despite the widely-recognized utility of mammography for detecting breast cancer at early stages when it is most curable, many Icelandic women do not adhere to mammography screening recommendations. The aim of the present population-based study was to identify factors that facilitate and hinder women s adherence to mammography screening in Iceland. Material and methods: A randomly selected sample of Icelandic women between the ages of 40-69 years, not previously diagnosed with breast cancer (n=1000), were recruited to the study by mail. Participants (n=619) completed questionnaires assessing: demopgraphic variables, knowledge of screening guidelines, possible facilitators (e.g., physician recommendation) and barriers (e.g. concern about radiation) to adherence, as well as stages of mammography screening adoption (precontemplation, contemplation, action and maintenance). Results: Women in the precontemplation stage were more afraid of radiation than women on other stages. They as well as women on contemplation stage were more afraid that mammography would be painful, and less satisfied with previous service at the mammography screening center. Doctors recommendations, as well as women s knowledge about mammography screening guidelines, were positively related to mammography adherence. Conclusions: These findings suggest that physicians may have an important role in motivating women to follow mammography screening recommendations. Educating women about mammography screening guidelines and addressing their concern about radiation and pain may increase mammography adherence further. Service at the mammography screening center may also improve adherence.Tilgangur: Brjóstakrabbamein, ásamt lungnakrabbameini, er langalgengasta dánarorsök íslenskra kvenna á miðjum aldri. Þrátt fyrir alþjóðlegan árangur reglubundinnar brjóstamyndatöku við að finna brjóstakrabbamein á for- eða byrjunarstigi, þegar mestar líkur eru á lækningu, mæta íslenskra konur ekki nægilega vel í myndatöku. Tilgangur þessarar rannsóknar var að kanna hvaða þættir hvetja eða letja íslenskar konur til að mæta í myndatöku. Efniviður og aðferðir: Konur á Stór-Reykjavíkursvæðinu, 40-69 ára, sem ekki höfðu greinst með brjóstakrabbamein, voru valdar af handahófi (n=1000) og var þeim sendur spurningalisti í pósti. Þátttakendur (n=619) fengur spurningalista um: lýðfræðilegar breytur, þekkingu á brjóstamyndatöku, mögulega hvetjandi þætti (til dæmis hvatningu frá lækni) og hindranir (til dæmis ótta við geislun) sem tengdust mætingu, ásamt aðlögunarstigum að mætingu í brjóstamyndatöku, það er foríhugun (precontemplation), íhugun (contemplation), framkvæmd (action) og viðhald (maintenance). Niðurstöður: Konur á foríhugunarstigi voru hræddari við geislun en konur á öðrun stigum. Þær ásamt konum á íhugunarstigi óttuðust meira sársauka frá myndavél og voru óánægðari með þjónustu leitarstöðvar Krabbameinsfélagsins. Hvatning frá einkalækni og þekking á því hvenær fara á í myndatöku tengdust einnig jákvætt mætingu. Ályktanir: Þessar niðurstöður gefa til kynna að læknar geti gegnt mikilvægu hlutverki í að hvetja konur til að mæta í brjóstamyndatöku. Með því að upplýsa konur um gildi myndatökunnar og að ræða við þær um áhyggjur þeirra af geislun og sársauka væri hugsanlega hægt að auka þátttöku. Þjónusta á leitarstöðinni virðist einnig geta haft áhrif á það hvort konur halda áfram að mæta í myndatöku

Psychiatric disorders and subsequent risk of cardiovascular disease: a longitudinal matched cohort study across three countries

Background: Several psychiatric disorders have been associated with increased risk of cardiovascular disease (CVD), however, the role of familial factors and the main disease trajectories remain unknown. Methods: In this longitudinal cohort study, we identified a cohort of 900,240 patients newly diagnosed with psychiatric disorders during January 1, 1987 and December 31, 2016, their 1,002,888 unaffected full siblings, and 1:10 age- and sex-matched reference population from nationwide medical records in Sweden, who had no prior diagnosis of CVD at enrolment. We used flexible parametric models to determine the time-varying association between first-onset psychiatric disorders and incident CVD and CVD death, comparing rates of CVD among patients with psychiatric disorders to the rates of unaffected siblings and matched reference population. We also used disease trajectory analysis to identify main disease trajectories linking psychiatric disorders to CVD. Identified associations and disease trajectories of the Swedish cohort were validated in a similar cohort from nationwide medical records in Denmark (N = 875,634 patients, same criteria during January 1, 1969 and December 31, 2016) and in Estonian cohorts from the Estonian Biobank (N = 30,656 patients, same criteria during January 1, 2006 and December 31, 2020), respectively. Findings: During up to 30 years of follow-up of the Swedish cohort, the crude incidence rate of CVD was 9.7, 7.4 and 7.0 per 1000 person-years among patients with psychiatric disorders, their unaffected siblings, and the matched reference population. Compared with their siblings, patients with psychiatric disorders experienced higher rates of CVD during the first year after diagnosis (hazard ratio [HR], 1.88; 95% confidence interval [CI], 1.79–1.98) and thereafter (1.37; 95% CI, 1.34–1.39). Similar rate increases were noted when comparing with the matched reference population. These results were replicated in the Danish cohort. We identified several disease trajectories linking psychiatric disorders to CVD in the Swedish cohort, with or without mediating medical conditions, including a direct link between psychiatric disorders and hypertensive disorder, ischemic heart disease, venous thromboembolism, angina pectoris, and stroke. These trajectories were validated in the Estonian Biobank cohort. Interpretation: Independent of familial factors, patients with psychiatric disorders are at an elevated risk of subsequent CVD, particularly during first year after diagnosis. Increased surveillance and treatment of CVDs and CVD risk factors should be considered as an integral part of clinical management, in order to reduce risk of CVD among patients with psychiatric disorders. Funding: This research was supported by EU Horizon 2020 Research and Innovation Action Grant, European Research Council Consolidator grant, Icelandic Research fund, Swedish Research Council, US NIMH, the Outstanding Clinical Discipline Project of Shanghai Pudong, the Fundamental Research Funds for the Central Universities, and the European Union through the European Regional Development Fund; the Research Council of Norway; the South-East Regional Health Authority, the Stiftelsen Kristian Gerhard Jebsen, and the EEA-RO-NO-2018-0535

Cohort Profile: COVIDMENT: COVID-19 cohorts on mental health across six nations

Why were the cohorts set up? With more than 218 million cases and 4.5 million deaths worldwide (Worldometers, 31 August 2021), the COVID-19 pandemic has had an unprecedented influence on the global economy and population health. As a potent global disaster, it is likely to significantly affect the incidence of adverse mental health symptoms and psychiatric disorders, particularly in vulnerable and highly affected populations. The World Health Organization and leading scientific journals have alerted concerning the potential adverse mental health impact of COVID-19 and emphasized the need for multinational research in this area, which additionally provides new insights into disease mechanisms

Use of antidepressants and association with elective termination of pregnancy: population based case-control study

Objective To assess whether the use of selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, mirtazapine, venlafaxine or other antidepressants is associated with late elective termination of pregnancy. Design Case–control study using data from national registers. Setting Denmark,Finland, andNorwayduring the period 1996–2007. Population A total of 14 902 women were included as cases and 148 929 women were included as controls. Methods Cases were women with elective termination of pregnancy at 12–23 weeks of gestation. Controls continued their pregnancy and were matched with cases on key factors. Main outcome measures Association between antidepressant use during pregnancy and elective termination of pregnancy at 12– 23 weeks of gestation for fetal anomalies, or for maternal ill health or socio-economic disadvantage. Results At least one prescription of antidepressants was filled by 3.7% of the cases and 2.2% of the controls. Use of any type of antidepressant was associated with elective termination of pregnancy for maternal ill health or socio-economic disadvantage (odds ratio, OR 2.3; 95% confidence interval, 95% CI 2.0–2.5). Elective termination of pregnancy for fetal anomalies was associated with the use of mirtazapine (OR 2.2, 95% CI 1.1–4.5). There was no association between the use of any of the other antidepressants and elective termination of pregnancy for fetal anomalies. Conclusion The use of any type of antidepressants was associated with elective termination of pregnancy at 12–23 weeks for maternal ill health or socio-economic disadvantage, but not with terminations for fetal anomalies. Further studies need to confirm the findings concerning mirtazapine and termination of pregnancy for fetal anomalies

Interest in breast cancer genetic testing among Icelandic women

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenObjective: It is estimated that 6-10% of all breast cancers in Iceland can be attributed to inherited mutations in newly identified breast cancer susceptibility genes (BRCA1 and BRCA2). Before genetic testing becomes widely available in Iceland it is important to understand what motivates women s interest in undergoing testing as that will provide the data necessary for designing effective counseling interventions. Therefore, the aim of this population-based study was to examine interest in and predictors of interest in genetic testing among Icelandic women. Material and methods: A randomly selected sample of 534 Icelandic women, who had not been previously diagnosed with breast cancer, completed questionnaires assessing, demographic/medical variables, interest in genetic testing, perceived risk of carrying mutations in BRCA1/2 genes, cancer-specific distress and perceived benefits and barriers of genetic testing. The mean age was 53.8 years and 197 of the women had at least one first degree-relative that had been diagnosed with breast cancer. Results: Interest in testing was high with 74% of the women indicating that they were interested in testing. Family history of breast cancer was unrelated to interest in testing whereas perceived risk of being a mutation carrier was significantly and positively related to interest in testing. Interest in testing was also significantly higher among younger women and among women with higher levels of cancer-specific distress. The most commonly cited reasons for wanting to be tested were to increase use of mammography screening and to learn if one s children were at risk for developing cancer. The most commonly citied reasons against being tested were fear of being mutation carrier and worry that test results would not stay confidential. Conclusions: These results suggest that demand for genetic testing, once it becomes commercially available, among Icelandic women may be high even among women without family history of breast cancer. The results also suggest that genetic counseling needs to address women s breast cancer worries as that may increase the probability that the decision to undergo testing is based on knowledge rather than driven by breast cancer fear and distress.Tilgangur: Áætlað er að um 6-10% brjóstakrabbameinstilfella á Íslandi megi rekja til arfgengra stökkbreytinga á tveimur erfðaefnum sem nýlega hafa verið einangruð (BRCA1 og BRCA2). Greina má tilvist þeirra með erfðaprófum. Mikilvægt er að greina hvað ýtir undir áhuga kvenna á að fara í slíkt próf til að tryggja að erfðaráðgjöf beri tilætlaðan árangur. Þess vegna var markmið þessarar þýðisbundnu rannsóknar að kanna áhuga á og kanna forspárþætti fyrir áhuga íslenskra kvenna á að mæta í erfðapróf. Efniviður og aðferðir: Handahófsúrtak 534 íslenskra kvenna, sem ekki höfðu greinst með brjóstakrabbamein, svaraði spurningalista með lýðfræðilegum þáttum/fjölskyldusögu um brjóstakrabbamein, áhuga á að mæta í erfðapróf, mati á líkum á að vera með brjóstakrabbameinserfðaefni, sértækum krabbameinsótta og mælikvarða á hindranir og hvatningu fyrir mætingu í erfðapróf. Meðalaldur var 53,8 ár og 197 konur áttu að minnsta kosti einn ættingja sem fengið hafði brjóstakrabbamein. Niðurstöður: Áhugi á erfðaprófi var mikill þar sem um 74% kvenna höfðu áhuga á að mæta í slíkt próf. Fjölskyldusaga um brjóstakrabbamein tengdist ekki áhuga á erfðaprófi, en mat á líkum á að hafa brjóstakrabbameinserfðaefni tengdist marktækt og jákvætt áhuga á prófinu. Áhugi á erfðaprófi var einnig meiri hjá yngri konum og hjá konum sem óttuðust brjóstakrabbamein. Helstu kostir erfðaprófa voru taldir að þau gæfu vísbendingu um hvort fara ætti oftar í brjóstamyndatöku og til að vita hvort börn þátttakenda væru í aukinni áhættu fyrir brjóstakrabbameini. Helstu ókostir erfðaprófa voru ótti við að greinast með stökkbreytingar og áhyggjur af ónógri persónuvernd. Ályktanir: Þessar niðurstöður gefa til kynna að kröfur íslenskra kvenna um að fá að fara í erfðapróf, þegar þau eru orðin almenn hér á landi verði miklar, jafnvel hjá konum sem ekki hafa ættarsögu um brjóstakrabbamein. Niðurstöður rannsóknarinnar gefa einnig til kynna að erfðaráðgjöf þurfi að taka mið af ótta kvenna við brjóstakrabbamein því það gæt

Predictors of mammography adherence among Icelandic women

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenObjective: In Iceland, breast cancer is a second only to lung cancer as a cause of women s cancer related deaths. Despite the widely-recognized utility of mammography for detecting breast cancer at early stages when it is most curable, many Icelandic women do not adhere to mammography screening recommendations. The aim of the present population-based study was to identify factors that facilitate and hinder women s adherence to mammography screening in Iceland. Material and methods: A randomly selected sample of Icelandic women between the ages of 40-69 years, not previously diagnosed with breast cancer (n=1000), were recruited to the study by mail. Participants (n=619) completed questionnaires assessing: demopgraphic variables, knowledge of screening guidelines, possible facilitators (e.g., physician recommendation) and barriers (e.g. concern about radiation) to adherence, as well as stages of mammography screening adoption (precontemplation, contemplation, action and maintenance). Results: Women in the precontemplation stage were more afraid of radiation than women on other stages. They as well as women on contemplation stage were more afraid that mammography would be painful, and less satisfied with previous service at the mammography screening center. Doctors recommendations, as well as women s knowledge about mammography screening guidelines, were positively related to mammography adherence. Conclusions: These findings suggest that physicians may have an important role in motivating women to follow mammography screening recommendations. Educating women about mammography screening guidelines and addressing their concern about radiation and pain may increase mammography adherence further. Service at the mammography screening center may also improve adherence.Tilgangur: Brjóstakrabbamein, ásamt lungnakrabbameini, er langalgengasta dánarorsök íslenskra kvenna á miðjum aldri. Þrátt fyrir alþjóðlegan árangur reglubundinnar brjóstamyndatöku við að finna brjóstakrabbamein á for- eða byrjunarstigi, þegar mestar líkur eru á lækningu, mæta íslenskra konur ekki nægilega vel í myndatöku. Tilgangur þessarar rannsóknar var að kanna hvaða þættir hvetja eða letja íslenskar konur til að mæta í myndatöku. Efniviður og aðferðir: Konur á Stór-Reykjavíkursvæðinu, 40-69 ára, sem ekki höfðu greinst með brjóstakrabbamein, voru valdar af handahófi (n=1000) og var þeim sendur spurningalisti í pósti. Þátttakendur (n=619) fengur spurningalista um: lýðfræðilegar breytur, þekkingu á brjóstamyndatöku, mögulega hvetjandi þætti (til dæmis hvatningu frá lækni) og hindranir (til dæmis ótta við geislun) sem tengdust mætingu, ásamt aðlögunarstigum að mætingu í brjóstamyndatöku, það er foríhugun (precontemplation), íhugun (contemplation), framkvæmd (action) og viðhald (maintenance). Niðurstöður: Konur á foríhugunarstigi voru hræddari við geislun en konur á öðrun stigum. Þær ásamt konum á íhugunarstigi óttuðust meira sársauka frá myndavél og voru óánægðari með þjónustu leitarstöðvar Krabbameinsfélagsins. Hvatning frá einkalækni og þekking á því hvenær fara á í myndatöku tengdust einnig jákvætt mætingu. Ályktanir: Þessar niðurstöður gefa til kynna að læknar geti gegnt mikilvægu hlutverki í að hvetja konur til að mæta í brjóstamyndatöku. Með því að upplýsa konur um gildi myndatökunnar og að ræða við þær um áhyggjur þeirra af geislun og sársauka væri hugsanlega hægt að auka þátttöku. Þjónusta á leitarstöðinni virðist einnig geta haft áhrif á það hvort konur halda áfram að mæta í myndatöku