The effects and costs of breast cancer screening

In 1986, the Dutch Ministry of Welfare, Health and Cultural Affairs asked a research group to investigate the expected effect of breast cancer screening on mortality and possibly morbidity, if implemented in the Netherlands. The research group consisted of members from 3 centres, the Dept. of Public Health (Erasmus Universiteit Rotterdam), the Dept. of Public Health and Epidemiology/ Preventicon (Rijksuniversiteit Utrecht) and the Dept. of Epidemiology/ Radiology (Katholieke Universiteit Nijmegen). Data from the two Dutch breast cancer screening projects, the DOM-projects in Utrecht (Rombach, 1980; Collette et a!., 1984; de Waard et a!., 1984) and the Nijmegen project (Hendriks, 1982; Verbeek et a!., 1984; Peeters, 1989) which started in 1974/1975, was made available in order to first establish more precise estimates for the parameters in the above mentioned model for the disease process of breast cancer and screening in the Netherlands. Together with research on the cost, one of the first Dutch cost-effectiveness analyses in health care was started.With the research described in this thesis, both the concept of screening and the underlying model earlier described have been extended to include the impact on almost all aspects after or beyond the screening examination itself: impact on advanced disease late in life, on assessment and primary treatment for women and for health care, on quality of life, impact on financial cost and impact on the situation of the disease in a population outside the invited or screened grou

Mammographic screening: evidence from randomised controlled trials

BACKGROUND: All randomised breast cancer screening trials have shown a reduction in breast cancer mortality in the 'invited for mammography' screening arm compared with the 'control arm' for women aged 50 years and older at randomisation (overall 25%). However, individually published point estimates differ and concern has been raised about methodological quality and outcome measures. Materials and Methods Review of the evidence on breast cancer mortality reduction and discussion of the causes of difference in point estimates in the five Swedish and Canadian trials. A summary of the prerequisites for methodological quality and its available evidence from the trials is given. Data to support breast cancer mortality as a correct outcome measure are presented. RESULTS: There is no reason not to use breast cancer mortality as an outcome measure for trials intended to reduce breast cancer mortality, both from a clinical and a methodological point of view. Everything possible was performed in these trials in order to determine this outcome measure as accurately as possible. The fact that a few of the trials showed a relatively large breast cancer mortality reduction and others far lower reduction rates is irrelevant, if one does not consider the background situation in the region before the trial started, the design of the trial or quality of screening. CONCLUSIONS: There seems no reason to change or halt the current nation-wide population-based screening programmes. Nor is there any justifiable reason for negative reports towards women or professionals

Do Firms with Low Disability Risks Opt Out from Public to Private Insurance?

In the Netherlands, firms may opt out from public to private disability insurance (DI). Opponents of this "mixed market" for insurance argue that it may trigger a segmentation between firms with high risks with public insurance and low disability risks with private insurance. This article tests the importance of such risk segmentation, using administrative information on DI benefits and opting-out decisions of a panel of about 250,000 Dutch firms between 2007 and 2011. We find strong selection into private insurance of firms with low recent DI inflow rates and low current sickness rates. Accordingly, private insurers succeeded in attracting firms with low anticipated DI benefit costs in the first years to come. Our results also suggest that these effects are transitory - that is, firms that opted out have DI risks that are not structurally lower

The effect of a multispecies probiotic on the composition of the faecal microbiota and bowel habits in chronic obstructive pulmonary disease patients treated with antibiotics

Short-term antibiotic treatment profoundly affects the intestinal microbiota, which may lead to sustained changes in microbiota composition. Probiotics may restore such a disturbance. The objective of the present study was to investigate the effect of a multispecies probiotic on the faecal microbiota during and after antibiotic intake in patients with a history of frequent antibiotic use. In this randomised, placebo-controlled, double-blind study, thirty chronic obstructive pulmonary disease (COPD) patients treated with antibiotics for a respiratory tract infection received 5 g of a multispecies probiotic or placebo twice daily for 2 weeks. Faecal samples were collected at 0, 7, 14 and 63 d. Changes in the composition of the dominant faecal microbiota were determined by PCR-denaturing gradient gel electrophoresis (DGGE). Changes in bacterial subgroups were determined by quantitative PCR and culture. Bowel movements were scored daily according to the Bristol stool form scale. During and after antibiotic treatment, DGGE-based similarity indices (SI) were high ( >/= 84 %) and band richness was relatively low, both remaining stable over time. No difference in SI was observed between patients with and without diarrhoea-like bowel movements. The multispecies probiotic had a modest effect on the bacterial subgroups. Nevertheless, it affected neither the composition of the dominant faecal microbiota nor the occurrence of diarrhoea-like bowel movements. The dominant faecal microbiota was not affected by antibiotics in this COPD population, suggesting an existing imbalance of the microbiota, which may also have contributed to the lack of effect by probiotic intak

De mysterieuze massa.

... Het leven is een mysterie. En geldt dit niet des te meer voor zijn tegenhanger, de dood? Er zijn talrijke theorieën omtrent de oorsprong van het leven, dan wel het einde van het leven. In dit Darwinjaar is de evolutietheorie, en daarmee de eindigheid van ons bestaan, populairder dan ooit. Er is het scheppingsverhaal met een indicatie van het oneindige van ons bestaan; er is de theorie van een oneindig bewustzijn, geformuleerd op basis van bijna-dood ervaringen van patiënten. Er bestaan Japanse verhalen over shinigami’s, engelen des doods, die met het schrijven van je naam in een zogenaamde ‘death note’ je tijdstip van overlijden bepalen. Deze shinigami’s zouden tegenwoordig, uit verveling of om niet als streber te worden aangemerkt, steeds minder vaak namen noteren. ..

Screening for cancers with a good prognosis:The case of testicular germ cell cancer

Background: To determine, using testicular germ cell cancer screening as an example, whether screening can also be effective for cancers with a good prognosis. Methods: Based on the Dutch incidence, stage distribution, and survival and mortality data of testicular germ cell cancer, we developed a microsimulation model. This model simulates screening scenarios varying in screening age, interval, self-examination or screening by the general practitioner (GP), and screening of a defined high-risk group (cryptorchidism). For each scenario, the number of clinically and screen-detected cancers by stage, referrals, testicular germ cell cancer deaths, and life-years gained were projected. Results: Annual self-examination from age 20 to 30 years resulted in 767 cancers detected per 100,000 men followed over life-time, of which 123 (16%) by screening. In this scenario, 19.2 men died from the disease, 4.7 (20%) less than without screening, and 230 life-years were gained. Around 14,000 visits to the GP and 2080 visits to an urologist were required. This scenario resulted in the most favorable ratio between extra visits to the GP or urologist and deaths prevented (1418 and 116 respectively). Monthly screening, or screening until age 40 resulted in less favorable ratios. Self-examination by only the high-risk population prevented 1.0 death per 100,00 men in the general population. In all scenarios, 46–50 life-years were gained for each testicular germ cell cancer death prevented. Conclusion: Despite the good prognosis, self-examination at young ages for testicular germ cell cancer could be considered