Cancer screening in Spain

Objective: To describe the current status of breast, colorectal and cervical cancer screening in Spain. Methodology: The situation was analysed on the basis of data drawn from surveys conducted in each autonomous region (Comunidad Autónoma). Results: Currently, breast cancer screening coverage is 100%. In 2007, overall participation was 67.0% with an adherence of 91.2%. The detection rate was 3.4 per thousand, 15.1% intraductal and 30% invasive <1 cm in diameter, with 65% showing axilary node negative. Colorectal cancer screening had been implemented in six regions (4.5% of the target population). Participation ranged from 17.2% to 42.3%, with positive test percentages ranging from 1.7 per thousand (guaiac) to 9.5% (immunological). The invasive cancer detection rate was 1.7 per thousand (guaiac) and 3.4 per thousand (immunological). In most cases, cervical cancer screening was undertaken opportunistically, with an estimated coverage of 69.0%. Conclusions: In Spain, cancer screening is being conducted in accordance with national and international recommendations. The fact that screening programmes are operated as a network has led to a high degree of consensus as to the methodology and information systems to be used to enable joint evaluation

Vacunas en situaciones especiales. Embarazo, inmunodepresión, transplante

En las recomendaciones de vacunación de grupos de población que por su situación de salud requieren medidas específicas deben conjugarse: Las limitaciones en la aplicación de determinadas vacunas por la mayor probabilidad de efectos secundarios en estos pacientes (por ejemplo la aplicación de vacunas de virus vivos en pacientes inmunodeprimidos). El mayor riesgo de infección frente a determinados agentes que genera la patología o situación inmunitaria del paciente, y que determina un mayor interés sanitario de la aplicación de las vacunas frente a los mismos. La menor respuesta inmunitaria a las vacunas, por la menor capacidad de respuesta del sistema inmune de estos pacientes. La consideración de estos tres factores, en el marco de una creciente evidencia de la importancia sanitaria de las estrategias de vacunación diseñadas específicamente para cada grupo de pacientes por los efectos protectores y la disminución de la incidencia o gravedad de las infecciones frente a las que se ha inmunizado, está llevando, en la última década, al diseño de calendarios de vacunación específicos, así como a un creciente impulso de estrategias de vacunación específicas para garantizar la captación y cumplimiento de estos calendarios. En este artículo se revisan las siguientes situaciones: Embarazo; Inmunosupresión ; Inmunodepresión ; Trasplante de progenitores hematopoyéticos ; Asplenia ; Trasplante de órganos sólidos. Se reseña la importancia de que toda mujer esté protegida frente a la rubéola antes del embarazo, y de la administración de esta vacuna en el post-parto a aquellas mujeres que no hubieran sido vacunadas previamente. Así mismo se insiste en la necesidad de la vacunación antigripal anual en el 2º o 3º trimestre del embarazo y de la importancia de la vacunación frente al tétanos antes del parto en las mujeres que no hayan completado previamente su vacunación. El paciente receptor de progenitores hematopoyéticos, independientemente de la edad, requiere la revacunación con todas las vacunas del calendario infantil, a las que debe añadirse la vacuna antineumocócica, antihaemophilus influenzae tipo b y antigripal, además de otras vacunas vinculadas a riesgos individuales. Los pacientes asplénicos presentan un alto riesgo de infecciones provocadas por bacterias capsuladas, por lo que cobra especial trascendencia la vacunación frente al neumococo, el Hib y el meningococo, además de la vacunación antigripal anual. Los pacientes sometidos a programa de trasplante de órgano sólido suponen un colectivo específico en el que debe programarse la aplicación de las vacunas antes del trasplante dada la mejor respuesta inmune en ese momento, y la vacunación postrasplante, según la situación inmune previa. Se destaca la importancia de la prevención pretrasplante frente a la varicela y la hepatitis B, así como las recomendaciones específicas de vacunación según el tipo de trasplante: frente al neumococo, el Haemophilus influenzae tipo b, la gripe, la Hepatitis A, etc, además de completar el calendario de vacunación infantil en los menores de 14 años, y de estar vacunado frente al tétanos, difteria, sarampión, rubéola, parotiditis y gripe anualmente en los adultos. Un aspecto a resaltar es la importancia de la vacunación del entorno del paciente inmunodeprimido, en especial en caso de trasplante, así como las consideraciones a tener en cuenta en las vacunas recomendadas a los convivientes

Effect of protocol-related variables and women's characteristics on the cumulative false-positive risk in breast cancer screening

Background: Reducing the false-positive risk in breast cancer screening is important. We examined how the screening-protocol and women's characteristics affect the cumulative false-positive risk. Methods: This is a retrospective cohort study of 1 565 364 women aged 45-69 years who underwent 4 739 498 screening mammograms from 1990 to 2006. Multilevel discrete hazard models were used to estimate the cumulative false-positive risk over 10 sequential mammograms under different risk scenarios. Results: The factors affecting the false-positive risk for any procedure and for invasive procedures were double mammogram reading [odds ratio (OR) = 2.06 and 4.44, respectively], two mammographic views (OR = 0.77 and 1.56, respectively), digital mammography (OR = 0.83 for invasive procedures), premenopausal status (OR = 1.31 and 1.22, respectively), use of hormone replacement therapy (OR = 1.03 and 0.84, respectively), previous invasive procedures (OR = 1.52 and 2.00, respectively), and a familial history of breast cancer (OR = 1.18 and 1.21, respectively). The cumulative false-positive risk for women who started screening at age 50-51 was 20.39% [95% confidence interval (CI) 20.02-20.76], ranging from 51.43% to 7.47% in the highest and lowest risk profiles, respectively. The cumulative risk for invasive procedures was 1.76% (95% CI 1.66-1.87), ranging from 12.02% to 1.58%. Conclusions: The cumulative false-positive risk varied widely depending on the factors studied. These findings are relevant to provide women with accurate information and to improve the effectiveness of screening programs

Expansion of Human Limbal Epithelial Stem/Progenitor Cells Using Different Human Sera: A Multivariate Statistical Analysis

Transplantation of human cultured limbal epithelial stem/progenitor cells (LESCs) has demonstrated to restore the integrity and functionality of the corneal surface in about 76% of patients with limbal stem cell deficiency. However, there are different protocols for the expansion of LESCs, and many of them use xenogeneic products, being a risk for the patients’ health. We compared the culture of limbal explants on the denuded amniotic membrane in the culture medium—supplemental hormone epithelial medium (SHEM)—supplemented with FBS or two differently produced human sera. Cell morphology, cell size, cell growth rate, and the expression level of differentiation and putative stem cell markers were examined. Several bioactive molecules were quantified in the human sera. In a novel approach, we performed a multivariate statistical analysis of data to investigate the culture factors, such as differently expressed molecules of human sera that specifically influence the cell phenotype. Our results showed that limbal cells cultured with human sera grew faster and contained similar amounts of small-sized cells, higher expression of the protein p63α, and lower of cytokeratin K12 than FBS cultures, thus, maintaining the stem/progenitor phenotype of LESCs. Furthermore, the multivariate analysis provided much data to better understand the obtaining of different cell phenotypes as a consequence of the use of different culture methodologies or different culture components.Research study supported by grants from Mutua Madrileña Foundation (FMM11/02), Basque Foundation for Health Research and Innovation BIOEF (BIO14/TP/002), National Eye Institute (R01EY021797), California Institute for Regenerative Medicine (TR-TR2-01768 and CLIN1-08686) and an unrestricted grant from Research to Prevent Blindness to the Department of Ophthalmology, University of California, Los Angeles. R.H.-M. was supported by fellowships from the University of the Basque Country UPV/EHU and the Jesus de Gangoiti Barrera foundation

Peri-Implant Behavior of Tissue Level Dental Implants with a Convergent Neck

he aim of this retrospective study was to analyze the radiographic peri-implant bone loss of bone level implants and tissue level implants with a convergent neck inscrew-retained single crowns and in screw-retained fixed partial prostheses, after two years offunctional loading.Odontologí

Increasing grid integration of wind energy by using ampacity techniques

The grid integration of renewable energy, particularly in Spain, supposes an important problem to deal with for Distributor System Operators (DSO). Most of the times Wind Energy Farms are located in places that are far away from the transmission networks so they have to be integrated into distribution networks that are frequently operating close to their static rate. Current regulations make almost impossible to build new overhead lines so the increase of the capacity of the existing lines is a new target for the DSO. This paper is devoted to the analysis of a new methodology and monitoring system that have been developed to overcome the existing static rates by moving the operation point of the overhead lines close to their dynamic rate. This new rate is computed by using both the IEEE and CIGRÉ algorithms and a local weather forecast. The obtained results show that this approach can increase the capacity of the lines in a significant percentage.This work was supported by the Spanish Government under the R+D initiative INNPACTO with reference IPT2011-1447-920000

Tumor phenotype and breast density in distinct categories of interval cancer: results of population-based mammography screening in Spain

Introduction: Interval cancers are tumors arising after a negative screening episode and before the next screening invitation. They can be classified into true interval cancers, false-negatives, minimal-sign cancers, and occult tumors based on mammographic findings in screening and diagnostic mammograms. This study aimed to describe tumor-related characteristics and the association of breast density and tumor phenotype within four interval cancer categories. Methods: We included 2,245 invasive tumors (1,297 screening-detected and 948 interval cancers) diagnosed from 2000 to 2009 among 645,764 women aged 45 to 69 who underwent biennial screening in Spain. Interval cancers were classified by a semi-informed retrospective review into true interval cancers (n = 455), false-negatives (n = 224), minimal-sign (n = 166), and occult tumors (n = 103). Breast density was evaluated using Boyd’s scale and was conflated into: 75%. Tumor-related information was obtained from cancer registries and clinical records. Tumor phenotype was defined as follows: luminal A: ER+/HER2- or PR+/HER2-; luminal B: ER +/HER2+ or PR+/HER2+; HER2: ER-/PR-/HER2+; triple-negative: ER-/PR-/HER2-. The association of tumor phenotype and breast density was assessed using a multinomial logistic regression model. Adjusted odds ratios (OR) and 95% confidence intervals (95% CI) were calculated. All statistical tests were two-sided. Results: Forty-eight percent of interval cancers were true interval cancers and 23.6% false-negatives. True interval cancers were associated with HER2 and triple-negative phenotypes (OR = 1.91 (95% CI:1.22-2.96), OR = 2.07 (95% CI:1.42-3.01), respectively) and extremely dense breasts (>75%) (OR = 1.67 (95% CI:1.08-2.56)). However, among true interval cancers a higher proportion of triple-negative tumors was observed in predominantly fatty breasts (<25%) than in denser breasts (28.7%, 21.4%, 11.3% and 14.3%, respectively; <0.001). False-negatives and occult tumors had similar phenotypic characteristics to screening-detected cancers, extreme breast density being strongly associated with occult tumors (OR = 6.23 (95% CI:2.65-14.66)). Minimal-sign cancers were biologically close to true interval cancers but showed no association with breast density. Conclusions: Our findings revealed that both the distribution of tumor phenotype and breast density play specific and independent roles in each category of interval cancer. Further research is needed to understand the biological basis of the overrepresentation of triple-negative phenotype among predominantly fatty breasts in true interval cancers

Trends in detection of invasive cancer and ductal carcinoma in situ at biennial screening mammography in Spain: a retrospective cohort study

Background: Breast cancer incidence has decreased in the last decade, while the incidence of ductal carcinoma in situ (DCIS) has increased substantially in the western world. The phenomenon has been attributed to the widespread adaption of screening mammography. The aim of the study was to evaluate the temporal trends in the rates of screen detected invasive cancers and DCIS, and to compare the observed trends with respect to hormone replacement therapy (HRT) use along the same study period. Methods: Retrospective cohort study of 1,564,080 women aged 45–69 years who underwent 4,705,681 screening mammograms from 1992 to 2006. Age-adjusted rates of screen detected invasive cancer, DCIS, and HRT use were calculated for first and subsequent screenings. Poisson regression was used to evaluate the existence of a change-point in trend, and to estimate the adjusted trends in screen detected invasive breast cancer and DCIS over the study period. Results: The rates of screen detected invasive cancer per 100.000 screened women were 394.0 at first screening, and 229.9 at subsequent screen. The rates of screen detected DCIS per 100.000 screened women were 66.8 at first screen and 43.9 at subsequent screens. No evidence of a change point in trend in the rates of DCIS and invasive cancers over the study period were found. Screen detected DCIS increased at a steady 2.5% per year (95% CI: 1.3; 3.8), while invasive cancers were stable. Conclusion: Despite the observed decrease in breast cancer incidence in the population, the rates of screen detected invasive cancer remained stable during the study period. The proportion of DCIS among screen detected breast malignancies increased from 13% to 17% throughout the study period. The rates of screen detected invasive cancer and DCIS were independent of the decreasing trend in HRT use observed among screened women after 2002

CanScreen5, a global repository for breast, cervical and colorectal cancer screening programs

The CanScreen5 project is a global cancer screening data repository that aims to report the status and performance of breast, cervical and colorectal cancer screening programs using a harmonized set of criteria and indicators. Data collected mainly from the Ministry of Health in each country underwent quality validation and ultimately became publicly available through a Web-based portal. Until September 2022, 84 participating countries reported data for breast (n = 57), cervical (n = 75) or colorectal (n = 51) cancer screening programs in the repository. Substantial heterogeneity was observed regarding program organization and performance. Reported screening coverage ranged from 1.7% (Bangladesh) to 85.5% (England, United Kingdom) for breast cancer, from 2.1% (Côte d’Ivoire) to 86.3% (Sweden) for cervical cancer, and from 0.6% (Hungary) to 64.5% (the Netherlands) for colorectal cancer screening programs. Large variability was observed regarding compliance to further assessment of screening programs and detection rates reported for precancers and cancers. A concern is lack of data to estimate performance indicators across the screening continuum. This underscores the need for programs to incorporate quality assurance protocols supported by robust information systems. Program organization requires improvement in resource-limited settings, where screening is likely to be resource-stratified and tailored to country-specific situations.</p

Trends in detection of invasive cancer and ductal carcinoma in situ at biennial screening mammography in spain : A retrospective cohort study

Background: Breast cancer incidence has decreased in the last decade, while the incidence of ductal carcinoma in situ (DCIS) has increased substantially in the western world. The phenomenon has been attributed to the widespread adaption of screening mammography. The aim of the study was to evaluate the temporal trends in the rates of screen detected invasive cancers and DCIS, and to compare the observed trends with respect to hormone replacement therapy (HRT) use along the same study period. Methods: Retrospective cohort study of 1,564,080 women aged 45-69 years who underwent 4,705,681 screening mammograms from 1992 to 2006. Age-adjusted rates of screen detected invasive cancer, DCIS, and HRT use were calculated for first and subsequent screenings. Poisson regression was used to evaluate the existence of a change-point in trend, and to estimate the adjusted trends in screen detected invasive breast cancer and DCIS over the study period. Results: The rates of screen detected invasive cancer per 100.000 screened women were 394.0 at first screening, and 229.9 at subsequent screen. The rates of screen detected DCIS per 100.000 screened women were 66.8 at first screen and 43.9 at subsequent screens. No evidence of a change point in trend in the rates of DCIS and invasive cancers over the study period were found. Screen detected DCIS increased at a steady 2.5% per year (95% CI: 1.3; 3.8), while invasive cancers were stable. Conclusion: Despite the observed decrease in breast cancer incidence in the population, the rates of screen detected invasive cancer remained stable during the study period. The proportion of DCIS among screen detected breast malignancies increased from 13% to 17% throughout the study period. The rates of screen detected invasive cancer and DCIS were independent of the decreasing trend in HRT use observed among screened women after 2002