28 research outputs found
Recent Developments in the Dutch Cervical Cancer Screening Programme
Worldwide, cervical cancer is the second most common female
malignancy, diagnosed in 500,000 women each year, while 275,000
die from it. Without prevention, the peak incidence occurs at a
relatively young age, between 40-55 years, when women are
still active on the labour market and have young children.
While cervical cancer is the leading cancer-related cause of
death and the second most common cancer in women in developing
countries (incidence rates ≥30 per 100,000), it became
much less common in developed countries in the recent decades.
In the Netherlands, the incidence and mortality have been
decreasing for decades (Figure 1-1). In 2003, cervical cancer was
newly diagnosed in 584 women (World standardized incidence
rate (WSR): 4.9 per 100,000 women) and 214 women died from
it (WSR: 1.4 per 100,000 women).
Inter-country differences in cervical cancer incidence are
caused by differences in determinants and in access to preventive
measures. The prevalence of the Human Papillomavirus (HPV)
infection, the necessary factor in the development of cervical cancer,
is generally higher in developing countries. Differences in
the host factor, e.g. more common malnourishment and the prevalence
of other infections in the developing countries, may also
play a role. These countries typically do not offer population-wide
cervical cancer screening facilities, which require a high level of
organization and adequate health care resources
Risk of cervical cancer after completed post-treatment follow-up of cervical intraepithelial neoplasia: Population based cohort study
Abstract
Objective To compare the risk of cervical cancer in women with
histologically confirmed cervical intraepithelial neoplasia who returned
to routine screening after having completed post-treatment follow-up
with consecutive normal smear test results with women with a normal
primary smear test result.
Design Population based cohort study using data from a nationwide
pathology register.
Setting The Netherlands, 1994 to 2006.
Population 38 956 women with histologically confirmed intraepithelial
neoplasia grades 1 to 3 with completed follow-up after treatment.
Intervention Routine post-treatment follow-up of cervical intraepithelial
neoplasia, recommending smear tests at six, 12, and 24 months.
Main outcome measure Incidence of cervical cancer in the period from
completed follow-up with negative test results after cervical intraepithelial
neoplasia to the next primary test. 10-year hazard ratios were compared
with periods after normal results for the primary smear test, adjusted for
year in follow-up.
Results 20 cervical cancers were diagnosed during 56 956 woman
years after completed follow-up of cervical intraepithelial neoplasia,
whereas 1613 cervical cancers were diagnosed during 25 020 697
woman years after a normal primary smear test result. The incidence of
35.1 (95% confidence interval 21.4 to 54.2) per 100 000 woman years
and 6.4 (6.1 to 6.8) per 100 000 woman years, respectively, led to an
adjusted hazard ratio of 4.2 (95% confidence interval 2.7 to 6.5) for
periods after completed follow-up compared with periods after normal
primary smear test results. This hazard ratio was increased for all ages.
No significant difference in risk of cervical cancer was observed by grade
of cervical intraepithelial neoplasia.
Conclusions An excess risk
Cervical cancer incidence after normal cytological sample in routine screening using SurePath, ThinPrep, and conventional cytology: population based study
#### Objective
To compare the cumulative incidence of cervical cancer
diagnosed within 72 months after a normal screening
sample between conventional cytology and liquid
based cytology tests SurePath and ThinPrep.
#### Design
Retrospective population based cohort study.
#### Setting
Nationwide network and registry of histo- and
cytopathology in the Netherlands (PALGA), January
2000 to March 2013.
#### Population
Women with 5924474 normal screening samples
(23833123 person years).
#### Exposure
Use of SurePath or ThinPrep versus conventional
cytology as screening test.
#### Main outcome measure
72 month cumulative incidence of invasive cervical
cancer after a normal screening sample for each
screening test. Cox regression analyses assessed the
hazard ratios, adjusted for calendar time, age,
screening history, and socioeconomic status and
including laboratories as random effects.
#### Results
The 72 month cumulative cancer incidence was 58.5
(95% confidence interval 54.6 to 62.7) per 100000
normal conventional cytology samples, compared with
66.8 (56.7 to 78.7) for ThinPrep and 44.6 (37.8 to 52.6)
for SurePath. Compared with conventional cytology,
the hazard of invasive cancer was 19% lower (hazard
ratio 0.81, 95% confidence interval 0.66 to 0.99) for
SurePath, mainly caused by a 27% lower hazard (0.73,
0.57 to 0.93) of a clinically detected cancer. For
ThinPrep, the hazard was on average 15% higher
(hazard ratio 1.15, 0.95 to 1.38), mainly caused by a
56% higher hazard of a screen detected cancer (1.56,
1.17 to 2.08).
#### Conclusions
These findings should provoke reconsideration of the
assumed similarity in sensitivity to detect progressive
cervical intraepithelial neoplasia between different
types of liquid based cy
Addition of ultrasound to mammography in the case of dense breast tissue: systematic review and meta-analysis.
BACKGROUND: Mammography is less effective in detecting cancer in dense than in fatty breasts. METHODS: We undertook a systematic search in PubMed to identify studies on women with dense breasts who underwent screening with mammography supplemented with ultrasound. A meta-analysis was undertaken on the proportion of cancers detected only by ultrasound, out of all screen-detected cancers, and the proportion of women with negative mammography who were referred for assessment following ultrasound screening. RESULTS: Twenty-nine studies satisfied our inclusion criteria. The proportion of total cancers detected only by ultrasound was 0.29 (95% CI: 0.27-0.31), consistent with an approximately 40% increase in the detection of cancers compared to mammography. In the studied populations, this translated into an additional 3.8 (95% CI: 3.4-4.2) screen-detected cases per 1000 mammography-negative women. About 13% (32/248) of cancers were in situ from 17 studies with information on this subgroup. Ultrasound approximately doubled the referral for assessment in three studies with these data. CONCLUSIONS: Studies have consistently shown an increased detection of breast cancer by supplementary ultrasound screening. An inclusion of supplementary ultrasound into routine screening will need to consider the availability of ultrasound and diagnostic assessment capacities.Department of Health Policy Research Programme (106/0001).
Cancer Research UK (grants C8162/A16892 and C569/A16891)