Cervical cancer in women under 30 years of age in Norway: a population-based cohort study

Background We compared women with incident cervical cancer under the age of 30 with older women with regard to stage, morphology, screening history and cervical cancer mortality in a population-based cohort study. Methods We included data from the Cancer Registry of Norway. Incidence rates (per 100,000 women-years) were calculated and joinpoint regression was used to analyse trends. The Nelson-Aalen cumulative hazard function for risk of cervical cancer death during a 15-year follow-up was displayed. The hazard ratios (HRs) of cervical cancer mortality with 95% confidence intervals (CIs) were derived from Cox regression models. Results The incidence of cervical cancer in women under the age of 30 has almost tripled since the 1950s, with the steepest increase during 1955–80 (with an annual percentage change (APC) of 7.1% (95%CI 4.4–9.8)) and also an increase after 2004 (3.8% (95%CI -1.3–9.2)). Out of 21,160 women with cervical cancer (1953–2013), 5.3% were younger than 30 years. A lower proportion of younger women were diagnosed at more advanced stages and a slightly higher proportion were diagnosed with adenocarcinoma and adenosquamous carcinoma comparing women above 30 years. The cumulative risk of cervical cancer death was lower for patients under the age of 30. However, the difference between the age groups decreased over time. The overall adjusted HR of cervical cancer mortality was 0.69 (95% CI 0.58–0.82) in women diagnosed under the age of 30 compared to older women. Conclusion There has been an increase in cervical cancer incidence in women under the age of 30. Cervical cancer in younger women was not more advanced at diagnosis compared to older women, and the cervical cancer mortality was lower.publishedVersio

Optimisation in strategies in diffusion tensor MR imaging

With diffusion MR imaging, the Brownian motion (or self-diffusion) of water molecules is measured. In the corresponding ADC (Apparent Diffusion Coefficient) image, each image element (voxel) represents the average diffusion. In MRI, the diffusion is measured with diffusion gradients along certain directions in space. The diffusion-weighting gradients are often incorporated in an echo planar imaging (EPI) pulse sequence. Depending on the type of tissue being imaged, the measured diffusion may be isotropic, i.e. equal for an directions of the diffusion gradient, as Seen, e.g., in grey matter and the cerebrospinal fluid (CSF). In contrast, in white matter, the diffusion is higher along the nerve fibres than across because water molecules moving along fibres are not hindered - this is referred to as anisotropic diffusion. In diffusion tensor imaging (DTI), the diffusion, for each voxel, is represented by an ellipsoid with a certain shape and orientation. For e.g. grey matter the ellipsoid is a sphere, whereas for white matter it is elongated in one direction like a cigar. From the diffusion tensor the mean diffusion (size of the ellipsoid) and the degree of anisotropy (shape of the ellipsoid) may be calculated. In this thesis different strategies to improve the image quality and reliability of the DTI data and diffusion anisotropy maps are presented. These include simulation studies to determine 1) which anisotropy index is most insensitive to noise and 2) which diffusion scheme (i.e. which set of diffusion gradients to use in the scanning process) minimises the variance and bias of the calculated DTI data. The simulation results were also complemented with data from phantoms and volunteers. Additionally, two major types of image artefacts in diffusion weighted single-shot echo planar imaging (DW SS-EPI) and means of correcting them have been investigated. The first artefact is signal dropout, predominantly in the mid-lower part of the brain, due to brain motion. The second is eddy currents induced by the diffusion gradients that cause the DW images to be distorted differently depending on the direction of the diffusion gradient. The distortions are translation, scaling and shear effects in the phase encoding direction of the image. These distortions, together with patient motion, result in anatomical mismatch between the different DW images used for the calculation of the diffusion tensor data. A new distortion correction method that corrects for this mismatch has been developed. DTI has been performed in a study comparing schizophrenic patients and normal controls with respect to diffusion anisotropy, mean diffusion and morphological differences

Kostnader ved Masseundersøkelsen mot livmorhalskreft

Bakgrunn: Forebygging står sentralt i norsk helsepolitikk, og observasjonsstudier tyder på at organisert screening har redusert forekomsten av livmorhalskreft i Norge. Samfunnets ressurser er imidlertid knappe. Hensikt: Vår hensikt var å estimere de årlige kostnadene av Masseundersøkelsen mot livmorhalskreft. Metode: Vi beregnet statens direkte utgifter og de årlige samfunnsøkonomiske kostnader av dagens screeningprogram for livmorhalskreft på grunnlag av opplysninger fra Kreftregisteret om antall utførte undersøkelser under Masseundersøkelsen for livmorhalskreft og enhetskostnadene for disse. De samfunnsøkonomiske enhetskostnadene er basert på ulike beregninger av faktiske kostnader, mens statens utgifter er basert på de ulike takstsystemer. Resultater: I 2011 ble det utført i alt 360 704 primærscreeningprøver, som med våre beregninger ville medføre 21 783 nye etterundersøkelser. Det ble innsendt biopsier for omtrent 9000 kvinner, og 3057 kvinner fikk utført konisering. De samlete samfunnsøkonomiske kostnader ved screeningprogrammet var 730 millioner kroner, hvorav 52 prosent utgjorde indirekte kostnader i form av reisekostnader og fravær fra arbeid. Statens direkte utgifter utgjorde 163 millioner kroner. Konklusjon: Det norske screeningprogrammet for livmorhalskreft har betydelige kostnader, der kvinnenes tids- og reisekostnader og legekonsultasjoner veier mest

Cervical cancer in women under 30 years of age in Norway: a population-based cohort study

Background We compared women with incident cervical cancer under the age of 30 with older women with regard to stage, morphology, screening history and cervical cancer mortality in a population-based cohort study. Methods We included data from the Cancer Registry of Norway. Incidence rates (per 100,000 women-years) were calculated and joinpoint regression was used to analyse trends. The Nelson-Aalen cumulative hazard function for risk of cervical cancer death during a 15-year follow-up was displayed. The hazard ratios (HRs) of cervical cancer mortality with 95% confidence intervals (CIs) were derived from Cox regression models. Results The incidence of cervical cancer in women under the age of 30 has almost tripled since the 1950s, with the steepest increase during 1955–80 (with an annual percentage change (APC) of 7.1% (95%CI 4.4–9.8)) and also an increase after 2004 (3.8% (95%CI -1.3–9.2)). Out of 21,160 women with cervical cancer (1953–2013), 5.3% were younger than 30 years. A lower proportion of younger women were diagnosed at more advanced stages and a slightly higher proportion were diagnosed with adenocarcinoma and adenosquamous carcinoma comparing women above 30 years. The cumulative risk of cervical cancer death was lower for patients under the age of 30. However, the difference between the age groups decreased over time. The overall adjusted HR of cervical cancer mortality was 0.69 (95% CI 0.58–0.82) in women diagnosed under the age of 30 compared to older women. Conclusion There has been an increase in cervical cancer incidence in women under the age of 30. Cervical cancer in younger women was not more advanced at diagnosis compared to older women, and the cervical cancer mortality was lower

Atypical glandular lesions of the cervix and risk of cervical cancer

Introduction Cytology screening has been effective in reducing risks for cervical squamous cell carcinoma but less so for adenocarcinoma. We explored the association of atypical glandular cells or absence of glandular cells in cytology, and subsequent histological diagnoses and cancer risk. Material and methods All women in Norway with atypical glandular cells of undetermined significance (AGUS), adenocarcinoma in situ (ACIS) and normal/benign cells, but absence of endocervical or metaplastic cells (NC‐NEC) in their first cytology during 1992‐2014 (NC‐NEC; 2005‐2014), recorded in the Cancer Registry of Norway, were included (n = 142 445). Histology diagnoses (stratified by age) within 1 and 3 years after cytology were examined. The Nelson‐Aalen cumulative hazard function for gynecological cancer risk was displayed. Results The majority of AGUS and particularly ACIS were followed with histology within 1 and 3 years. Cervical intraepithelial neoplasia (CIN) lesions were more common in women <35 than in women ≥35 years. Cervical adenocarcinoma followed 13% of ACIS after 1 and 3 years. After ACIS and AGUS, cervical adenocarcinoma was the most frequent cancer subtype. Cumulative risks of cervical adenocarcinoma following ACIS, AGUS and NC‐NEC were 3.5%, 0.9% and 0.05%, respectively, after 22, 22 and 9 years of follow‐up. Conclusions There was a high‐risk of glandular malignancies after AGUS and ACIS in cytology. If effective treatment of pre‐cancer and early cancer is available, cytology screening provides some level of prevention of adenocarcinoma. Lack of glandular cells did not entail a higher cancer risk