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Purpose: Long-term breast cancer survivors are women surviving at least 5 years after diagnosis. This systematic review aimed to summarize the main characteristics and patterns of healthcare service use (frequency of visits, health providers visited, and preventive care performed) among long-term breast cancer survivors. Methods: We used standard Cochrane Collaboration methods and searched the MEDLINE and EMBASE databases up to January 2018. We included English language observational studies reporting health service use among long-term cancer survivors. The quality of the studies was appraised through the ROBINS-I assessment tool. Two independent reviewers performed both the study quality assessment and the data extraction. Results: A total of 23 observational studies were included that reported data on health services use by long-term breast cancer survivors. Despite heterogeneity among studies, about half of them reported that breast cancer survivors visited a medical provider at least once a year, as recommended by breast cancer survival guidelines. Although survivors visited medical providers with the recommended frequency, a substantial number used specialist care instead of primary care during follow-up. The results showed underuse of the recommended annual mammogram. Conclusions: Long-term breast cancer survivors differ in their health services use with regard to the frequency of visits as well as the health providers seen. Our results indicate the need for active surveillance through primary care providers in coordination with specialized care. Implications for cancer survivors: This review could help to standardize the management of breast cancer survivors and decision-makers to adapt their guidelines and clinical protocols.

Objective: To describe and analyse the factors associated with the use of health services (emergency departments, admissions and primary care) in women survivors of breast cancer diagnosed or treated in four university hospitals of Barcelona (Spain) between 2003 and 2013, within the framework of the Cohort DAMA project. Method: Descriptive design nested in a mixed cohort (Cohort Dama). We obtained sociodemographic information and information on the use of health services through a questionnaire, and on the tumour from the clinical history. Logistic regression models were performed, calculating the odds ratio of the use of health services (emergency departments, hospital admissions and primary care) raw and adjusted (aOR) by diagnostic method, the characteristics of the tumour and of the women and their 95% confidence intervals. Results: The presence of chronic diseases was associated with greater use of the three levels of care. A disadvantaged economic level increases the risk of use of emergency departments and primary care but not of hospital admissions, while a higher tumour stage is associated with a greater risk of admission. By age, those under 50 had a higher risk of using emergency departments and admissions. Conclusions: The factors associated with the use of health services differ according to the level of care (aOR: 3.53 emergency departments, 1.67 admissions, 3.89 primary care) and treatment-derived complications (aOR: 1.35 emergency departments, 1.43 primary care). The presence of chronic disorders, younger age, disadvantaged social class, increases the risk of using services more than the tumour stage and treatment-derived complications. Neither the diagnostic method nor the survival time, nor the use of non-conventional therapies influence this. (C) 2018 SESPAS. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Background: The effect of changes in mammographic density over time on the risk of breast cancer remains inconclusive. Methods: We used information from four centres of the Breast Cancer Screening Program in Spain in the period 1996-2015. We analysed individual level data from 117,388 women first screened age 50-54, with at least two screening examinations. Breast density was determined using the BI-RADS classification (A to D in increasing order) at earliest and latest screening examination. Adjusted Poisson regression models were used to estimate the relative risk (RR) and 95% confidence intervals (95% CI) of the association between changes in mammographic density and breast cancer risk over time. Results: During an average 5.8 years of follow-up, 1592 (1.36%) women had a breast cancer diagnosis. An increase in density category increased breast cancer risk, and a decrease in density decreased the risk, compared with women who remained in the same BI-RADS category. Women whose density category increased from B to C or B to D had a RR of 1.55 (95% CI = 1.24-1.94) and 2.32 (95% CI = 1.48-3.63), respectively. The RR for women whose density increased from C to D was 1.51 (95% CI = 1.03-2.22). Changes in BI-RADS density were similarly associated with the risk for invasive cancer than for ductal carcinoma in situ. Conclusions: Although a modest proportion of women changed BI-RADS density category, mammographic density changes modulated the risk of breast cancer and identified women at a differential risk. Using two longitudinal measures of BI-RADS density could help target women for risk-based screening strategies. (C) 2019 Elsevier Ltd. All rights reserved.

Objectives: To investigate how breast density affects screening performance indicators in a digital mammography context. Methods: We assessed the effect of breast density over the screen-detected and interval cancers rates, false-positives, specificity, sensitivity, recall rate, positive predictive value of recall (PPV-1), and PPV of invasive tests (PPV-2). Radiologists classified breast density using the BIRADS System. We used generalized estimating equations to account for within-woman correlation by means of the robust Huber-While variance estimator. Results: We included 177,164 women aged 50-69 years who underwent 499,251 digital mammograms from 2004 to 2015 in Spain. According to the fibroglandular tissue percentage, 24.7% of mammograms were classified as BI-RADS 1 ( < 25% glandular), 54.7% as BI-RADS 2 (25-50% glandular), 14.0% as BI-RADS 3 (51-75% glandular) and 6.6% as BI-RADS 4 ( > 75% glandular). Overall, women with BI-RADS 3 had the highest screen-detected cancer rate (5.9 per 1000) and BI-RADS 4 the highest interval cancer rate (2.4 per 1000). Sensitivity decreased from 89.2% in women with BI-RADS 1 to 67.9% in BI-RADS 4. Both PPV-1 and PPV-2 decreased from 10.4% to 5.7% and from 49.8% to 32.4% in women with BI-RADS 1 and BI-RADS 4, respectively. Women aged 60-69 years with BI-RADS 4 had the lowest sensitivity (54.9%) and the highest interval cancer rate (3.8 per 1000). Conclusions: Performance screening measures are negatively affected by breast density falling to a lower sensitivity and PPV, and higher interval cancer rate as breast density increases. Particularly women aged 60-69 years with > 75% glandular breasts had the worst results and therefore may be candidates for screening using other technologies.

Neither breast cancer prevention and early-detection programs, nor their outcomes, are uniform across Europe. This article describes the rationale, methods, and process for development of the European Commission ( EC) Initiative on Breast Cancer Screening and Diagnosis Guidelines. To be consistent with standards set by the Institute of Medicine and others, the EC followed 6 general principles. First, the EC selected, via an open call, a panel with broad representation of areas of expertise. Second, it ensured that all recommendations were supported by systematic reviews. Third, the EC separately considered important subgroups of women, included patient advocates in the guidelines development group, and focused on good communication to inform women's decisions. Fourth, EC rules on conflicts of interest were followed and the GRADE ( Grading of Recommendations Assessment, Development and Evaluation) Evidence to Decision frameworks were used to structure the process and minimize the influence of competing interests. Fifth, it focused its recommendations on outcomes that matter to women, and certainty of the evidence is rated for each. Sixth, the EC elicited stakeholder feedback to ensure that the recommendations remain up to date and relevant to practice. This article describes the approach and highlights ways of disseminating and adapting the recommendations both within and outside Europe, using innovative information technology tools.

Objectives: The objective of the study was to develop and validate an adequate tool to evaluate the risk of bias of randomized controlled trials, observational studies, and systematic reviews assessing drug adverse events. Study Design and Setting: We developed a structured risk of bias checklist applicable to randomized trials, cohort, case control and nested case-control studies, and systematic reviews focusing on drug safety. Face and content validity was judged by three experienced reviewers. Interrater and intrarater reliability were determined using 20 randomly selected studies, assessed by three other independent reviewers including one performing a 3-week retest. Results: The developed checklist examines eight domains-study design and objectives, selection bias, attrition, adverse events information bias, other information bias, statistical methods to control confounding, other statistical methods, and conflicts of interest. The total number of questions varied from 10 to 32 depending on the study design. Interrater and intrarater agreements were fair with Kendall's W of 0.70 and 0.74, respectively. Median time to complete the checklist was 8.5 minutes. Conclusion: The developed checklist showed face and content validity and acceptable reliability to assess the risk of bias for studies analyzing drug adverse events. Hence, it might be considered as a novel useful tool for systematic reviews and meta-analyses focusing on drug safety. (C) 2017 Elsevier Inc. All rights reserved.

Purpose The aim of this study was to assess effectiveness and safety of antithrombotics for stroke prevention in non-valvular atrial fibrillation in real-use conditions. Methods We used a population-based retrospective cohort study. Information emerges from SIDIAP, a database containing anonymized information from electronic health records from 274 primary healthcare centres of the Catalan Health Institute, Catalonia (Spain), with a reference population of 5 835 000 people. Population includes all adults with a new diagnosis of non-valvular atrial fibrillation registered in SIDIAP from 2007 to 2012. The main outcome of antithrombotics' effectiveness was stroke. The main outcomes of safety were cerebral and gastrointestinal haemorrhages. We also estimated all-cause mortality. We used multivariable Cox proportional hazard models to examine association between antithrombotic treatment and main outcomes. Results We included 22 205 subjects with non-valvular atrial fibrillation; 40.8% initiated on vitamin K antagonists (VKA), 33.4% on antiplatelets and 25.8% untreated. We found stroke-risk reduction with VKA, hazard ratio (HR) 0.72 (95% confidence interval (CI), 0.58-0.91), also seen in patients with CHADS(2) >= 2, HR 0.65 (95% CI, 0.49-0.86), and CHA(2)DS(2)-VASc >= 2, HR 0.66 (95% CI, 0.52-0.84). We observed a higher risk of digestive bleeding with antiplatelets, HR 1.32 (95% CI, 1.01-1.73). Both VKA and antiplatelets were associated with reduction of all-cause mortality risk; HR 0.55 (95% CI, 0.49-0.62) and HR 0.89 (95% CI, 0.80-0.97), respectively. Conclusions This study found a stroke-risk reduction associated with VKA and an increased risk of gastrointestinal bleeding associated with platelet-aggregation inhibitors in comparison with untreated patients. Both antithrombotic groups showed a reduction in all-cause mortality. Copyright (C) 2016 John Wiley & Sons, Ltd.

Objetivo: Analizar las variaciones en el proceso de confirmación diagnóstica entre unidades de cribado, las variaciones en los resultados de cada episodio y la relación entre las tasas de las diferentes pruebas de confirmación diagnóstica y las de detección de lesiones. Método: Estudio observacional de las variaciones de las tasas estandarizadas de pruebas diagnósticas y de detección de lesiones, en 34 unidades de cribado de los programas poblacionales de detección precoz de cáncer de mama, de tres comunidades autónomas, en el periodo de 2002 a 2011. Resultados: Las razones de variación entre los percentiles 25-75 en las tasas de realización de pruebas diagnósticas oscilaron entre 1,68 (recitaciones) y 3,39 (punción-aspiración con aguja fina). En las tasas de detección de lesiones benignas, carcinoma ductal in situ y cáncer invasivo fueron, respectivamente, 2,79, 1,99 y 1,36. Se encontró una relación positiva entre las tasas de realización de pruebas y las tasas de detección en punción-aspiración con aguja fina y lesiones benignas (R²: 0,53), punción-aspiración con aguja fina y carcinoma invasivo (R²: 0, 28), biopsias cerradas y lesiones benignas (R²: 0,64), biopsias cerradas y carcinoma ductal in situ (R²: 0,61), y biopsias cerradas y carcinoma invasivo (R²: 0,48). Conclusiones: Se observaron variaciones en la realización de pruebas invasivas entre las unidades de detección precoz de cáncer de mama de mayor magnitud que las de detección de lesiones. Las unidades con más pruebas de punción-aspiración con aguja fina tienen mayores tasas de detección de lesiones benignas, y las que realizan más biopsias cerradas detectan más lesiones benignas y cáncer. Objective: To analyse variations in the diagnostic confirmation process between screening units, variations in the outcome of each episode and the relationship between the use of the different diagnostic confirmation tests and the lesion detection rate. Method: Observational study of variability of the standardised use of diagnostic and lesion detection tests in 34 breast cancer mass screening units participating in early-detection programmes in three Spanish regions from 2002-2011. Results: The diagnostic test variation ratio in percentiles 25-75 ranged from 1.68 (further appointments) to 3.39 (fine-needle aspiration). The variation ratio in detection rates of benign lesions, ductal carcinoma in situ and invasive cancer were 2.79, 1.99 and 1.36, respectively. A positive relationship between rates of testing and detection rates was found with fine-needle aspiration-benign lesions (R²: 0.53), fine-needle aspiration-invasive carcinoma (R²: 0 28), core biopsy-benign lesions (R²: 0.64), core biopsy-ductal carcinoma in situ (R²: 0.61) and core biopsy-invasive carcinoma (R²: 0.48). Conclusions: Variation in the use of invasive tests between the breast cancer screening units participating in early-detection programmes was found to be significantly higher than variations in lesion detection. Units which conducted more fine-needle aspiration tests had higher benign lesion detection rates, while units that conducted more core biopsies detected more benign lesions and cancer.

Editorial of vol 28-3.

In the context of a population-based screening program, we aimed to evaluate the major mammographic features and clinicopathological characteristics of breast tumors at diagnosis and the associations between them, focusing on tumors with the worst prognosis. We analyzed cancers diagnosed in a cohort of 645,764 women aged 45-69 years participating in seven population-based screening programs in Spain, between January 1, 2000 and December 31, 2006 and followed up until June 2009. We included all interval cancers and a sample of screen-detected cancers, whether invasive or in situ. We compared tumor-related information and breast density for different phenotypes (Triple-negative (TN), HER2+, Luminal B and Luminal A) in screen-detected and interval cancers. We used Chi-square or Fisher's exact test to compare major mammographic features of invasive versus in situ tumors, of screen-detected versus interval cancers, and of different types of interval cancers. We included 2582 tumors (1570 screen-detected and 1012 interval cancers). There were significant differences in the distribution of most clinicopathological variables between screen-detected and interval cancers. Invasive TN interval tumors were more common than other phenotypes in breasts with low mammographic density; three-quarters of these tumors presented as masses without associated calcifications. HER2+ tumors were more common in denser breasts and were associated with calcifications and multifocality. Architectural distortion was more common in Luminal A and Luminal B tumors. Certain radiologic findings are associated with pre-invasive lesions; these differ among invasive tumor phenotypes. We corroborate that TN and HER2+ cancers have distinctive appearances also in the context of population-based screening programs. This information can be useful for establishing protocols for diagnostic strategies in screening units.

The aim of the present study was to determine the role of specific environmental and climatic factors affecting the distribution and density of Phlebotomus ariasi and P. perniciosus, the proven vectors for Leishmania infantum in Spain. An entomological study was carried out in July 2006 in the province of Lleida with sticky traps set in their diurnal resting places at altitudes ranging from 86 to 1,755 m above the mean sea level (339 sites were sampled). Bivariate analysis revealed that factors such as altitude, bioclimatic zone, temperature, precipitation, sampling site (site relative to settlement, site situation, site category), wall vegetation, particular environment (in this case a natural park), general environment, adjacent natural vegetation and land cover were significantly associated with sand fly densities. The multivariate model for P. perniciosus revealed that its density was affected by site and land cover. Specifically, paved driveways correlated negatively with vector density (Incidence Risk Ratio (IRR): 0.41) and arable land cover correlated positively (IRR: 4.59). In the case of P. ariasi, a significant correlation was observed with the altitude and bioclimatic zone, with density increasing at >800 m above the mean sea level (IRR: 3.40) and decreasing in the meso-Mediterranean bioclimatic zone (IRR: 0.08). Both species were mostly found in agricultural and forest areas far from domestic environments. However, the two species correlated differently with altitude, bio-climate, vegetation, temperature and precipitation, which emphasises the importance of their individual analysis in studies regarding risk of leishmaniasis transmission.

Objetivo: Evaluar la incidencia y los costes de los eventos adversos presentes en el Conjunto Mínimo Básico de Datos (CMBD) en los hospitales españoles en el período 2008-2010. Método: Estudio retrospectivo que estima el coste incremental por episodio, según la presencia de eventos adversos. El coste se obtiene de la Red Española de Costes Hospitalarios (RECH), creada a partir de los registros de costes por paciente basados en actividades y CMBD. Los eventos adversos se han identificado mediante Indicadores de Seguridad del Paciente (validados en el Sistema Sanitario español) de la Agency of Healthcare Research and Quality, junto a indicadores del proyecto europeo EuroDRG. Resultados: Se incluyen 245.320 episodios, con un coste de 1.308.791.871 €. Aproximadamente 17.000 episodios (6,8%) sufrieron un evento adverso, lo que representa un 16,2% del coste total. Los eventos adversos, ajustados por el Grupo Relacionado por el Diagnóstico, añaden un coste incremental medio que oscila entre 5.260 € y 11.905 €. Seis de los diez eventos adversos con mayor coste incremental son posteriores a intervenciones quirúrgicas. El coste incremental total de los eventos adversos es de 88.268.906€, un 6,7% adicional del total del gasto sanitario. Conclusiones: Valorando su impacto, los eventos adversos representan relevantes costes que pueden revertirse en mejora de la calidad y la seguridad del sistema de salud. Objective: To evaluate the incidence and costs of adverse events registered in an administrative dataset in Spanish hospitals from 2008 to 2010. Methods: A retrospective study was carried out that estimated the incremental cost per episode, depending on the presence of adverse events. Costs were obtained from the database of the Spanish Network of Hospital Costs. This database contains data from 12 hospitals that have costs per patient records based on activities and clinical records. Adverse events were identified through the Patient Safety Indicators (validated in the Spanish Health System) created by the Agency for Healthcare Research and Quality together with indicators of the EuroDRG European project. Results: This study included 245,320 episodes with a total cost of 1,308,791,871€. Approximately 17,000 patients (6.8%) experienced an adverse event, representing 16.2% of the total cost. Adverse events, adjusted by diagnosis-related groups, added a mean incremental cost of between €5,260 and €11,905. Six of the 10 adverse events with the highest incremental cost were related to surgical interventions. The total incremental cost of adverse events was € 88,268,906, amounting to an additional 6.7% of total health expenditure. Conclusions: Assessment of the impact of adverse events revealed that these episodes represent significant costs that could be reduced by improving the quality and safety of the Spanish Health System.

Background: Interval cancers are primary breast cancers diagnosed in women after a negative screening test and before the next screening invitation. Our aim was to evaluate risk factors for interval cancer and their subtypes and to compare the risk factors identified with those associated with incident screen-detected cancers. Methods: We analyzed data from 645,764 women participating in the Spanish breast cancer screening program from 2000-2006 and followed-up until 2009. A total of 5,309 screen-detected and 1,653 interval cancers were diagnosed. Among the latter, 1,012 could be classified on the basis of findings in screening and diagnostic mammograms, consisting of 489 true interval cancers (48.2%), 235 false-negatives (23.2%), 172 minimal-signs (17.2%) and 114 occult tumors (11.3%). Information on the screening protocol and women's characteristics were obtained from the screening program registry. Cause-specific Cox regression models were used to estimate the hazard ratios (HR) of risks factors for interval cancer and incident screen-detected cancer. A multinomial regression model, using screen-detected tumors as a reference group, was used to assess the effect of breast density and other factors on the occurrence of interval cancer subtypes. Results: A previous false-positive was the main risk factor for interval cancer (HR = 2.71, 95%CI: 2.28-3.23); this risk was higher for false-negatives (HR = 8.79, 95%CI: 6.24-12.40) than for true interval cancer (HR = 2.26, 95%CI: 1.59-3.21). A family history of breast cancer was associated with true intervals (HR = 2.11, 95%CI: 1.60-2.78), previous benign biopsy with a false-negatives (HR = 1.83, 95%CI: 1.23-2.71). High breast density was mainly associated with occult tumors (RRR = 4.92, 95%CI: 2.58-9.38), followed by true intervals (RRR = 1.67, 95%CI: 1.18-2.36) and false-negatives (RRR = 1.58, 95%CI: 1.00-2.49). Conclusion: The role of women's characteristics differs among interval cancer subtypes. This information could be useful to improve effectiveness of breast cancer screening programmes and to better classify subgroups of women with different risks of developing cancer.

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 (

10.1371/journal.pone.0110207 Background Interval cancers are primary breast cancers diagnosed in women after a negative screening test and before the next screening invitation. Our aim was to evaluate risk factors for interval cancer and their subtypes and to compare the risk factors identified with those associated with incident screen-detected cancers. Methods We analyzed data from 645,764 women participating in the Spanish breast cancer screening program from 2000¿2006 and followed-up until 2009. A total of 5,309 screen-detected and 1,653 interval cancers were diagnosed. Among the latter, 1,012 could be classified on the basis of findings in screening and diagnostic mammograms, consisting of 489 true interval cancers (48.2%), 235 false-negatives (23.2%), 172 minimal-signs (17.2%) and 114 occult tumors (11.3%). Information on the screening protocol and women's characteristics were obtained from the screening program registry. Cause-specific Cox regression models were used to estimate the hazard ratios (HR) of risks factors for interval cancer and incident screen-detected cancer. A multinomial regression model, using screen-detected tumors as a reference group, was used to assess the effect of breast density and other factors on the occurrence of interval cancer subtypes. Results A previous false-positive was the main risk factor for interval cancer (HR = 2.71, 95%CI: 2.28¿3.23); this risk was higher for false-negatives (HR = 8.79, 95%CI: 6.24¿12.40) than for true interval cancer (HR = 2.26, 95%CI: 1.59¿3.21). A family history of breast cancer was associated with true intervals (HR = 2.11, 95%CI: 1.60¿2.78), previous benign biopsy with a false-negatives (HR = 1.83, 95%CI: 1.23¿2.71). High breast density was mainly associated with occult tumors (RRR = 4.92, 95%CI: 2.58¿

Objective: The consolidation of breast cancer screening programs, with full coverage of the target population in all Spanish regions, has encouraged the beginning of a joint research strategy. This strategy aims to improve the effectiveness of breast cancer screening by gathering information from distinct screening programs. Methods: A retrospective cohort with information on over 1.5 million screened women was constructed to evaluate risk factors for a false-positive result. The impact of the change from digital mammography to screen-film mammography was evaluated, while results for interval cancers and false negatives are currently being studied. Results: The results are highly useful from the perspective of public health, as they can be used to identify and improve the information provided to women with a higher risk of experiencing an adverse effect. These results will also be helpful to identify screening program-related characteristics and women's personal characteristics, which will allow better prevention strategies to be developed. Conclusions: The results obtained will be included in mathematical models currently under development to evaluate the efficiency of breast cancer screening. These models could be highly useful to provide information and guide clinical and health policy decisions on cancer prevention and control. (C) 2011 SESPAS. Published by Elsevier Espana, S.L. All rights reserved.

Objectives Breast cancer screening is offered to 100% of the target population in Spain and intermediate mammograms (IMs) are sometimes indicated. This study was aimed at analysing the frequency of IMs, the factors determining their recommendation, and their impact on the risk of false-positive results and the detection rate. Methods Data from 3,471,307 mammograms from Spanish breast cancer screening programmes were included. Results 3.36% of the mammograms were IMs. The factors associated with the use of IMs were age, initial screening, previous invasive tests, a familial history of breast cancer and use of hormone replacement therapy. In screening episodes with an IM, the probability of a false-positive result was 13.74% (95% CI: 13.43-14.05), almost double that in episodes without IMs (6.02%, 95% CI 5.99-6.05). In young women with previous invasive procedures, a familial history of breast cancer or hormone replacement therapy use who were undergoing their initial screen, this probability was lower when IMs were performed. IMs always increased the detection rate. Conclusions The factors prompting IMs should be characterised so that radiologists can systematise their recommendations according to the presence of the factors maximising the benefits and minimising the adverse effects of this procedure. Key Points Intermediate mammograms in breast screening offer potential benefits but also disadvantages. Intermediate mammograms increase the false-positive rate except in specific groups. Intermediate mammograms reduce the false-positive rate in younger women and initial screens. Intermediate mammograms also reduce false-positive results in women with personal risk factors Intermediate mammograms increase cancer detection mainly in women without risk factors.

Purpose: To evaluate the effect of the introduction of digital mammography on the recall rate, detection rate, false-positive rate, and rates of invasive procedures in a cohort of women from four population-based breast cancer screening programs in Spain. Materials and Methods: The study was approved by the ethics committee; informed consent was not required. A total of 242 838 mammograms (171 191 screen film [screen-film mammography group] and 71 647 digital [digital mammography group]) obtained in 103 613 women aged 45-69 years were included. False-positive results for any additional procedure and for invasive procedures, the breast cancer rate, and the positive predictive value in each group were compared by using Pearson chi(2) test. The effect of the mammographic technology used (screen-film or digital) on the false-positive results and cancer detection risk was evaluated with multivariate logistic regression models, adjusted according to women's and the screening program's characteristics and time trends. Results: The false-positive rate was higher for screen-film than for digital mammography (7.6% and 5.7%, respectively; P < .001). False-positive results after an invasive procedure were significantly higher for screen-film than for digital mammography (1.9% and 0.7%, respectively; P < .001). No significant differences were observed in the overall cancer detection rate between the two groups (0.45% and 0.43% in the screen-film and digital mammography groups, respectively; P = .59). The adjusted risk of a false-positive result was higher for screen-film than for digital mammography (odds ratio = 1.32). The adjusted risk was also lower for the digital mammography group when time trends were taken into account. Conclusion: The lower false-positive risk with use of digital mammography should be taken into account when balancing the risks and benefits of breast cancer screening. (C)RSNA, 2011

Objective. To estimate the false-positive (FP) risk according to the start age of mammography screening (45-46 or 50-51 years). Method. Data from eight regions of the Spanish breast cancer screening programme from 1990 to 2006 were included (1,565,364 women). Discrete time-hazard models were used to ascertain the effect of age and time-related, programme-related and personal variables on FP leading to any further procedure and to invasive procedures (FPI). In a subset we estimated the differential FP risk of starting screening at 45-46 years (175.656 women) or 50-51 (251,275). Results. A start age of 45-46 versus 50-51 years increased both FP (OR = 1.20: 95%Cl: 1.13-1.26) and FPI risks (OR = 1.43 (95%Cl: 1.18-1.73). Other factors increasing FP risk were premenopausal status (FP OR = 1.26: 95%Cl: 1.23-1.29 and FPI OR = 1.22; 95%Cl: 1.13-1.31), prior invasive procedures (FP OR = 1.52; 95%Cl: 1.47-1.57 and FPI (OR = 2.08; 95%Cl: 1.89-2.28) and family history (FP OR = 1.16: 95% Cl: 1.12-1.20 and FPI OR = 1.26; 95%Cl: 1.13-1.41). FP risk was increased by double reading (OR= 1.36: 95% Cl: 1.23-1.51) and FPI risk by double views (OR = 1.34; 95%Cl: 1.18-1.52). Both the cumulative FP and FPI risks were higher in women commencing screening at 45-46 years versus 50-51 years (33.30% versus 20.39% and 2.68% versus 1.76%). Conclusions. Starting screening earlier increases the cumulative risk of FP and FPI. (C) 2011 Elsevier Inc. All rights reserved.

espanolObjetivo: El envejecimiento de la poblacion ha provocado un aumento de la prevalencia de cataratas afectando a una amplia y creciente proporcion de la poblacion. El objetivo del presente estudio es describir la prevalencia de catarata a partir de estudios poblacionales mediante una revision bibliografica sistematica y exhaustiva. Metodos: Se realizo una busqueda sistematica de estudios poblacionales de prevalencia e incidencia de cataratas, realizados en poblacion sana no institucionalizada, mayor de 40 anos, de raza blanca, con una muestra superior a 1.000 individuos y cuyo ano de publicacion estuviera entre 1980 y 2002. Resultados: Diez estudios cumplieron con los criterios de inclusion (3 europeos, 5 de Estados Unidos y 2 australianos), realizados entre 1984 y 2001. La prevalencia de catarata segun opacificacion del cristalino en los estudios que la describen estaba entre el 15 y 19%. Cuando se define catarata como opacificacion y nivel de agudeza visual conjuntamente los estudios describen prevalencias entre el 15 y 30%. La prevalencia aumenta con la edad, alcanzando entre un 40% y mas del 60% de la poblacion a partir de los 70/75 anos. Las mujeres tienen una prevalencia mayor que los hombres, con un aumento mas pronunciado en edades mas avanzadas. Conclusiones: No existe una forma estandarizada de medir la prevalencia de catarata, lo que dificulta la comparacion entre los estudios. La prevalencia de catarata fue mayor en los grupos de mayor edad y entre las mujeres, en especial en edades mayores. La creciente prevalencia asociada a la edad muestra el aumento de la carga poblacional de las cataratas asociada al envejecimiento de la poblacion. EnglishObjective: The prevalence of cataracts has increased due to the progressive ageing of the population and the fact that cataracts affect a wide and increasing proportion of the population. The goal of the present study was to describe the prevalence of cataracts through a systematic and exhaustive review of population-based studies. Methods: A systematic review of population-based studies of the prevalence and incidence of cataracts was performed. Inclusion criteria were: a healthy non- institutionalised population, older than 40 years of age, of white race, with a sample size of greater than 1,000 and published between 1980 and 2002. Results: Ten studies met the inclusion criteria (3 European, 5 from the United States and 2 from Australia), and were performed between 1984 and 2001. The cataract prevalence, according to lens opacity criteria, ranged between 15% and 19%. When the cataract was defined as a lens opacity combined with a decreased visual acuity, the prevalence ranged from 15% to 30%. The overall prevalence increased with age, reaching 40% and more than 60% in populations older than 70 and 75 years respectively. The prevalence among women was higher than that among men, with a more marked increase being evident at older ages than for men. Conclusions: There were variations among the criteria used to measure the prevalence of cataract, which made it difficult to compare all the studies. Overall the prevalence was higher in the older population, especially among women. The increasing prevalence associated with age predicts an increasing burden of cataract to health services, this being particularly related to the ageing of the population.

Objetivo: El envejecimiento de la población ha provocado un aumento de la prevalencia de cataratas afectando a una amplia y creciente proporción de la población. El objetivo del presente estudio es describir la prevalencia de catarata a partir de estudios poblacionales mediante una revisión bibliográfica sistemática y exhaustiva. Métodos: Se realizó una búsqueda sistemática de estudios poblacionales de prevalencia e incidencia de cataratas, realizados en población sana no institucionalizada, mayor de 40 años, de raza blanca, con una muestra superior a 1.000 individuos y cuyo año de publicación estuviera entre 1980 y 2002. Resultados: Diez estudios cumplieron con los criterios de inclusión (3 europeos, 5 de Estados Unidos y 2 australianos), realizados entre 1984 y 2001. La prevalencia de catarata según opacificación del cristalino en los estudios que la describen estaba entre el 15 y 19%. Cuando se define catarata como opacificación y nivel de agudeza visual conjuntamente los estudios describen prevalencias entre el 15 y 30%. La prevalencia aumenta con la edad, alcanzando entre un 40% y más del 60% de la población a partir de los 70/75 años. Las mujeres tienen una prevalencia mayor que los hombres, con un aumento más pronunciado en edades más avanzadas. Conclusiones: No existe una forma estandarizada de medir la prevalencia de catarata, lo que dificulta la comparación entre los estudios. La prevalencia de catarata fue mayor en los grupos de mayor edad y entre las mujeres, en especial en edades mayores. La creciente prevalencia asociada a la edad muestra el aumento de la carga poblacional de las cataratas asociada al envejecimiento de la población. Objective: The prevalence of cataracts has increased due to the progressive ageing of the population and the fact that cataracts affect a wide and increasing proportion of the population. The goal of the present study was to describe the prevalence of cataracts through a systematic and exhaustive review of population-based studies. Methods: A systematic review of population-based studies of the prevalence and incidence of cataracts was performed. Inclusion criteria were: a healthy non- institutionalised population, older than 40 years of age, of white race, with a sample size of greater than 1,000 and published between 1980 and 2002. Results: Ten studies met the inclusion criteria (3 European, 5 from the United States and 2 from Australia), and were performed between 1984 and 2001. The cataract prevalence, according to lens opacity criteria, ranged between 15% and 19%. When the cataract was defined as a lens opacity combined with a decreased visual acuity, the prevalence ranged from 15% to 30%. The overall prevalence increased with age, reaching 40% and more than 60% in populations older than 70 and 75 years respectively. The prevalence among women was higher than that among men, with a more marked increase being evident at older ages than for men. Conclusions: There were variations among the criteria used to measure the prevalence of cataract, which made it difficult to compare all the studies. Overall the prevalence was higher in the older population, especially among women. The increasing prevalence associated with age predicts an increasing burden of cataract to health services, this being particularly related to the ageing of the population.

The determination of electrolytes in the clinical laboratories is carried out in samples of serum or plasma in situations that tubes remain open during a lingering time.To estimate the agreement and the interchangeability in the determination of electrolytes for three types of tubes (serum with separator, plasma with and without separator) in samples that remain at room temperature and open up to two hours.Samples of 36 voluntary patients were selected determining the levels of sodium, potassium, chlorine, calcium, magnesium and phosphate in the three tubes on time 0 (basal), 60 and 120 minutes. The agreement was estimated by means of the intraclass correlation coefficient (ICC) and the interchangeability of results by means of lineal regression.Agreement among the samples was very high with ICC higher than 0.9 in all basal determinations except for the potassium for which the presence of a constant systematic error was detected between serum and two tubes of plasma. The stability of the parameters is good in all the samples.It is possible the use of different types of tubes in the determination of electrolytes under the working conditions of the clinical laboratories. The determination of potassium needs to be corrected before the exchange of results obtained with serum and plasma. The stability in the two first hours is good in all the cases.