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2. Position paper:breast cancer screening, diagnosis, and treatment in Denmark

Author

Christiansen, Peer, Vejborg, Ilse Merete Munk, Kroman, Niels Thorndahl, Holten, Iben, Garne, Jens Peter, Vedsted, Peter, Møller, Susanne, Lynge, Elsebeth, Christiansen, Peer, Vejborg, Ilse Merete Munk, Kroman, Niels Thorndahl, Holten, Iben, Garne, Jens Peter, Vedsted, Peter, Møller, Susanne, and Lynge, Elsebeth

Abstract

BACKGROUND: During the last decades the diagnosis, treatment, and prognosis of breast cancer have changed and improved in Denmark. The first mammography screening programme started in 1991. However, for many years only about 20% of Danish women aged 50-69 were offered screening. The national roll-out of screening took place in 2008-2010.MATERIAL AND METHODS: Based on published Danish data, this overview describes the status of diagnosis and treatment, and the screening programme. For further evaluating the potential overdiagnosis and overtreatment, additional Danish Breast Cancer Cooperative Group (DBCG) data are included.RESULTS AND CONCLUSION: Using incidence-based mortality method, reduction in breast cancer mortality was estimated to be 25% in the target group of women after 10 years of screening in Copenhagen; an outcome comparable to that of randomised controlled trials. A recent Danish study has indicated overdiagnosis to be around 4%. Others have estimated overdiagnosis to be 33%. National DBCG data showed that the rude breast cancer incidence increased during the period 1990-2011 from 126 to 206 per 100 000. The incidence was almost constant for women younger than 50 years. In regions not offering screening, the incidence increased with 3% per year for women aged 50-69 years with similar trends for small and large tumours. After introduction of screening the increase in the age group 50-69 years was confined to small tumours ≤ 20 mm, and most pronounced for node negative patients. From the 1990s, the use of breast conserving surgery has increased from around 25% to 69% in 2010. Screening has not increased the number of mastectomies. Breast cancer treatment in Denmark is evidence based and in agreement with international recommendations. After the introduction of mammography screening the absolute number of patients with a more advanced stage at diagnosis and the absolute number of patients undergoing mastectomy have decreased.

Published
2014

11. Kidney Scintigraphy with 99mTC-DMSA and 131I-Hippurate

Author

Holten, Iben and Storm, Hans Henrik

Abstract

43 patients underwent an extended scintigraphic procedure with 99mTc-dimercaptosuccinylic acid in order to investigate its proper use for diagnosing morphological and functional kidney abnormalities. The group was comprised of patients without renal disease, and patients with diffuse parenchymal disease, obstructive uropathy, renal cysts and renal tumors. The study was followed by 131I-hippurate renography.We propose a simplified routine procedure with scintiphotos taken 10-15 min after injection for topographic information and 120 min after injection for renal morphology. This procedure allows excellent case finding of diffuse parenchymal disease of a special value in cases of radiological non-visualization. The technique is indicated, when iodine contrast media cannot be used for radiological examinations.DMSA studies, however, do not allow safe functional evaluation in all categories of patients. Neither can obstructive nephropathy be diagnosed unless the renal pelvis is dilated.Renal perfusion studies are contaminated by the perfusion of liver and spleen. Nevertheless, a tentative differentation between cysts and tumours is possible, the former being hypoperfused the latter hyperperfused.When supplemented with gamma camera 131I-hippurate renography, the total scintigraphic procedure will also include split function determination and run-off evaluation.

Published
1979
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14. Comments to the paper: Influence of mammography screening on use of mastectomies in Denmark.

Author

Christiansen, Peer, Vejborg, Ilse, Kroman, Niels, Holten, Iben, Garne, Jens Peter, Vedsted, Peter, Møller, Susanne, and Lynge, Elsebeth

Subjects
EARLY detection of cancer, MAMMOGRAMS, BREAST tumors, MASTECTOMY, RESEARCH methodology
Abstract

A letter to the editor in response to the article "Influence of mammography screening on use of mastectomies in Denmark" by K. Jørgensen and others in a 2015 issue is presented.

Published
2015
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15. [Screening for colorectal cancer. Collaboration among politicians and scientists is necessary].

Author

Bretthauer M, Ekbom A, Malila N, Stefánsson T, Fischer A, Hof G, Weiderpass E, Tretli S, Tryggvadóttir L, Storm H, Holten I, and Adam HO

Subjects
Cooperative Behavior, Evidence-Based Medicine, Health Policy, Humans, Politics, Research Personnel, Colonoscopy adverse effects, Colorectal Neoplasms diagnosis, Colorectal Neoplasms prevention & control, Mass Screening methods
Abstract

Colorectal cancer is one of the most common cancers in the western world. It is especially common in the Nordic countries. In many of the European countries and in the United States colonoscopy is recommended as a screening procedure for CRC. However, there are no randomized studies of the effects of the method on incidence, mortality, possible complications or negative effects on the population. Public pressure to have screening for CRC with colonoscopy will probably increase heavily in the next years to come. We fear that colonoscopy will be introduced as a screening method without proper scientific support. Therefore we want to argue for a common Nordic randomized study on population screening with colonoscopy.

Published
2006

16. [Politics and science in colorectal cancer screening].

Author

Bretthauer M, Ekbom A, Malila N, Stefansson T, Fischer A, Hoff G, Weiderpass E, Tretli S, Trygvadottir L, Holten IW, Storm HH, and Adami HO

Subjects
Colonography, Computed Tomographic, Colonoscopy, Colorectal Neoplasms diagnosis, Colorectal Neoplasms epidemiology, Denmark epidemiology, Evidence-Based Medicine, Female, Finland epidemiology, Humans, Iceland epidemiology, Incidence, International Cooperation, Male, Norway epidemiology, Sweden epidemiology, Colorectal Neoplasms prevention & control, Health Policy, Mass Screening methods, Mass Screening organization & administration
Published
2006

17. [Barriers in screening for cervical cancer].

Author

Espersen MM and Holten IW

Subjects
Adult, Attitude to Health, Denmark, Female, Focus Groups, Humans, Interviews as Topic, Uterine Cervical Neoplasms prevention & control, Health Knowledge, Attitudes, Practice, Mass Screening psychology, Patient Acceptance of Health Care psychology, Uterine Cervical Neoplasms diagnosis, Vaginal Smears psychology
Abstract

Introduction: Approximately 25 percent of Danish women do not participate in the national cervical cancer screening programme. This study aims to identify and describe the barriers to participation., Materials and Methods: Eight focus groups were held with 48 women aged 23-39., Results: There is usually more than one reason for an individual woman's non-participation. The various barriers are often mutually reinforced. The study reveals seven general barriers: Insufficient and incorrect knowledge about screening and cervical cancer, Lack of understanding of why screening is relevant to the individual woman, The gynaecological examination, Fear of having cancer, Attitude towards seeing one's general practitioner, Practical circumstances that make participation difficult, Attitude towards screening. In general, women do not discuss cervical cancer screening with people close to them, but general practitioners seem to have a great potential to help them overcome the barriers., Discussion: This study indicates that non-participation does not necessarily mean that the individual woman has made an informed choice. But since the individual woman often has more than one barrier towards screening, it is not an issue of information and knowledge alone. In order to increase compliance, efforts must be made to resolve as many of the seven barriers as possible.

Published
2005

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