Even though the information in the Nordic Cancer Registries in general can be considered more similar than any other collection of data from five different countries, there are numerous differences in registration routines, classification systems and inclusion of some tumors. These differences are important to be aware of when comparing time trends in the Nordic countries.

Background: Attendance in screening is an important determinant of cervical cancer. Previous experience on high-risk human papillomavirus (hrHPV) DNA testing on patient-obtained samples suggests a good effect among nonattendees of screening. We assessed the effects of self-sampling on attendance in the Finnish screening program.Methods: Nonattendees after the primary invitation in one municipality (Espoo) were randomized to receive either a self-sampling kit (2,397 women) or an extra invitation (6,302 women). One fourth (1,315 women) of reminder letter arm nonattendees also received a self-sampling kit as a third intervention. Main outcomes were increases in screening attendance and coverage.Results: The adjusted relative risk for participation by self-sampling as a second intervention in comparison to a reminder letter arm was 1.21 (95% CI: 1.13-1.30). Total attendance increased from 65% to 76% by selfsampling and from 65% to 74% with a reminder letter. Combining the interventions (reminder letter and then self-sampling) increased total attendance from 63% to 78%. One fifth of the participants in all three groups increased screening coverage (previous Pap smear !5 years ago or never). Self-obtained samples were more often HPV positive than provider-obtained ones (participants after primary invitation and reminder letter), 12% to 13% versus 7%.Conclusions: Self-sampling is a feasible option in enhancing the attendance at organized screening, particularly as an addition to a reminder letter.Impact: If self-sampling is used as a third intervention after two written invitations, the overall attendance in Finland could most likely reach the desired 80% to 85%. Cancer Epidemiol Biomarkers Prev; 20(9); 1960-9. Ó2011 AACR.

Chemotherapy resistance is a critical contributor to cancer mortality and thus an urgent unmet challenge in oncology. To characterize chemotherapy resistance processes in high-grade serous ovarian cancer, we prospectively collected tissue samples before and after chemotherapy and analyzed their transcriptomic profiles at a single-cell resolution. After removing patient-specific signals by a novel analysis approach, PRIMUS, we found a consistent increase in stress-associated cell state during chemotherapy, which was validated by RNA in situ hybridization and bulk RNA sequencing. The stress-associated state exists before chemotherapy, is subclonally enriched during the treatment, and associates with poor progression-free survival. Co-occurrence with an inflammatory cancer–associated fibroblast subtype in tumors implies that chemotherapy is associated with stress response in both cancer cells and stroma, driving a paracrine feed-forward loop. In summary, we have found a resistant state that integrates stromal signaling and subclonal evolution and offers targets to overcome chemotherapy resistance.

Optimizing attendance and coverage of organized screening is needed to reduce cervical cancer incidence to previous lower levels. In our study, all nonparticipants in organized cervical cancer screening in 2008 in Espoo, Finland were randomized to receive a self-sampling kit (1,130 women) or a reminder letter (3,030 women). Effects on screening coverage were assessed according to the self-reported previous Pap smear history of the participants. Participation rate in the self-sampling arm, 29.8%, was significantly higher than in the reminder letter arm, 26.2% (adjusted relative risk for participation 1.13). Total participation in Espoo in 2008 rose significantly after the two interventions from 64.0 to 75.4%. In both arms,~20% of the participants after second intervention could be considered under screened (previous Pap smear ≥5 years ago) and thus increased screening coverage. Respectively, for 70-75%, the second intervention only provided overscreening. Participation was lowest among young age groups and immigrants, after primary invitation and after interventions. Our study shows that a second intervention for nonattendees after the first invitation is needed to optimize the attendance rates. Self-sampling might be slightly more successful in this, but the effects on screening coverage were similar in both groups.During the 50-year-old history of the Finnish cervical cancer screening program, the incidence of the cancer has reduced by 80%.1 After the mid-1990s, the incidence of cervical cancer increased again significantly, especially among women aged less than 40 years. A low attendance rate to screening in a particular municipality or age group correlates with a high incidence in cervical cancer, indicating that by increasing the coverage of screening, the incidence rate could possibly be decreased to previous levels (1, http://www.cancerre gistry.fi/eng/statistics). Women not attending organized screening might also have an elevated high-risk human papillomavirus (hrHPV) prevalence.2 Considering this, there is an immense need to find ways to include the current nonattendees into the program.The currently recommended way to increase screening attendance in Finland is the use of a reminder letter for nonattendees after the primary invitation, but it is still used only in a few municipalities. A new potential method in increasing screening attendance could be a screening test where the sample for a HPV test is taken at home by the woman herself (i.e., a self-sampling test). Self-sampling tests have been shown to be sensitive for high-grade cervical intraepithelial lesions, and the results were concordant to those from samples taken by professionals 3-5 with some exceptions where self-sampling tests gave more often HPV-positive results. 6Previous European studies also show promising results on the acceptability of self-sampling 5,7-9 and on its effect on screening attendance. 6,10,11 The purpose of our study was to asses the effects of a hrHPV self-sampling test on increasing the attendance and coverage of cerv...

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High attendance is essential to cervical cancer screening results. Attendance in the Finnish program is currently at 70%, but extensive opportunistic screening occurs beside the organized. A shift from opportunistic to organized screening is imperative to optimize the costs and impact of screening and minimize potential harms. We evaluated the effect of reminder letters (1st reminder) and self-sampling test (2nd reminder) on program attendance. The study population consisted of 31,053 screening invitees in 31 Finnish municipalities. 8,284 non-attendees after one invitation received a reminder letter and 4,536 further non-attendees were offered a self-sampling option. Socioeconomic factors related to participation were clarified by combining screening data to data from Statistics Finland. Reminder letters increased participation from 72.6% (95% CI 72.1, 73.1) to 79.2% (95% CI 78.8, 79.7) and self-sampling further to 82.2% (95% CI 81.8, 82.7). Reminder letters with scheduled appointments resulted in higher increase than open invitations (10 vs. 6%). Screening of original non-attendees increased the yield of CIN31 lesions by 24%. Non-attendance was associated with young age, immigrant background, lower education level and having never been married. We showed that a total attendance of well over 80% can be achieved within an organized program when the invitational protocol is carefully arranged.Good coverage amongst those at risk and high attendance within the cervical cancer screening program are of paramount importance to results. In Finland, a substantial proportion of cancer incidence and especially mortality among women in screening ages 30-60 years is seen among nonattendees. 1,2 Attendance in the program is currently 70% with a slightly decreasing trend (www.cancerregistry.fi).In addition to personal invitations to screening, prebooked appointments in invitation letters and reminders sent to non-attendees increase screening attendance. 3-12 Selfsampling for high risk human papillomavirus (hrHPV) DNA testing helps to further increase attendance among women who are not reached by the routine screening program. [11][12][13][14][15][16][17][18][19] The ability (relative sensitivity) to detect moderate cervical intraepithelial neoplasias or worse (CIN21) of hrHPVtesting on self-taken samples has been shown to be somewhat lower than that of hrHPV-testing on clinician-based samples, but similar or even more sensitive to a Pap-smear, depending on the cytological threshold. 20 The main aim of this study was to study the effect of reminder letters (1st reminder) and self-sampling tests (2nd reminder) as means to increase attendance within the routine cervical cancer screening programme in a wide setting of Finnish municipalities. Screening results among the attendees and original non-attendees were also explored.We further studied the socioeconomic characteristics of nonparticipants to routine screening to find groups that should be in the focus when planning interventions to increase attendance. Material and MethodsIn...

Background: Differences in cancer survival between the Nordic countries have previously been reported. The aim of this study was to examine whether these differences in outcome remain, based on updated information from five national cancer registers. Materials and methods: The data used for the analysis was from the NORDCAN database focusing on nine common cancers diagnosed 1990-2016 in Denmark, Finland, Iceland, Norway and Sweden with maximum follow-up through 2017. Relative survival (RS) was estimated at 1 and 5 years using flexible parametric RS models, and percentage point differences between the earliest and latest years available were calculated. Results: A consistent improvement in both 1-and 5-year RS was found for most studied sites across all countries. Previously observed differences between the countries have been attenuated. The improvements were particularly pronounced in Denmark that now has cancer survival similar to the other Nordic countries. Conclusion: The reasons for the observed improvements in cancer survival are likely multifactorial, including earlier diagnosis, improved treatment options, implementation of national cancer plans, uniform national cancer care guidelines and standardized patient pathways. The previous survival disadvantage in Denmark is no longer present for most sites. Continuous monitoring of cancer survival is of importance to assess the impact of changes in policies and the effectiveness of health care systems.

Recent research on vaginal microbiota relies on high throughput sequencing while microscopic methods have a long history in clinical use. We investigated the correspondence between microscopic findings of Pap smears and the vaginal microbiota composition determined by next generation sequencing among 50 asymptomatic women. Both methods produced coherent results regarding the distinction between Lactobacillus -dominant versus mixed microbiota, reassuring gynaecologists for the use of Pap smear or wet mount microscopy for rapid evaluation of vaginal bacteria as part of diagnosis. Cytologic findings identified women with bacterial vaginosis and revealed that cytolysis of vaginal epithelial cells is associated to Lactobacillus crispatus -dominated microbiota. Education and socio-economic status were associated to the vaginal microbiota variation. Our results highlight the importance of including socio-economic status as a co-factor in future vaginal microbiota studies.