Effect of Screening for Cancer in the Nordic Countries on Deaths, Costs and Quality of Life up to the Year 2017

Hristova, Lora; Hakama, Matti

doi:10.1080/0284186x.1997.11835453

Cited by 71 publications

(66 citation statements)

References 55 publications

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“…In the municipalities that invited women aged 50 -69 years regularly to screening, the estimates were, however, consistent with those from Denmark at the age group of 60 -79 years at death and from Turku, Finland (Olsen et al, 2005;Parvinen et al, 2006). The results were also consistent with previous predictions on breast cancer mortality at 50 -69 years of age (Hristova and Hakama, 1997).…”

Section: Discussionsupporting

confidence: 82%

Breast cancer mortality with varying invitational policies in organised mammography

2008

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We examined the effect of different invitational policies on the reduction of breast cancer mortality at 60 -79 years of age within the Finnish mammography programme in 1992 -2003, which varied in its coverage at 60 -69 years of age. The data from 260 municipalities were grouped into three categories: regular invitations at 50 -59 years of age only, regular invitations at 50 -69 years of age, and regular invitations at 50 -59 years of age with irregular invitations at 60 -69 years of age. Observed deaths from breast cancer were compared to those expected without screening among all women and among the screened and non-screened women. Observed deaths were obtained from population data and from a cohort follow-up in 1992 -2003. Expected deaths were derived by modelling breast cancer mortality at population level in 1974 -1985 and 1992 -2003. The reduction in breast cancer mortality was strongest, 28% (0.72, 0.51 -0.97), in municipalities with regular invitations at 50 -69 years of age. No overall effect at 60 -79 years of age was observed with regular invitations at 50 -59 years of age. The study confirms a reduction by screening of breast cancer mortality in Finland. Uniform extension of invitations to 60 -69 years of age would increase the number of prevented breast cancer deaths among the elderly.

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Section: Discussionsupporting

confidence: 82%

Breast cancer mortality with varying invitational policies in organised mammography

2008

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“…4,15,16 The risk of cervical adenocarcinoma was less than 3 per 100,000 person-years in the 1960s, and it has stayed quite stable over time. 17,18 Therefore, the expected incidence without screening (P 0 ) for squamous cell carcinoma was estimated at 17/10 5 person years.…”

Section: Methodsmentioning

confidence: 99%

The HPV test has similar sensitivity but more overdiagnosis than the Pap test—A randomised health services study on cervical cancer screening in Finland

Malila

Leinonen

Kotaniemi-Talonen

et al. 2012

Intl Journal of Cancer

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We compared test sensitivity (in terms of prevented cancers) and overdiagnosis (in terms of non-progressive pre-invasive lesions) between the human papillomavirus test (HPV test, Hybrid Capture 2) and the traditional Pap test in routine screening for cervical cancer. The design was a randomised (1:1) health services study in Finland with intake between 2003 and 2007. We estimated sensitivity by the incidence method within one screening round. Overdiagnosis was based on the rate of cervical intraepithelial Grade 3 (CIN3) lesions diagnosed at screen and during the following interval. Out of 203,788 randomised women 132,298 attended (65% in both study arms) and 600,753 person-years accumulated among attenders up to the end of 2010. In all attenders, 34 invasive cervical cancers and 288 CIN3 lesions were diagnosed at screen or during the following interval. The interval cancer incidence was 2.5/10 5 person-years (sensitivity 0.87) and 1.4 (sensitivity 0.93) in the HPV arm and Pap test arm, respectively. The rate of CIN3 lesions was 57.1 and 38.8, respectively. In conclusion, sensitivity of HPV testing was similar to that of Pap testing but caused more overdiagnosis. Therefore, implementation of HPV testing needs to be reconsidered especially in countries with well organised programmes.Recommendations concerning new screening tests for cervical cancer are mostly based on cross-sectional studies and on detection rates of pre-invasive lesions. 1-5 The few follow-up studies have focused on pre-invasive lesions and on the length of reassurance that a negative test provides. 6-10 Only few studies have had emphasis on public health aspects. 11,12 The purpose of screening is to prevent invasive cervical cancer and the demonstration of this effect requires follow-up for incident invasive cancers after the screen. In fact, detection (at screen) of pre-invasive lesions results in both benefit and harm; benefit through preventing some of the lesions from progressing to invasive cancer, and harm by detecting also such pre-invasive lesions that would never have progressed to invasive cancers. These two types of pre-invasive lesions cannot be separated and thus, both types have to be treated if diagnosed.Sensitivity measures a screening test's ability to correctly identify unrecognised disease. It can be estimated in several ways. The most common way is called the detection method 4 which is based on screen detected lesions, both pre-invasive and invasive ones. However, the sensitivity estimate is usually biased and too big (closer to one) due to overdiagnosis of the detection of pre-invasive lesions. Sensitivity can also be estimated by the incidence method 13 that is based on failures of screening.The purpose of the present study was to compare the human papillomavirus (HPV) test to the traditional Pap test in cervical cancer screening in terms of sensitivity (detection of progressive lesions) and overdiagnosis (detection of nonprogressive lesions). Material and methodsIn Finland, women between 30 and 60 years of age (sometimes ...

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“…We have used nationally five to seven invitations in lifetime, and there has been an 80 percent decrease in the rates within the whole female population. 2,23,24 The cervical cancer incidence rates varied in our country in time before screening at approximately 10-40 cases/ 100,000 woman-years among age group of the our study (agespecific averages approximately 10/100,000 for age 25-39 years; and 40/100,000 for ages 40-69 years in early 1960s). Based on these figures from the prescreening era, the cervical cancer rates among the test negative women in this study were very low (approximately 90% lower) in all the age groups.…”

Section: Epidemiologymentioning

confidence: 99%

Cervical cancer patterns with automation‐assisted and conventional cytological screening: A randomized study

Anttila

Pokhrel

Kotaniemi-Talonen

et al. 2010

Intl Journal of Cancer

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The purpose was to evaluate alternative cytological screening methods in population-based screening for cervical cancer up to cancer incidence and mortality outcome. Automation-assisted screening was compared to conventional cytological screening in a randomized design. The study was based on follow-up of 503,391 women invited in the Finnish cervical cancer screening program during 1999-2003. The endpoints were incident cervical cancer, severe intraepithelial neoplasia and deaths from cervical cancer. One third of the women had been randomly allocated to automation-assisted screening and two thirds to conventional cytology. Information on cervical cancer and severe neoplasia were obtained through 1999-2007 from a linkage between screening and cancer registry files. There were altogether 3.2 million woman-years at risk, and the average follow-up time was 6.3 years. There was no difference in the risk of cervical cancer between the automation-assisted and conventional screening methods; the relative risk (RR) of cervical cancer between the study and control arm was 1.00 (95% confidence interval [CI] 5 0.76-1.29) among all invited and 1.08 (95% CI 5 0.76-1.51) among women who were test negative at entry. Comparing women who were test negative with nonscreened, RR of cervical cancer incidence was 0.26, 95% CI 5 0.19-0.36 and of mortality 0.24 (0.13-0.43). Both methods were valid for screening. Because cervical cancer is rare in our country, we cannot rule out small differences between methods. Evidence on alternative methods for cervical cancer screening is increasing and it is thus feasible to evaluate new methods in large-scale population-based screening programs up to cancer outcome.Incidence and mortality of invasive cancer is the most informative outcome (gold standard) when evaluating screening programs and screening methods. 1,2 Until now cancer incidence and mortality data has been available only from some conventional Pap-smear screening programs. Alternative technologies such as automation-assisted or liquid-based cytology or human papillomavirus (HPV) testing have been proposed during the last 15-20 years to improve cervical cancer prevention. 2 Most data from these techniques are based on surrogate markers, e.g., cross-sectional cervical intraepithelial neoplasia (CIN) rates or sometimes only on cytological findings. 3 Longitudinal follow-up information on the surrogate markers or cancer is rarely available. 4-8 These indicators may not reflect the real effect.When considering large-scale use of the novel alternative methods, information on the effectiveness need to be obtained. Another drawback is that new methods might be that the overall or incremental cost-effectiveness may not be the same as for the conventional method. It has not been straightforward to decide about use of the new methods in population-based screening.The purpose of our study was to evaluate cervical cancer patterns when using alternative cytological screening methods in population-based organized screening for cervical cancer. We ...

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Effect of Screening for Cancer in the Nordic Countries on Deaths, Costs and Quality of Life up to the Year 2017

Cited by 71 publications

References 55 publications

Breast cancer mortality with varying invitational policies in organised mammography

Breast cancer mortality with varying invitational policies in organised mammography

The HPV test has similar sensitivity but more overdiagnosis than the Pap test—A randomised health services study on cervical cancer screening in Finland

Cervical cancer patterns with automation‐assisted and conventional cytological screening: A randomized study

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