Effect of screening on incidence and mortality of cervical cancer in Denmark

Lynge, Elsebeth; Madsen, Mette; Engholm, Gerda

doi:10.1016/0277-5379(88)90364-1

Cited by 26 publications

(35 citation statements)

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“…By 2008, the mortality rate decreased to ϳ20%-30% of the 1993 level in both countries. Studies have shown decreases in mortality rates associated with screening methods for certain cancers [15,16]. To date, however, no single drug has been proven to decrease the mortality rate.…”

Section: Discussionmentioning

confidence: 99%

Decreasing Trend in Mortality of Chronic Myelogenous Leukemia Patients After Introduction of Imatinib in Japan and the U.S.

Chihara

Ito

Matsuda³

et al. 2012

The Oncologist

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Disclosures:The authors indicated no financial relationships. ABSTRACTPurpose. Although the impact of imatinib in improving survival outcomes in chronic myelogenous leukemia (CML) patients has been widely reported, its impact on mortality from CML has not been evaluated. A survival benefit demonstrated in clinical trials does not simply translate to a decrease in mortality. To evaluate the impact of imatinib on the public health, we estimated the agestandardized mortality rate of CML patients in Japan and the U.S. using vital statistics data for Japan and data from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute for the U.S.Patients and Methods. The period covered in this analysis is 1993-2008, during which 64,203 patients in Japan and 26,888 patients in nine registries in the U.S. died as a result of CML. We used joinpoint regression analysis to evaluate the significance of trends in mortality.Results. Estimated age-standardized mortality rates decreased significantly in both countries after the availability of imatinib. The annual percent changes (95% confidence interval) in the U.S. were ؊12.3% (؊14.8% to ؊9.7%) for men and ؊11.6% (؊13.1% to ؊10.1%) for women. In Japan, these were ؊20.8% (؊36.2% to ؊1.6%) for men and ؊15.6% (؊18.8% to ؊12.2%) for women. The period of change in the mortality trend seems to correlate with the period in which imatinib appeared in the two countries. The CML mortality rate in 2008 was nearly 30% that of the 1993 level.Conclusion. This is one example of the advent of a single new drug changing the picture of a single disease, CML. These results may encourage further development of drugs based on the concept of molecular targeting. The Oncologist

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Section: Discussionmentioning

confidence: 99%

Decreasing Trend in Mortality of Chronic Myelogenous Leukemia Patients After Introduction of Imatinib in Japan and the U.S.

Chihara

Ito

Matsuda³

et al. 2012

The Oncologist

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“…In Denmark, a RR of 0.67 (95% CI, 0.61 -0.73) was observed for women aged 30 -59 years in 1963 -1982 when comparing counties with and without organised screening (Lynge et al, 1989).…”

Section: Discussionmentioning

confidence: 99%

Impact of the introduction of organised screening for cervical cancer in Turin, Italy: cancer incidence by screening history 1992–98

et al. 2005

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After an organised cervical screening programme was introduced in Turin in 1992, the age-adjusted cervical cancer incidence ratio in 1992 -98 was 0.81 (95% confidence interval (CI) 0.59 -1.09) for invited vs not invited women and 0.25 (95% CI 0.13 -0.50) for attenders vs non attenders. An organised screening programme can further reduce cervical cancer incidence in an area where substantial spontaneous activity was previously present. There is clear evidence of efficacy for cervical cancer screening (IARC, 2005). High effectiveness and cost-effectiveness were obtained in Nordic countries, where cervical screening was organised from the outset (Laara et al, 1987). In the United Kingdom, a relevant reduction in cervical cancer mortality followed reorganisation (Sasieni and Adams, 1999;Peto et al, 2004), There is however little experience of the impact of moving from opportunistic activity to an organised programme.For many years, cervical cancer screening in Italy was almost only opportunistic (Segnan et al, 2000). An organised programme started in Turin in 1992, the main changes being (a) an active callrecall system, (b) protocols for diagnosis and treatment, (c) a failsafe system for both these phases and (d) monitoring and intensive quality assurance for every step of the screening process.In order to evaluate the impact of these changes on invasive cervical cancer incidence, we linked the screening registry to the local population cancer registry. MATERIALS AND METHODSFrom June 1992, female Turin inhabitants aged 25 -64 years were invited, irrespective of their previous spontaneous screening history, for a Pap-test, with 3-year intervals for screen-negatives. Activation was progressive: in 1996, about 78% of the target population had been invited and in 1998, about 95%. The order of invitation was substantially random, with some stratification by area (women were enrolled by general practitioners, who were selected with balance by location of practice).About one-third of invited women attended the organised programme. Attenders mostly had not had spontaneous recent cytology. As a combined result of organised and opportunistic screening, we estimated a 74% 3-year overall coverage (Ronco et al, 1997) vs 40% before the start of the programme (Segnan et al, 1990).We computed cervical cancer incidence for women aged 24 -69 years in the following groups: not invited (not yet having received the first invitation in the organised programme), invited (having already received the first invitation), attenders (invited women with at least one cytology in the organised programme), nonattenders (invited women with no cytology in the organised programme).Person-years (py) at risk of cervical cancer for the last three categories were calculated using the computerised screening registry. It was not possible to consider the screening history outside the organised programme. Each woman contributed to the 'invited' cohort from first invitation to the end of follow-up, that is, the earliest among (a) diagnosis of cervical cancer, ...

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“…Opportunistic or nonorganised screening also decrease cervical cancer rates, although not to the extent of organised programmes (Magnus and Langmark, 1986;Lynge et al, 1989;Nieminen et al, 1999). One problem with nonorganised screening is that it may not adequately cover the population targeted, sometimes missing those at highest risk (Coleman et al, 1993a).…”

Section: Introductionmentioning

confidence: 99%

Cervical cancer screening programmes and policies in 18 European countries

et al. 2004

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There were six invitational and nine partially invitational programmes, the rest employing opportunistic screening only. Recommended lifetime number of smears varied from seven to more than 50. Coverage of smear test within the recommended screening interval (usually 3 or 5 years) was above 80% in three countries. Screening registration took place in 13 programmes. Eight programmes reported the rates of screen-detected cervical cancers and precursor lesions. There was wide variation in the CIN3 detection rates. International guidelines and quality assurance protocols are useful for monitoring and evaluating screening programmes systematically. Our survey indicated that the recommendations as currently given are met in only few European countries. Health authorities need to consider stronger measures and incentives than those laid out in the current set of recommendations.

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Effect of screening on incidence and mortality of cervical cancer in Denmark

Cited by 26 publications

References 0 publications

Decreasing Trend in Mortality of Chronic Myelogenous Leukemia Patients After Introduction of Imatinib in Japan and the U.S.

Decreasing Trend in Mortality of Chronic Myelogenous Leukemia Patients After Introduction of Imatinib in Japan and the U.S.

Impact of the introduction of organised screening for cervical cancer in Turin, Italy: cancer incidence by screening history 1992–98

Cervical cancer screening programmes and policies in 18 European countries

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