Showing papers by "Elsebeth Lynge published in 2002"

Long term mortality trends behind low life expectancy of Danish women.

Abstract: Study objective: To examine the long time mortality trends of women in Denmark. Design: Age-period-cohort analysis. Setting: To search for possible causes we analysed mortality rates for all Danish women and men aged 40–84 during 1960–1999. Age-period-cohort modelling was used, handling the well known indeterminacy in a sensitivity analysis. Main results: The results indicate that the high risk of dying among Danish women is associated with being born between the two world wars. A similar pattern was not seen for men. Conclusion: The rather simple descriptive exploration in the framework of age-period-cohort modelling used, revealed a pattern not reflected by the commonly used life expectancy calculation. It is suggested that future studies on the low life expectancy of Danish women focus on the “between wars” generations identified with a high risk of dying in this study.

Early outcome of mammography screening in Copenhagen 1991–99

Abstract: OBJECTIVES: To evaluate the early outcome of an organised mammography screening programme in an area with little opportunistic screening. SETTING: The municipality of Copenhagen, Denmark, during four invitation rounds 1991–99. METHODS: The following outcome measures were used: rates of participation, recall, false positive, and cancer detection. Benign biopsy, distribution of tumour size, lymph node status, and malignancy grade. RESULTS: A total of 106 933 screens were undertaken, and 824 invasive breast carcinomas or CIS were detected. The detection rate was 11.9 per 1000 participants in the first invitation round, and it continued to be high in subsequent rounds. The percentage of CIS cases was 11%. Coverage declined from 71% in the first round to 62% in the fourth, although 91% of those participating in the previous three rounds attended. The programme operated with a high recall rate. The false positive rate was also high, being 5.6% at first screen, and 1.8% later on. However, 90% of false positives ...

Mammography screening in the county of Copenhagen. Results of the first three screening rounds

Abstract: Introduction: Biennial service mammography screening for breast cancer has been offered to women aged 50-69 years in the municipality of Copenhagen since 1991. We report the results of the first three invitation rounds. Material and methods: Data were collected from the Copenhagen service mammography screening database and other Danish registers. Results: The average participation rate during the first three invitation rounds was 66%. The breast cancer detection rate was 10/1,000 screened in the first invitation round and 5/1,000 in the consecutive rounds. The probability of a false positive mammography was 6% at the prevalent screen, and this was reduced to 3% at incidence screens. Fifty-two cases of interval cancer were seen after the first invitation round. The expected number was 152, which gives a proportional interval cancer rate of 0.34. The sensitivity was 86% and the specificity 94% after the first round. Discussion: The detection rate of breast cancer was high, especially in the prevalence round. The trend in the incidence of breast cancer at the subsequent rounds was similar to that before screening, which indicates that mammography screening does not lead to any greater over-diagnosis. The rate of false positive mammography was high at the initial screening round, but was acceptable at subsequent rounds, and a false positive mammography does not seem to have affected participation in subsequent rounds. The Copenhagen screening programme conforms to international quality assurance guidelines for process evaluation.

Clinical impact of introduction of mammography screening in a non-screening country with special reference to the Copenhagen service mammography screening programme.

Abstract: As stated in the European guidelines for quality assurance in mammography screening, the objective of screening for breast cancer is to reduce morbidity and mortality from the disease without adversely affecting the health status of those who participate in screening (1). The effectiveness of a programme therefore relies on the quality, organisation, and population acceptability. When organising a screening programme, baseline epidemiological data is a prerequisite upon which the outcome measures of mammography screening must be compared, since a more favourable stage distribution in screen-detected cancers compared to clinically diagnosed cancers forms the basis of the mortality reduction (2). It has repeatedly been shown that tumour stage correlates with survival in breast cancer (3, 4). An early predictor of the effect of screening on breast cancer mortality is therefore an indubitable increase in early stage breast cancer incidence with the onset of screening, and a subsequent decrease in more advanced stage breast cancer incidence (5). The obtained change in stage distribution brought about by screening should also result in a higher degree of breast conserving therapy and a decrease in need of adjuvant treatment (6). Among the adverse effects of screening is the risk of a false positive mammography leading to a certain number of healthy women recalled for further assessment, and, further, the risk of overdiagnosis with mammographic detection of small, indolent malignancies, that might not have surfaced clinically in the absence of screening. In order to monitor the effects of a screening programme the European guidelines have set up performance indicators stating acceptable levels for the quality of the screening process, and early surrogate indicators by which the impact of a breast cancer screening programme can be assessed (1). These indicators are used as surrogate measures of the likelihood of achieving a subsequent mortality reduction (7). This review focuses on the clinical impact of introduction of mammography screening, exemplified by comparison of tumour stage and treatment of breast cancer detected by mammography screening with clinically detected breast cancers.

Mammographic screening in the county of Copenhagen. Clinical consequences of the first three screening rounds

Abstract: Introduction: Service mammography has been offered biennially to women aged 50-69 years in the municipality of Copenhagen since 1991. The results were compared to breast cancer cases before initiation of screening. The comparison concerns prognostic factors and the treatment-related consequences. Material and methods: Data from the Copenhagen service mammography screening were linked to data from the DBCG database. Results: Before screening, 16% of breast cancer cases had a tumour size of 10 mm or less, this percentage increased to 41 in the screen-detected cases. Sixty per cent of breast cancer cases showed no evidence of metastatic spread to axillary lymph nodes before screening; this percentage increased to 78 per cent in the screen-detected cases. Forty per cent of ductal carcinomas showed a malignancy grade I before screening, compared to 53% in the screen-detected cases. Thirteen per cent were treated with breast conserving therapy before screening, as opposed to 48% in the screen-detected cases. Forty-one per cent needed postoperative adjuvant treatment before screening, compared with 21% in the screen-detected cases. Discussion: A marked improvement was seen in the prognostic and treatment-related characteristics of the screen-detected breast cancer cases, as compared to breast cancer cases from the same area before screening was initiated.

[Mammographic screening in the municipality of Copenhagen 1991-1997. Evaluation of the preoperative assessment].

Abstract: Introduction: A biennial mammography screening programme started for all women aged 50-69 in the municipality of Copenhagen, Denmark, in April 1991. The aim of the present study was to evaluate the quality of the preoperative diagnostic assessment for women recalled for further examination. Quality indicators were: validity of the fine-needle aspiration cytology, rate of malignant to benign surgery, and frequency of one-step surgery for malignant lesions. Material and method: Database registries during the first three screening rounds from April 1991 to March 1997 were studied retrospectively, for fine-needle aspiration cytology tests where surgical biopsy was also performed. Results: In the period 1991-1997, 4,111 women were recalled for clinical mammography and subsequently 1,086 women underwent surgery. The use of the triple test in the preoperative assessment increased from 50% in the first screening round to 72% in the third. Throughout the period of evaluation, the number of inadequate fine-needle aspiration cytology (FNAC) was reduced from 32% to 6%. Inadequate FNAC from malignant lesions declined from 27% to 6%. The sensitivity of FNAC increased from 67% to 90% and the accuracy from 60% to 81%. The malignant/benign ratio of surgery rose from 1.4 in the first screening round to 2.8 in the third. One-step surgery as definitive treatment was performed in 67% of malignant instances. Discussion: The preoperative diagnostic assessment improved during the evaluation period. The triple test was used more often over time, the validity of FNAC and the malignant/benign ratio of surgery increased.