Abstract P3-02-12: The Cost of Mammography Screening in the United States by Screening Policy

Background: Multiple mammography screening strategies exist; however, the resources associated with screening strategies are not well known and are rarely discussed. Many organizations recommend annual mammography for women over the age of 40, while the United States Preventative Services Task Force (USPSTF) and most countries outside the US recommend biennial screening, focusing screening efforts on women over 50 years. Additionally, some suggest risk-based approaches to improve screening. This analysis seeks to estimate the aggregate cost of mammography screening in the US in 2010 and to then further compare the costs of these proposed strategies, specifically comparing annual versus biennial screening.

Methods: We simulated the annual cost of mammography in the US under the following screening strategies: 1) estimate of screening that occurred in 2010 under current policy, 2) annual screening of women older than 40 years, 3) biennial screening of women 50 to 75 years, and 4) biennial screening of women 50 to 75 years and high risk women 40–50 years following USPSTF guidelines. The simulated 2010 screening policy was based on current screening rates ranging from 51% of forty-year-old women to 66% of sixty-five-year-old women. Screening strategies 2–4 simulated screening 85% of women overall, and for the USPSTF policy 20% of women 40–50 years were estimated to be high risk. The simulation was carried out using R statistical software.

Results: Aggregate costs of the four screening strategies were estimated. The total cost of mammography screening in the US in 2010 was estimated to be $7.95 billion. The projected cost under an annual screening policy beginning at 40 years was $10.71 billion. The projected cost of biennial screening from 50–75 years was $5.25 billion compared to $5.33 billion following the USPSTF guidelines. The biennial USPSTF policy cost $5.38 billion less than annual screening. The largest drivers of cost were the percent of women screened, the cost of a mammogram, and the percent of women recalled after mammography.

Conclusions: The costs of mammography vary greatly by strategy and are relevant to screening policy. The basic biennial strategy was the least expensive; however for a slight increase in cost, the USPSTF 2009 guideline strategy screened more age appropriate women for $2.62 billion less than current policy. For less cost, the modeled USPSTF guidelines screened 85% of women compared to current policies that screen less than 65% of women. Biennial screening provides screening to more women, lowers overall false-positive rates, and improves capacity for access to high-quality equipment and well-trained mammographers. As data to support evidenced based strategies increase, resources can be better allocated toward screening a broader, larger population of women that are most likely to benefit from screening. With no evidence for adverse outcomes, a biennial screening policy enables the population of US women to benefit from mammography for less cost.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-02-12.

Effect of soybean meal origin on standardized ileal amino acid digestibility in piglets

The present study with piglets was conducted to estimate standardized ileal digestibility (SID) of AA in European Union soybean (Glycine max) meal (SBM) imports sourced from Argentina, Brazil, and the United States. Twelve piglets with an average initial BW of 9 kg (47 d of age) were fitted with a simple ileal T-cannula to determine SID of AA in 4 batches of SBM originating either from Argentina (n = 1), Brazil (n = 1), or the United States (n = 2; US1 and US2). A semisynthetic diet based on corn (Zea mays) starch and casein (125 g casein/kg as-fed) was supplemented with 1 of 4 batches SBM at an inclusion rate of 235 g SBM/kg (as-fed) each. The chemical composition did not differ largely, with CP contents ranging from 458 in Argentinean to 461 g/kg (as-fed) in US1 SBM. The SID of indispensable AA ranged from 80% in US2 SBM to 83% in Argentinean SBM and from 74% for Trp in US2 and Brazilian SBM to 91% for Arg in US2, Brazilian, and Argentinean SBM. Most SID values did not differ among the SBM batches (P > 0.05). In conclusion, European SBM imports from Brazil, Argentina, or the United Sates were similar in their chemical composition. For most AA, high and uniform SID values were obtained independent from their source of origin.

Effect of particle size and heat treatment of soybean meal on standardized ileal digestibility of amino acids in growing pigs

A study with growing barrows was conducted to evaluate of variations in particle size and degree of heat treatment during processing on standardized ileal digestibility (SID) of AA in soybean (Glycine max) meal (SBM). A commercial SBM batch was visually identified as being overtoasted due to its brownish color and was separated into small and large particles using a 1-mm sieve. In addition, 3 SBM were produced from 1 batch of soybean and exposed to different processing conditions (temperature and direct steam contact) referred to as mild (105°C; 34 min), medium (115°C; 45 min), and strong (139°C; 7 min). In total, 5 SBM-corn (Zea mays) starch-based diets were formulated to contain SBM as the sole protein source. This experiment was conducted according to a 6 × 6 Latin square design using 6 barrows (23 kg initial BW) fitted with a T-cannula at the distal ileum. With increasing particle size, SID of His and some dispensable AA increased (P < 0.05). Lower SID values in small compared to large SBM particles indicate more pronounced heat damage possibly due to increased surface area. The SID of CP and AA was lowest in the mild, intermediate in the strong, and highest in the medium toasted SBM (P < 0.001). These differences in SID are reflected in varying contents of trypsin inhibitors, Lys, reactive Lys, and NDF. In conclusion, both differences in particles size and variations in thermal processing conditions of SBM may affect SID of CP and AA.

Effect of feeding level on the composition of the intestinal microbiota in weaned piglets

In piglets, the development and composition of intestinal microbiota is influenced by dietary factors. A considerable reduction in feed intake during the transition from liquid to solid feed is often accompanied by postweaning diarrhea. Therefore, it is hypothesized that variations in feeding level during weaning may affect intestinal microbial composition. Forty-eight piglets fitted with simple ileal T-cannulas were used to examine the effects of a high (60 g/kg BW) and a low (30 g/kg BW) feeding level on the composition of the ileal and fecal microbiota. The assay diets contained graded inclusion levels of soybean (Glycine max) meal or casein. Bacterial cell numbers of total eubacteria, Lactobacillus spp., and the mainly proteolytic Clostridium leptum, Clostridium coccoides, Enterobacteriaceae, and Bacteroides-Prevotella-Porphyromonas group (Bacteroides group) of feces and ileal digesta were determined by use of real-time PCR. There were no interactions between feeding level and protein source except for the Bacteroides group in ileal digesta. Ileal cell numbers of lactobacilli were increased (P < 0.001) at the higher feeding level. In contrast, ileal cell numbers of Clostridium coccoides were lower (P < 0.001) at the higher feeding level. There were no differences of bacterial cell numbers in feces. Results indicate that feeding level affects microbial composition in the small intestine. Also, sufficient feed intake during weaning encourages proliferation of beneficial bacteria, thereby contributing to improved gut health.

Standardized ileal digestibilities of crude protein, amino acids, and contents of antinutritional factors, mycotoxins, and isoflavones of European soybean meal imports fed to piglets

A study with 3 experiments and 3 periods each was conducted to assess the protein value of soybean meal (SBM) batches that were imported into the European Union (EU) from Argentina, Brazil, or the United States (US). Six random SBM batches from each origin were analyzed for contents of CP, AA, ether extract, crude ash, NDF, ADF, oligosaccharides, isoflavones, mycotoxins, trypsin inhibitor activity (TIA), and protein dispersibility index. Piglets were used for determination of standardized ileal digestibilities (SID) of CP and AA in these 18 SBM batches. In each experiment, 12 piglets (initial BW = 5.6 ± 0.7 kg) were surgically fitted with simple T-cannulas at the distal ileum. The piglets were randomly allotted to 18 semisynthetic assay diets, which included 1 of the 18 SBM batches from the 3 origins at an inclusion level of 250 g/kg (as-fed). Average content of CP was 480, 505, and 488 g/kg (as-fed) for Argentinean, Brazilian, and US SBM batches, respectively, and was greater for Brazilian SBM (P ≤ 0.05) compared with the other 2 origins. Contents of most AA were greater (P ≤ 0.05) in Brazilian compared with Argentinean SBM batches. Amino acid contents in US SBM batches ranged between those from Argentina and Brazil. Average TIA were 3.9, 5.1, and 3.4 mg trypsin inhibitor/g CP for Argentinean, Brazilian, and US SBM batches, and were greater (P ≤ 0.05) for Brazilian SBM compared with the other origins. Mycotoxins were detected in 8 out of 18 SBM batches, but all mycotoxin concentrations were less than their critical benchmarks. The contents of individual isoflavones varied considerably and differed (P ≤ 0.05) among SBM origins. The SID of CP, Arg, Phe, Thr, Trp, Asp, Gly, and Ser were greater (P ≤ 0.05) for US compared with Argentinean SBM batches, with intermediate values for Brazilian SBM batches. The obtained SID values were most variable within Argentinean SBM batches and most homogenous within US SBM batches, as indicated by great and small CV, respectively. However, SID of CP and AA were not affected (P > 0.05) by any of the chemical variables measured in this study, according to linear and quadratic regression analyses. Greatest SID values and good homogeneity between individual batches of the same origin were observed for US SBM. The results of this study with piglets will expand the database on SID of CP and AA in SBM from 3 of the major soybean-producing and processing countries.

The effects of pure nucleotides on performance, humoral immunity, gut structure and numbers of intestinal bacteria of newly weaned pigs

Weaning is often stressful for piglets and accompanied by morphological, histological, microbial, and immunological changes along the digestive tract. Dietary nucleotides are bioactive compounds which have the potential to diminish weaning-associated challenges. The experiment was carried out with 5 litters each of 7 pigs (mixed sex), weaned at 20 d of age. One baseline pig per litter was slaughtered at d 0. The remaining 30 pigs were housed individually and randomly allocated to 2 dietary treatments: the control diet or the control diet supplemented with a mixture of nucleotides. Measurements of growth performance traits included ADFI, ADG, G:F, and BW. At d 17, fresh fecal samples were taken to determine bacterial numbers. On d 19 and 20, pigs were slaughtered and blood samples were analyzed for plasma immunoglobulins and intestinal samples were assessed for morphological traits. Digesta from the jejunum and cecum were collected for analysis of the microbiome. The ADFI was greater in the nucleotide treatment compared with the control treatment (P < 0.05), but ADG, G:F, and BW did not differ between treatments. Plasma IgA concentrations increased with age and were greater in the nucleotide (P < 0.05) compared with the control group. There were no treatment differences in plasma IgG and IgM, gut morphology, or intestinal and fecal bacterial counts. Supplemental nucleotides may increase ADFI but without having any impact on growth performance of the pigs. Greater plasma IgA concentrations indicate that adding nucleotides in the weaning diet supported humoral immunity. However, there was no effect of dietary nucleotide supplementation on the composition of the bacterial community in parts of the small and large intestine. Further research is warranted before the use of nucleotide as a feed additive in pig diet can be recommended.

Children born to women with intellectual disabilities - 5-year incidence in a Swedish county

BACKGROUND

Families with parental intellectual disabilities (ID) are likely to need support in achieving a decent family life. In order to accurately plan for such support services, society needs data regarding the occurrence of those parents and their children. The aim of this study was to investigate the 5-year incidence of children born to women with ID in a county in Sweden.

METHODS

Women born between 1975 and 1989 were identified from school registers for children and adolescents with ID in the county of Blekinge. The women's personal identification numbers were, in 2010, linked and matched with the Swedish Medical Birth Register.

RESULTS

In total, 98 women with ID were identified. Nine of these had given birth to children; one woman to two children and eight women to one child each. The 10 children were born between 2004 and 2008.

CONCLUSION

The incidence rate calculated as a result of the present study indicates that approximately 2.12 per 1000 children are born per year to women with ID. For the whole of Sweden that rate indicates an incidence of approximately 225 children each year. On the basis of this, the prevalence of children (aged 0-18 years) being born to women with ID is estimated at about 4050.

Short-term effect of dietary yeast nucleotide supplementation on small intestinal enzyme activities, bacterial populations and metabolites and ileal nutrient digestibilities in newly weaned pigs

In previous studies, dietary nucleotides have been shown to improve performance in single-stomached animals by promoting the renewal of small intestine epithelial cells and by influencing the activity and composition of the microbial community in the digestive tract. The present experiment was carried out with 12 barrows weaned at the age of 18 days and fitted with a simple T-cannula at the distal ileum. To determine short-term effects of dietary yeast nucleotides, the piglets received a grain-soybean meal-based basal diet with or without supplementation of 1 g/kg of a dried yeast product containing free nucleotides. Dietary supplementation with yeast did not affect bacterial numbers in the ileum as well as ileal concentrations of individual short-chain fatty acids (SCFA), total SCFA and total lactic acid (p > 0.05). Moreover, there was no effect of supplemental yeast nucleotides on ileal α-amylase, leucine amino peptidase, maltase and lactase activities (p > 0.05), as well as on ileal dry matter, crude protein and crude fibre digestibilities (p > 0.05). In conclusion, short-term supplementation with dietary yeast nucleotides did not affect microbial metabolite concentrations, bacterial numbers and enzyme activities in the ileal digesta as well as ileal nutrient digestibilities of newly weaned pigs.

Joint investigation of working conditions, environmental and system performance at recycling centres--development of instruments and their usage

Recycling is a new and developing industry, which has only been researched to a limited extent. This article describes the development and use of instruments for data collection within a multidisciplinary research programme "Recycling centres in Sweden - working conditions, environmental and system performance". The overall purpose of the programme was to form a basis for improving the function of recycling centres with respect to these three perspectives and the disciplines of: ergonomics, safety, external environment, and production systems. A total of 10 instruments were developed for collecting data from employees, managers and visitors at recycling centres, including one instrument for observing visitors. Validation tests were performed in several steps. This, along with the quality of the collected data, and experience from the data collection, showed that the instruments and methodology used were valid and suitable for their purpose.

The interaction of multiple environmental stressors affects adaptation to a novel habitat in the natterjack toad Bufo calamita

The potential to adapt to novel environmental conditions is a key area of interest for evolutionary biology. However, the role of multiple selection pressures on adaptive responses has rarely been investigated in natural populations. In Sweden, the natterjack toad Bufo calamita inhabits two separate distribution areas, one in southernmost Sweden and one on the west coast. We characterized the larval habitat in terms of pond size and salinity in the two areas, and found that the western populations are more affected by both desiccation risk and pond salinity than the southern populations. In a common garden experiment manipulating salinity and temperature, we found that toads from the west coast populations were locally adapted to shorter pond duration as indicated by their higher development and growth rates. However, despite being subjected to higher salinity stress in nature, west coast toads had a poorer performance in saline treatments. We found that survival in the saline treatments in the west coast populations was positively affected by larger body mass and longer larval period. Furthermore, we found negative genetic correlations between body mass and growth rate and their plastic responses to salinity. These results implicate that the occurrence of multiple environmental stressors needs to be accounted for when assessing the adaptive potential of organisms and suggest that genetic correlations may play a role in constraining adaptation of natural populations.

Working ability in relation to disease severity, everyday occupations and well-being in women with limited systemic sclerosis

OBJECTIVE

To investigate how women with SSc and varying degrees of working ability differed regarding disease severity, everyday occupations and well-being. Working ability was operationalized according to the degree of sick leave.

METHODS

Forty-four women of working age with lcSSc were assessed regarding sociodemographic characteristics, disease severity including organ manifestation, perceived physical symptoms, hand function, and satisfaction with everyday occupations, self-rated health and well-being.

RESULTS

The subjects formed three groups with regard to reduction in working capacity. Twenty-one women (48%) had no sick leave, 15 women (34%) were on partial sick leave and eight women (18%) were temporarily on full-time sick leave or had a full disability pension. There were no statistically significant differences concerning sociodemographics between the groups. Women without sick leave had less physically demanding jobs (P = 0.026), and the hypothesis that working ability reflects lower disease severity was confirmed regarding dexterity grip force and perceived fatigue and breathlessness (P < 0.05). Greater working ability was associated with better capacity to perform activities of daily life (P < 0.01), greater satisfaction with occupations (P < 0.01), better well-being (P < 0.001) and better health (P < 0.001).

CONCLUSIONS

Fifty per cent of the women were restricted in their working ability; the lower the working ability, the lower their perceived well-being. This emphasizes the need for further research into the factors that promote working ability and the development of suitable methods to improve working ability.