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Aagaard KA, Al-Far HM, Piscator U, Krogh RA, Lauszus FF. Manifest diabetes after gestational diabetes: a double-cohort, long-term follow-up in a Danish population. Arch Gynecol Obstet 2020; 302:1271-1278. [PMID: 32656592 DOI: 10.1007/s00404-020-05669-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 06/25/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE The aim was to follow-up two cohorts of women with GDM to investigate the incidence and time of diagnosis of manifest diabetes mellitus (DM) postpartum and identify the risk factors for diabetes in our population. METHODS A follow-up study on two independent cohorts having oral glucose tolerance test (OGTT) in 1991/1992 and 2011-2016: Cohort 1 consisted of 406 women including 54 with GDM and 352 with a non-GDM OGTT-test and cohort 2 had 433 women diagnosed with GDM. The first cohort had nearly 25 years of follow-up and gave information on magnitude, conversion rate and type of diabetes manifestation. The second cohort was started recently to evaluate whether newer diagnostic criteria and baseline information on the old cohort are still valid for prediction of diabetes risk. RESULTS The risk of manifest diabetes in cohort 1 at the end of follow-up was six times higher in women with previous GDM compared with non-GDM (RR = 6; 95% CI 4-11). We observed a 70% diabetes rate 25 years after pregnancy. Only family history of diabetes in cohort 2 was associated with conversion to manifest diabetes (p = 0.002), also after adjustment for age, BMI, non-Danish origin and smoking during pregnancy (p < 0.001) CONCLUSION: The incidence of diabetes after GDM is higher than that previously reported in Scandinavian populations and the rate of manifest diabetes rises steeply 15 years after pregnancy and after 40 years of age. The women of cohort 2 with recent GDM are at risk of DM at a higher rate. On this background our results are useful in identifying the time where GDM women may benefit from the effective implementation of evidence-based treatment to postpone and advert manifest DM.
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Affiliation(s)
- Kristina Aaskjær Aagaard
- Department of Gynecology and Obstetrics, Herning Hospital, Gl. Landevej 61, 7400, Herning, Denmark
| | - Hanine Mustafa Al-Far
- Department of Gynecology and Obstetrics, Herning Hospital, Gl. Landevej 61, 7400, Herning, Denmark
| | - Ulrika Piscator
- Department of Gynecology and Obstetrics, Herning Hospital, Gl. Landevej 61, 7400, Herning, Denmark
| | - Rubab Agha Krogh
- Department of Gynecology and Obstetrics, Herning Hospital, Gl. Landevej 61, 7400, Herning, Denmark
| | - Finn Friis Lauszus
- Department of Gynecology and Obstetrics, Herning Hospital, Gl. Landevej 61, 7400, Herning, Denmark.
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Kjaer SK, Nygård M, Sundström K, Dillner J, Tryggvadottir L, Munk C, Berger S, Enerly E, Hortlund M, Ágústsson ÁI, Bjelkenkrantz K, Fridrich K, Guðmundsdóttir I, Sørbye SW, Bautista O, Group T, Luxembourg A, Marshall JB, Radley D, Yang YS, Badshah C, Saah A. Final analysis of a 14-year long-term follow-up study of the effectiveness and immunogenicity of the quadrivalent human papillomavirus vaccine in women from four nordic countries. EClinicalMedicine 2020; 23:100401. [PMID: 32637895 PMCID: PMC7329692 DOI: 10.1016/j.eclinm.2020.100401] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The quadrivalent human papillomavirus (qHPV) vaccine prevented vaccine HPV type-related infection and disease in young women in the 4-year FUTURE II efficacy study (NCT00092534). We report long-term effectiveness and immunogenicity at the end of 14 years of follow-up after enrollment in FUTURE II. METHODS Young women (16-23 years of age) from Denmark, Iceland, Norway, and Sweden who received three qHPV vaccine doses during the randomized, double-blind, placebo-controlled FUTURE II base study were followed for effectiveness for an additional ≥10 years through national registries. Tissue samples including but not limited to those collected during organized cervical cancer screening programs were obtained from regional biobanks to be adjudicated for histopathology diagnosis and tested for HPV DNA. The observed incidence of HPV16/18-related high-grade cervical dysplasia (primary outcome) was compared with recent historical background incidence rates in an unvaccinated population. Serum was collected at years 9 and 14 to assess antibody responses. FINDINGS No cases of HPV16/18-related high-grade cervical dysplasia were observed in the per-protocol effectiveness population (N = 2121; 24,099·0 person-years of follow-up) during the entire study. Vaccine effectiveness of 100% (95% CI 94·7-100) was demonstrated for ≥12 years, with a trend toward continued protection through 14 years post-vaccination. Seropositivity rates at study conclusion were >90% (HPV6/11/16) and 52% (HPV18) using competitive Luminex immunoassay, and >90% (all four HPV types) using the more sensitive IgG Luminex immunoassay. INTERPRETATION Vaccination of young women with qHPV vaccine offers durable protection against HPV16/18-related high-grade cervical dysplasia for ≥12 years, with a trend toward continued protection through 14 years post-vaccination, and induces sustained HPV6/11/16/18 antibody responses for up to 14 years post-vaccination. There was no evidence of waning immunity, suggesting no need for a booster dose during that period. FUNDING Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA.
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Affiliation(s)
- Susanne K. Kjaer
- Unit of Virus, Lifestyle & Genes, Danish Cancer Society Research Center and Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Corresponding author: Dr Susanne K. Kjaer, Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen O, Copenhagen, Denmark (Telephone: +45 35 25 76 63).
| | - Mari Nygård
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Karin Sundström
- Department of Laboratory Medicine, Karolinska Instituet, Stockholm, Sweden
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Instituet, Stockholm, Sweden
| | - Laufey Tryggvadottir
- Icelandic Cancer Registry, Icelandic Cancer Society, Faculty of Medicine, BMC, Laeknagardur, University of Iceland, Reykjavik, Iceland
| | - Christian Munk
- Unit of Virus, Lifestyle & Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Sophie Berger
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Espen Enerly
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Maria Hortlund
- Department of Laboratory Medicine, Karolinska Instituet, Stockholm, Sweden
| | | | - Kaj Bjelkenkrantz
- Department of Clinical Pathology and Cytology, Unilabs, Eskilstuna, Sweden
| | | | | | | | | | - Thomas Group
- Merck & Co., Inc., Kenilworth, NJ, United States
| | | | | | - David Radley
- Merck & Co., Inc., Kenilworth, NJ, United States
| | - Yi Shen Yang
- Merck & Co., Inc., Kenilworth, NJ, United States
| | | | - Alfred Saah
- Merck & Co., Inc., Kenilworth, NJ, United States
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Lousdal ML, Lash TL, Flanders WD, Brookhart MA, Kristiansen IS, Kalager M, Støvring H. Negative controls to detect uncontrolled confounding in observational studies of mammographic screening comparing participants and non-participants. Int J Epidemiol 2020; 49:1032-1042. [PMID: 32211885 PMCID: PMC7394947 DOI: 10.1093/ije/dyaa029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND When comparing mammography-screening participants and non-participants, estimates of reduction in breast-cancer mortality may be biased by poor baseline comparability. We used negative controls to detect uncontrolled confounding. METHODS We designed a closed cohort of Danish women invited to a mammography-screening programme at age 50-52 years in Copenhagen or Funen from 1991 through 2001. We included women with a normal screening result in their first-invitation round. Based on their second-invitation round, women were divided into participants and non-participants and followed until death, emigration or 31 December 2014, whichever came first. We estimated hazard ratios (HRs) of death from breast cancer, causes other than breast cancer and external causes. We added dental-care participation as an exposure to test for an independent association with breast-cancer mortality. We adjusted for civil status, parity, age at first birth, educational attainment, income and hormone use. RESULTS Screening participants had a lower hazard of breast-cancer death [HR 0.47, 95% confidence interval (CI) 0.32, 0.69] compared with non-participants. Participants also had a lower hazard of death from other causes (HR 0.43, 95% CI 0.39, 0.46) and external causes (HR 0.35, 95% CI 0.23, 0.54). Reductions persisted after covariate adjustment. Dental-care participants had a lower hazard of breast-cancer death (HR 0.75, 95% CI 0.56, 1.01), irrespective of screening participation. CONCLUSIONS Negative-control associations indicated residual uncontrolled confounding when comparing breast-cancer mortality among screening participants and non-participants.
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Affiliation(s)
| | - Timothy L Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - W Dana Flanders
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - M Alan Brookhart
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | | | - Mette Kalager
- Department of Health Management and Health Economics, Oslo University, Oslo, Norway
- Clinical effectiveness research group, Oslo University Hospital, Oslo, Norway
| | - Henrik Støvring
- Department of Public Health, Aarhus University, Aarhus, Denmark
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Cervical Cancer Screening Programs in Europe: The Transition Towards HPV Vaccination and Population-Based HPV Testing. Viruses 2018; 10:v10120729. [PMID: 30572620 PMCID: PMC6315375 DOI: 10.3390/v10120729] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 12/12/2018] [Accepted: 12/15/2018] [Indexed: 12/25/2022] Open
Abstract
Cervical cancer is the fourth most frequently occurring cancer in women around the world and can affect them during their reproductive years. Since the development of the Papanicolaou (Pap) test, screening has been essential in identifying cervical cancer at a treatable stage. With the identification of the human papillomavirus (HPV) as the causative agent of essentially all cervical cancer cases, HPV molecular screening tests and HPV vaccines for primary prevention against the virus have been developed. Accordingly, comparative studies were designed to assess the performance of cervical cancer screening methods in order to devise the best screening strategy possible. This review critically assesses the current cervical cancer screening methods as well as the implementation of HPV vaccination in Europe. The most recent European Guidelines and recommendations for organized population-based programs with HPV testing as the primary screening method are also presented. Lastly, the current landscape of cervical cancer screening programs is assessed for both European Union member states and some associated countries, in regard to the transition towards population-based screening programs with primary HPV testing.
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Nagel G, Oberaigner W, Peter RS, Ulmer H, Concin H. Evaluation of a mammography screening program within the population-based Vorarlberg Health Monitoring & Prevention Program (VHM&PP). Cancer Epidemiol 2015; 39:812-8. [DOI: 10.1016/j.canep.2015.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/24/2015] [Accepted: 10/01/2015] [Indexed: 11/25/2022]
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Azerkan F, Widmark C, Sparén P, Weiderpass E, Tillgren P, Faxelid E. When Life Got in the Way: How Danish and Norwegian Immigrant Women in Sweden Reason about Cervical Screening and Why They Postpone Attendance. PLoS One 2015; 10:e0107624. [PMID: 26158449 PMCID: PMC4497727 DOI: 10.1371/journal.pone.0107624] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 08/20/2014] [Indexed: 11/19/2022] Open
Abstract
Introduction Danish and Norwegian immigrant women in Sweden have an increased risk of cervical cancer compared to Swedish-born women. In addition, Danish and Norwegian immigrant women follow the national recommendations for attendance at cervical screening to much lesser extent than Swedish-born women. The aim of this study was to explore how Danish and Norwegian immigrant women in Sweden reason about attending cervical screening, focusing on women’s perceptions as to why they and their compatriots do not attend. Methods Eight focus group discussions (FGDs) were conducted with Danish and Norwegian immigrant women living in Stockholm. The women were between 26 and 66 years of age at the time of the FGDs, and were aged between <1 and 48 years old when they immigrated to Sweden. A FGD guide was used, which included questions related to cervical screening, and obstacles and motivators to attend cervical screening. The FGDs were tape recorded and transcribed, and the results analysed according to the principles of qualitative content analysis. Results The main theme was “Women have a comprehensive rationale for postponing cervical screening, yet do not view themselves as non-attenders”. Investigation of women’s rationale for non-attendance after being invited to cervical screening revealed some complex reasons related to immigration itself, including competing needs, organisational and structural factors and differences in mentality, but also reasons stemming from other factors. Postponing attendance at cervical screening was the category that linked all these factors as the reasons to why women did not attend to cervical screening according to the recommendations of the authorities. Conclusions The rationale used to postpone cervical screening, in combination with the fact that women do not consider themselves to be non-attenders, indicates that they have not actively taken a stance against cervical screening, and reveals an opportunity to motivate these women to attend.
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Affiliation(s)
- Fatima Azerkan
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Catarina Widmark
- Department of Quality and Patient Safety, Karolinska University Hospital, Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics, Medical Management Center, Karolinska Institutet, Stockholm, Sweden
| | - Pär Sparén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Elisabete Weiderpass
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Community Medicine, Faculty of Health Sciences, University of Tromso, The Arctic University of Norway, Tromsø, Norway
- Department of Research, Cancer Registry of Norway, Oslo, Norway
- Samfundet Folkhälsan, Helsinki, Finland
| | - Per Tillgren
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
- Division of Social Medicine, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Elisabeth Faxelid
- Department of Public
Health Sciences, Global Health (IHCAR) Karolinska Institutet, Stockholm, Sweden
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Kaplan HG, Malmgren JA, Atwood MK, Calip GS. Effect of treatment and mammography detection on breast cancer survival over time: 1990-2007. Cancer 2015; 121:2553-61. [PMID: 25872471 DOI: 10.1002/cncr.29371] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 01/14/2015] [Accepted: 03/04/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND The extent to which improvements over time in breast cancer survival are related to earlier detection by mammography or to more effective treatments is not known. METHODS At a comprehensive cancer care center, the authors conducted a retrospective cohort study of women ages 50 to 69 years who were diagnosed with invasive breast cancer (stages I through III) and were followed over 3 periods (1990-1994, 1995-1999, and 2000-2007). Data were abstracted from patient charts and included detection method, diagnosis, treatment, and follow-up for vital status in the institutional breast cancer registry (n = 2998). The method of detection was categorized as patient or physician detected or mammography detected. Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for 5-year disease-specific survival in relation to detection method and treatment factors, and differences in survival were analyzed using the Kaplan-Meier method. RESULTS Fifty-eight percent of breast cancers were mammography detected, and 42% were patient or physician detected; 56% of tumors were stage I, 31% were stage II, and 13% were stage III. The average length of follow-up was 10.71 years. The combined 5-year disease-specific survival rate was 89% from 1990 to 1994, 94% from 1995 to 1999, and 96% from 2000 to 2007 (P < .001). In an adjusted model, mammography detection (HR, 0.43; 95% CI, 0.27-0.70), hormone therapy (HR, 0.47; 95% CI, 0.30-0.75), and taxane-containing chemotherapy (HR, 0.61; 95% CI, 0.37-0.99) were significantly associated with a decreased risk of disease-specific mortality. CONCLUSIONS Better breast cancer survival over time was related to mammography detection, hormone therapy, and taxane-containing chemotherapy. Treatment improvements alone are not sufficient to explain the observed survival improvements over time.
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Affiliation(s)
- Henry G Kaplan
- Department of Oncology, Swedish Cancer Institute, Seattle, Washington
| | - Judith A Malmgren
- HealthStat Consulting, Seattle, Washington.,Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington
| | - Mary K Atwood
- Department of Oncology, Swedish Cancer Institute, Seattle, Washington
| | - Gregory S Calip
- Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, Illinois
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Andersen SB, Törnberg S, Kilpeläinen S, Lynge E, Njor SH, Von Euler-Chelpin M. Measuring the burden of interval cancers in long-standing screening mammography programmes. J Med Screen 2015; 22:83-92. [DOI: 10.1177/0969141314560386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 10/29/2014] [Indexed: 11/16/2022]
Abstract
Objectives Mammography screening programme sensitivity is evaluated by comparing the interval cancer rate (ICR) with the expected breast cancer incidence without screening, ie. the proportional interval cancer rate (PICR). The PICR is usually found by extrapolating pre-screening incidence rates, whereas ICR is calculated from data available in the screening programmes. As there is no consensus regarding estimation of background incidence, we seek to validate the ICR measure against the PICR. Methods Screening data from the three mammography screening programmes of Stockholm, Copenhagen, and Funen in the period 1989-2011 provided data to calculate the ICR. The most commonly described methods of extrapolating pre-screening incidence rates to calculate the PICR were illustrated and PICRs were calculated by year and programme using these different methods and compared with the ICRs. Results PICRs varied greatly, reaching a difference of 32–34% in Stockholm, 79% in Copenhagen, and 100–106% in Funen between the highest and the lowest value, depending on which method was applied. PICRs exhibited large variations yearly and from programme to programme. ICRs did not vary to the same extent, ranging on average from 0.100 to 0.136 in the first 12-months and between 0.201 and 0.225 in the last 12-months of the two-year period after a negative screen across the three programmes. Conclusion The value of the PICR is hugely influenced by which method is applied, whereas the ICR is calculated purely on data available within programmes. We find that the PICR, the establishing indicator for sensitivity, could preferably be replaced by the ICR.
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Affiliation(s)
| | | | | | - Elsebeth Lynge
- Department of Public Health, University of Copenhagen, Denmark
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Is mammography screening history a predictor of future breast cancer risk? Eur J Epidemiol 2014; 30:143-9. [PMID: 25421784 DOI: 10.1007/s10654-014-9972-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 11/11/2014] [Indexed: 10/24/2022]
Abstract
Inspired by the model by Walter and Day for risk of cervical cancer following negative screens, one might hypothesize that women in a mammography screening programme with a certain number of negative screens had a lower remaining breast cancer risk than that of women in general. We studied whether number of negative screens was a predictor for a low remaining breast cancer risk in women participating in the mammography screening programmes in Stockholm, Copenhagen and Funen. Data were collected from the mammography screening programmes in Stockholm, Sweden (1989-2012), Copenhagen, Denmark (1991-2009) and Funen, Denmark (1993-2009), and linked to the respective cancer registries. We calculated cumulative hazard rates for breast cancer in women in cohorts defined by age at entry and number of negative screens for the maximum follow-up period in each screening centre. For all centres and cohorts, the cumulative hazard were parallel for all number of negative screens, from after the time, when the women were scheduled to be invited for the next screen. This means that the remaining breast cancer risk is similar no matter how many negative screens a woman have had. Number of negative screens was not a predictor of a low remaining breast cancer risk in women participating in the mammography screening programmes in Stockholm, Sweden, Copenhagen and Funen, Denmark. The history of previous negative screens is therefore not suitable for personalisation of mammography screening.
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Vanagas G, Padaiga Z. Healthcare spending in the case of a HPV16/18 population-wide vaccination programme. Scand J Public Health 2012; 40:406-11. [PMID: 22821227 DOI: 10.1177/1403494812455467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The policy of population-wide human papillomavirus (HPV) vaccination has been debated as the introduction of such a programme in a low-resource country faces the risk of insufficient cost-effectiveness. OBJECTIVES To assess the potential healthcare spending changes after the introduction of a HPV16/18 population-wide vaccination programme in Lithuania. STUDY DESIGN For a cost-effectiveness analysis, we used mathematical simulation and epidemiological data modelling based on a Lithuanian female population. We performed comparative analysis of an annual 12-year-old girls population-wide vaccination programme combined with cervical cancer screening programme compared to the screening programme strategy only. RESULTS HPV vaccination would gain an average of 35.6 life years per death avoided or up to 284.8 thousand life years would be gained over 90 years in total. The programme costs would be 2932.58 EUR per life year gained. All costs associated with the introduction of the vaccination programme could be recovered in 48 years. The HPV vaccination programme in Lithuania has the potential to generate up to 40.07 million EUR of economic returns annually compared with the current practice of the cervical screening alone. CONCLUSIONS In Lithuania the HPV16/18 vaccination programme would be economically effective only in the long term. The investment costs of HPV16/18 vaccination have the potential to be recovered.
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Affiliation(s)
- Giedrius Vanagas
- Academy of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania.
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