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Benefits and harms of screening men for abdominal aortic aneurysm in Sweden: a registry-based cohort study.

https://arctichealth.org/en/permalink/ahliterature296578
Source
Lancet. 2018 06 16; 391(10138):2441-2447
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
06-16-2018
Author
Minna Johansson
Per Henrik Zahl
Volkert Siersma
Karsten Juhl Jørgensen
Bertil Marklund
John Brodersen
Author Affiliation
Department of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Cochrane Sweden, Skåne University Hospital, Lund, Sweden. Electronic address: minna.johansson@vgregion.se.
Source
Lancet. 2018 06 16; 391(10138):2441-2447
Date
06-16-2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adult
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal - diagnosis - epidemiology - mortality - surgery
Humans
Incidence
Male
Mass Screening
Medical Overuse - statistics & numerical data
Middle Aged
Registries
Risk assessment
Sweden
Unnecessary Procedures - statistics & numerical data
Abstract
Large reductions in the incidence of abdominal aortic aneurysm (AAA) and AAA-related mortality mean that results from randomised trials of screening for the disorder might be out-dated. The aim of this study was to estimate the effect of AAA screening in Sweden on disease-specific mortality, incidence, and surgery.
Individual data on the incidence of AAA, AAA mortality, and surgery for AAA in a cohort of men aged 65 years who were invited to screening between 2006 and 2009, were compared with data from an age-matched contemporaneous cohort of men who were not invited for AAA screening. We also analysed national data for all men aged 40-99 years between Jan 1, 1987, and Dec 31, 2015, to explore background trends. Adjustment for confounding was done by weighting the analyses with a propensity score obtained from a logistic regression model on cohort year, marital status, educational level, income, and whether the patient already had an AAA diagnosis at baseline. Adjustment for differential attrition was also done by weighting the analyses with the inverse probability of still being in the cohort 6 years after screening. Generalised estimating equations were used to adjust the variance for repeated measurement and in response to the weighting.
AAA mortality in Swedish men has decreased from 36 to ten deaths per 100?000 men aged 65-74 years between the early 2000s and 2015. Mortality decreased at similar rates in all Swedish counties, irrespective of whether AAA screening was offered. After 6 years with screening, we found a non-significant reduction in AAA mortality associated with screening (adjusted odds ratio [aOR] 0·76, 95% CI 0·38-1·51), which means that two men (95% CI -3 to 7) avoid death from AAA for every 10?000 men offered screening. Screening was associated with increased odds of AAA diagnosis (aOR 1·52, 95% CI 1·16-1·99; p=0·002) and an increased risk of elective surgery (aOR 1·59, 95% CI 1·20-2·10; p=0·001), such that for every 10?000 men offered screening, 49 men (95% CI 25-73) were likely to be overdiagnosed, 19 of whom (95% CI 1-37) had avoidable surgery that increased their risk of mortality and morbidity.
AAA screening in Sweden did not contribute substantially to the large observed reductions in AAA mortality. The reductions were mostly caused by other factors, probably reduced smoking. The small benefit and substantially less favourable benefit-to-harm balance call the continued justification of the intervention into question.
Research Unit and Section for General Practice, FoUU-centrum Fyrbodal, Sweden, and the region of Västra Götaland, Sweden.
Notes
CommentIn: Lancet. 2018 Jun 16;391(10138):2394-2395 PMID 29916370
CommentIn: Lakartidningen. 2018 Sep 5;115: PMID 30204225
CommentIn: Lakartidningen. 2018 Sep 5;115: PMID 30204226
PubMed ID
29916384 View in PubMed
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Breast cancer mortality in organised mammography screening in Denmark: comparative study.

https://arctichealth.org/en/permalink/ahliterature97599
Source
BMJ. 2010;340:c1241
Publication Type
Article
Date
2010
Author
Karsten Juhl Jørgensen
Per-Henrik Zahl
Peter C Gøtzsche
Author Affiliation
The Nordic Cochrane Centre, Rigshospitalet, University of Copenhagen, Denmark. kj@cochrane.dk
Source
BMJ. 2010;340:c1241
Date
2010
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Breast Neoplasms - mortality - prevention & control - radiography
Denmark - epidemiology
Epidemiologic Methods
Female
Humans
Mammography - mortality
Middle Aged
Abstract
OBJECTIVE: To determine whether the previously observed 25% reduction in breast cancer mortality in Copenhagen following the introduction of mammography screening was indeed due to screening, by using an additional screening region and five years additional follow-up. DESIGN: We used Poisson regression analyses adjusted for changes in age distribution to compare the annual percentage change in breast cancer mortality in areas where screening was used with the change in areas where it was not used during 10 years before screening was introduced and for 10 years after screening was in practice (starting five years after introduction of screening). SETTING: Copenhagen, where mammography screening started in 1991, and Funen county, where screening was introduced in 1993. The rest of Denmark (about 80% of the population) served as an unscreened control group. PARTICIPANTS: All Danish women recorded in the Cause of Death Register and Statistics Denmark for 1971-2006. MAIN OUTCOME MEASURE: Annual percentage change in breast cancer mortality in regions offering mammography screening and those not offering screening. RESULTS: In women who could benefit from screening (ages 55-74 years), we found a mortality decline of 1% per year in the screening areas (relative risk (RR) 0.99, 95% confidence interval (CI) 0.96 to 1.01) during the 10 year period when screening could have had an effect (1997-2006). In women of the same age in the non-screening areas, there was a decline of 2% in mortality per year (RR 0.98, 95% CI 0.97 to 0.99) in the same 10 year period. In women who were too young to benefit from screening (ages 35-55 years), breast cancer mortality during 1997-2006 declined 5% per year (RR 0.95, CI 0.92 to 0.98) in the screened areas and 6% per year (RR 0.94, CI 0.92 to 0.95) in the non-screened areas. For the older age groups (75-84 years), there was little change in breast cancer mortality over time in both screened and non-screened areas. Trends were less clear during the 10 year period before screening was introduced, with a possible increase in mortality in women aged less than 75 years in the non-screened regions. CONCLUSIONS: We were unable to find an effect of the Danish screening programme on breast cancer mortality. The reductions in breast cancer mortality we observed in screening regions were similar or less than those in non-screened areas and in age groups too young to benefit from screening, and are more likely explained by changes in risk factors and improved treatment than by screening mammography.
PubMed ID
20332505 View in PubMed
Less detail
Source
Ann Intern Med. 2017 10 03;167(7):524
Publication Type
Article
Date
10-03-2017
Author
Karsten Juhl Jørgensen
Peter C Gøtzsche
Mette Kalager
Per-Henrik Zahl
Source
Ann Intern Med. 2017 10 03;167(7):524
Date
10-03-2017
Language
English
Publication Type
Article
Keywords
Breast Neoplasms
Denmark
Early Detection of Cancer
Humans
Mammography
Mass Screening
Notes
Comment On: Ann Intern Med. 2017 Mar 7;166(5):313-32328114661
Comment On: Ann Intern Med. 2017 Oct 3;167(7):52228973198
Comment On: Ann Intern Med. 2017 Oct 3;167(7):523-52428973197
Comment On: Ann Intern Med. 2017 Oct 3;167(7):52328973199
PubMed ID
28973200 View in PubMed
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Breast Cancer Screening in Denmark: A Cohort Study of Tumor Size and Overdiagnosis.

https://arctichealth.org/en/permalink/ahliterature282568
Source
Ann Intern Med. 2017 Mar 07;166(5):313-323
Publication Type
Article
Date
Mar-07-2017
Author
Karsten Juhl Jørgensen
Peter C Gøtzsche
Mette Kalager
Per-Henrik Zahl
Source
Ann Intern Med. 2017 Mar 07;166(5):313-323
Date
Mar-07-2017
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Breast Neoplasms - diagnosis - epidemiology
Carcinoma, Intraductal, Noninfiltrating - diagnosis - epidemiology
Cohort Studies
Denmark - epidemiology
Early Detection of Cancer
Female
Humans
Incidence
Mammography
Mass Screening
Medical Overuse - statistics & numerical data
Middle Aged
Abstract
Effective breast cancer screening should detect early-stage cancer and prevent advanced disease.
To assess the association between screening and the size of detected tumors and to estimate overdiagnosis (detection of tumors that would not become clinically relevant).
Cohort study.
Denmark from 1980 to 2010.
Women aged 35 to 84 years.
Screening programs offering biennial mammography for women aged 50 to 69 years beginning in different regions at different times.
Trends in the incidence of advanced (>20 mm) and nonadvanced (=20 mm) breast cancer tumors in screened and nonscreened women were measured. Two approaches were used to estimate the amount of overdiagnosis: comparing the incidence of advanced and nonadvanced tumors among women aged 50 to 84 years in screening and nonscreening areas; and comparing the incidence for nonadvanced tumors among women aged 35 to 49, 50 to 69, and 70 to 84 years in screening and nonscreening areas.
Screening was not associated with lower incidence of advanced tumors. The incidence of nonadvanced tumors increased in the screening versus prescreening periods (incidence rate ratio, 1.49 [95% CI, 1.43 to 1.54]). The first estimation approach found that 271 invasive breast cancer tumors and 179 ductal carcinoma in situ (DCIS) lesions were overdiagnosed in 2010 (overdiagnosis rate of 24.4% [including DCIS] and 14.7% [excluding DCIS]). The second approach, which accounted for regional differences in women younger than the screening age, found that 711 invasive tumors and 180 cases of DCIS were overdiagnosed in 2010 (overdiagnosis rate of 48.3% [including DCIS] and 38.6% [excluding DCIS]).
Regional differences complicate interpretation.
Breast cancer screening was not associated with a reduction in the incidence of advanced cancer. It is likely that 1 in every 3 invasive tumors and cases of DCIS diagnosed in women offered screening represent overdiagnosis (incidence increase of 48.3%).
None.
PubMed ID
28114661 View in PubMed
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Content of invitations for publicly funded screening mammography.

https://arctichealth.org/en/permalink/ahliterature16445
Source
BMJ. 2006 Mar 4;332(7540):538-41
Publication Type
Article
Date
Mar-4-2006
Author
Karsten Juhl Jørgensen
Peter C Gøtzsche
Author Affiliation
Nordic Cochrane Centre, Rigshospitalet Department 7112, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. kj@cochrane.dk
Source
BMJ. 2006 Mar 4;332(7540):538-41
Date
Mar-4-2006
Language
English
Publication Type
Article
Keywords
Appointments and Schedules
Attitude to Health
Breast Neoplasms - prevention & control
Communication
Female
Humans
Informed consent
Mammography - standards - utilization
Mass Screening - standards - utilization
Pamphlets
Patient Acceptance of Health Care - statistics & numerical data
Patient Education - standards
Professional Practice
Notes
Comment In: BMJ. 2006 Mar 25;332(7543):72816565139
PubMed ID
16513713 View in PubMed
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Effect of mammography screening on surgical treatment for breast cancer in Norway: comparative analysis of cancer registry data.

https://arctichealth.org/en/permalink/ahliterature131329
Source
BMJ. 2011;343:d4692
Publication Type
Article
Date
2011
Author
Pål Suhrke
Jan Mæhlen
Ellen Schlichting
Karsten Juhl Jørgensen
Peter C Gøtzsche
Per-Henrik Zahl
Author Affiliation
Department of Pathology, Oslo University Hospital, N-0407 Oslo, Norway. paalsuhr@medisin.uio.no
Source
BMJ. 2011;343:d4692
Date
2011
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Breast Neoplasms - epidemiology - prevention & control - surgery
Carcinoma, Intraductal, Noninfiltrating - epidemiology - prevention & control - surgery
Female
Humans
Mammography
Mass Screening
Mastectomy - statistics & numerical data
Middle Aged
Norway - epidemiology
Proportional Hazards Models
Registries
Abstract
To determine the effect of mammography screening on surgical treatment for breast cancer.
Comparative analysis of data from Norwegian cancer registry.
Mammography screening, Norway (screening of women aged 50-69 was introduced sequentially from 1996 to 2004).
35,408 women aged 40-79 with invasive breast cancer or ductal carcinoma in situ treated surgically from 1993 to 2008.
Rates of breast surgery (mastectomy plus breast conserving treatment) and rates of mastectomy for three age groups of women: 40-49, 50-69, and 70-79. Changes in rates from pre-screening period (1993-5) to introduction of screening phase (1996-2004) and then to screening period (2005-8) are presented as hazard ratios in invited and non-invited women.
The annual rate for breast surgery from the pre-screening period (1993-5) to screening period (2005-8) in Norway increased by 70% (hazard ratio 1.70, 95% confidence interval 1.62 to 1.78), from 180 to 305 per 100,000 women in the invited age group (50-69 years). In the younger, non-invited age group (40-49 years), however, the increase was only 8% (1.08, 1.00 to 1.16), from 133 to 144 per 100,000 women per year, whereas in the older, non-invited age group (70-79 years) the rate decreased by 8% (0.92, 0.86 to 1.00), from 227 to 214 per 100,000 women per year. The rates for mastectomy decreased similarly from the pre-screening period to screening period in invited and non-invited women. From the pre-screening period to the introduction phase of screening (1996-2004), however, the annual mastectomy rate in women aged 50-69 invited to screening increased by 9% (1.09, 1.03 to 1.14), from 156 to 167 per 100,000 women, and in the younger non-invited women declined by 17% (0.83, 0.78 to 0.90), from 109 to 91 per 100,000 women. In consequence, the mastectomy rate was 31% (1.31, 1.20 to 1.43) higher in the invited than in the non-invited younger age group.
Mammography screening in Norway was associated with a noticeable increase in rates for breast cancer surgery in women aged 50-69 (the age group invited to screening) and also an increase in mastectomy rates. Although over-diagnosis is likely to have caused the initial increase in mastectomy rates and the overall increase in surgery rates in the age group screened, the more recent decline in mastectomy rates has affected all age groups and is likely to have resulted from changes in surgical policy.
Notes
Cites: Breast Cancer Res. 2009;11 Suppl 3:S1920030870
Cites: Cochrane Database Syst Rev. 2009;(4):CD00187719821284
Cites: BMJ. 2002 Aug 24;325(7361):41812193357
Cites: BMJ. 2004 Jan 17;328(7432):14814726344
Cites: BMJ. 2004 Apr 17;328(7445):921-415013948
Cites: Br J Cancer. 1994 Dec;70(6):1165-707981070
Cites: Cancer. 2005 Mar 1;103(5):892-915641031
Cites: BMJ. 2006 Mar 4;332(7540):538-4116513713
Cites: Eur J Cancer Prev. 2006 Apr;15(2):138-4816523011
Cites: Tidsskr Nor Laegeforen. 2006 Aug 24;126(16):2098-10016932777
Cites: Br J Cancer. 2006 Nov 6;95(9):1265-817043685
Cites: Eur J Epidemiol. 2007;22(7):447-5517594526
Cites: BMJ. 2009;339:b258719589821
Cites: CA Cancer J Clin. 2009 Sep-Oct;59(5):290-30219679690
Cites: Ann Surg Oncol. 2009 Oct;16(10):2682-9019653046
Cites: Radiology. 2011 Sep;260(3):621-721846758
PubMed ID
21914765 View in PubMed
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[Is the screening program for colorectal cancer outdated before it has begun?].

https://arctichealth.org/en/permalink/ahliterature272155
Source
Ugeskr Laeger. 2013 Nov 18;175(47):2900-1
Publication Type
Article
Date
Nov-18-2013
Author
Karsten Juhl Jørgensen
Source
Ugeskr Laeger. 2013 Nov 18;175(47):2900-1
Date
Nov-18-2013
Language
Danish
Publication Type
Article
Keywords
Colorectal Neoplasms - diagnosis - prevention & control
Denmark
Humans
Mass Screening - standards
Occult Blood
Sigmoidoscopy
Notes
Comment In: Ugeskr Laeger. 2013 Nov 18;175(47):289826504934
PubMed ID
26504935 View in PubMed
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[Overinterpretation of a non-conclusive population study on breast cancer]

https://arctichealth.org/en/permalink/ahliterature17522
Source
Ugeskr Laeger. 2004 Aug 9;166(33):2822
Publication Type
Article
Date
Aug-9-2004
Author
Karsten Juhl Jørgensen
Peter C Gøtzsche
Source
Ugeskr Laeger. 2004 Aug 9;166(33):2822
Date
Aug-9-2004
Language
Danish
Publication Type
Article
Keywords
Breast Neoplasms - mortality - radiography
Cohort Studies
Denmark - epidemiology
Female
Humans
Mammography
Survival Rate
Notes
Comment In: Ugeskr Laeger. 2004 Oct 11;166(42):3737; author reply 3737-815508301
PubMed ID
15344870 View in PubMed
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Overview of guidelines on breast screening: Why recommendations differ and what to do about it.

https://arctichealth.org/en/permalink/ahliterature280961
Source
Breast. 2017 Feb;31:261-269
Publication Type
Article
Date
Feb-2017
Author
Karsten Juhl Jørgensen
Mette Kalager
Alexandra Barratt
Cornelia Baines
Per-Henrik Zahl
John Brodersen
Russell P Harris
Source
Breast. 2017 Feb;31:261-269
Date
Feb-2017
Language
English
Publication Type
Article
Keywords
Age Factors
American Cancer Society
Breast Neoplasms - diagnostic imaging - epidemiology
Early Detection of Cancer - adverse effects - standards
Female
Humans
Mammography
Norway
Observational Studies as Topic
Practice Guidelines as Topic
Randomized Controlled Trials as Topic
Risk assessment
Switzerland
United Kingdom
United States
Abstract
Updated guidelines on breast cancer screening have been published by several major organisations over the past five years. Recommendations vary regarding both age range, screening interval, and even on whether breast screening should be offered at all. The variation between recommendations reflects substantial differences in estimates of the major benefit (breast cancer mortality reduction) and the major harm (overdiagnosis). Estimates vary considerably among randomised trials, as well as observational studies: from no benefit to large reductions, and from no overdiagnosis to substantial levels. The estimates vary according to the methodology of the randomised trials, and the design of the observational studies. Guideline recommendations reflect the choice of evidence informing them. While there are well-developed tools to deal with randomised trials in guideline work, these are not always used, or they may not be followed as recommended. Further, results of trials performed decades ago may no longer be applicable. For observational studies, the framework for inclusion in guidelines is not similarly well-developed and there are methodological concerns specific to screening interventions, such as small effects in absolute terms. There is a need for agreement on a hierarchy of observational study designs to quantify the major benefit and harm of cancer screening. This review provides a summary of recent guidelines on breast cancer screening and their major strengths and weaknesses, as well as a short overview of the major strengths and limitations of observational study designs. There is a need for agreement on a hierarchy of observational study designs in this field.
PubMed ID
27717717 View in PubMed
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14 records – page 1 of 2.