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Abnormal cervical cytology and health care use: a population-based register study.

https://arctichealth.org/en/permalink/ahliterature269043
Source
Gynecol Oncol. 2015 Oct;139(1):63-9
Publication Type
Article
Date
Oct-2015
Author
Maria Eiholm Frederiksen
Miguel Vázquez-Prada Baillet
Pierre-Antoine Dugué
Pernille Tine Jensen
Carsten Rygaard
Jesper Hallas
Elsebeth Lynge
Source
Gynecol Oncol. 2015 Oct;139(1):63-9
Date
Oct-2015
Language
English
Publication Type
Article
Keywords
Adult
Cervix Uteri - pathology
Delivery of Health Care - utilization
Denmark - epidemiology
Female
Humans
Middle Aged
Papanicolaou test
Registries
Uterine Cervical Dysplasia - diagnosis - epidemiology - pathology - therapy
Young Adult
Abstract
This study aimed to assess the long-term use of health care services in women with abnormal cytology results compared to women with normal cytology results.
We did a nationwide population-based study, using women aged 23 to 59years participating in the national organized cervical cancer screening program. We included a study population of 40,153 women with abnormal cytology (exposed) and 752,627 women with normal cytology (non-exposed). We retrieved data from the Danish Civil Registration System, the Danish Pathology Data Bank, the National Health Service, the National Patient and the National Prescription Register. We calculated the frequencies of contacts to general practitioner (GP), to private psychiatrist and/or psychologist, admissions to hospitals and use of prescription drugs. These frequencies were calculated separately in the 5-year period "before" the cytology result and for the 5-year period "after" the result.
During the "before" period exposed women had more contacts to GPs, more contacts to psychologists/psychiatrist, and more hospital admissions than non-exposed women. In both exposed and non-exposed women, health care use increased from the "before" to the "after" period. This increase was significantly higher for exposed than non-exposed women regarding contacts to GP, admissions to hospitals, and drug use.
Women with abnormal cytology results constitute a selected group with a higher health care use than other women even before they have the abnormal cytology. This difference is further enhanced after the abnormal cytology result.
PubMed ID
26268705 View in PubMed
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Alcohol consumption and mammographic density in the Danish Diet, Cancer and Health cohort.

https://arctichealth.org/en/permalink/ahliterature291562
Source
Cancer Causes Control. 2017 Dec; 28(12):1429-1439
Publication Type
Journal Article
Date
Dec-2017
Author
Katja Kemp Jacobsen
Elsebeth Lynge
Anne Tjønneland
Ilse Vejborg
My von Euler-Chelpin
Zorana J Andersen
Author Affiliation
Department of Technology, Faculty of Health and Technology, Metropolitan University College, Copenhagen, Denmark. katj@phmetropol.dk.
Source
Cancer Causes Control. 2017 Dec; 28(12):1429-1439
Date
Dec-2017
Language
English
Publication Type
Journal Article
Keywords
Alcohol drinking - epidemiology
Breast Density
Breast Neoplasms - diagnosis
Cohort Studies
Denmark - epidemiology
Early Detection of Cancer
Female
Humans
Logistic Models
Mammography
Middle Aged
Odds Ratio
Abstract
We examined the association between alcohol consumption and mammographic density (MD) considering in detail the time of exposure and the type of alcohol.
Of 5,356 women (4,489 post-menopausal) from the Danish Diet, Cancer and Health cohort (1993-1997) who attended mammographic screening in Copenhagen (1993-2001), we used MD (mixed/dense or fatty) assessed at the first screening after cohort entry. Alcohol consumption was assessed at the time of recruitment. Logistic regression was used to estimate associations [odds ratios (OR), 95% confidence intervals (CI)] between alcohol consumption and MD.
The mean age was 56.2 years, 56.5% of women had mixed/dense MD, and 91.8% were alcohol consumers. There was no association between current alcohol consumption and MD at baseline (age 50-65, on average 1 year before MD assessment) neither between age at drinking initiation and MD, in the fully adjusted model. There was a borderline statistically significantly increased OR of having mixed/dense MD in women who consumed?>?7 drinks/week at age 20-29 (1.31, 95% CI 1.00-1.72) compared to non-drinkers in this age group, and no effect of drinking at age 30-39, 40-49 or after >?50 years, when adjusting for current drinking. However, when considering different types of alcohol, drinking spirits at age 20-29 was positively associated with mixed/dense breast (3-7 drinks/week: OR 1.74, 95% CI 1.12-2.72); >7 drinks/week: (OR 1.76, 95% CI 0.73-4.23). No consistent pattern was found with beer, wine, or fortified wine.
We found higher MD among women with high alcohol consumption in early adulthood (ages 20-29), in those drinking spirits.
PubMed ID
28965165 View in PubMed
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Alcohol drinking may increase risk of breast cancer in men: a European population-based case-control study.

https://arctichealth.org/en/permalink/ahliterature9433
Source
Cancer Causes Control. 2004 Aug;15(6):571-80
Publication Type
Article
Date
Aug-2004
Author
Pascal Guénel
Diane Cyr
Svend Sabroe
Elsebeth Lynge
Franco Merletti
Wolfgang Ahrens
Cornelia Baumgardt-Elms
François Ménégoz
Håkan Olsson
Stein Paulsen
Lorenzo Simonato
Gun Wingren
Author Affiliation
INSERM, Unité 170, 16 avenue Paul-Vaillant Couturier, 94807 Villejuif Cedex, France. guenel@vjf.inserm.fr
Source
Cancer Causes Control. 2004 Aug;15(6):571-80
Date
Aug-2004
Language
English
Publication Type
Article
Keywords
Adult
Aged
Alcohol Drinking - adverse effects
Breast Neoplasms, Male - epidemiology - etiology
Case-Control Studies
Europe - epidemiology
Humans
Male
Middle Aged
Odds Ratio
Sex Factors
Abstract
OBJECTIVE: It has been estimated that alcohol drinking increases the risk of breast cancer in women by approximately 7% for each increment of 10 g alcohol per day. However, the few studies conducted on breast cancer among men have failed to detect an association with quantitative measures of alcohol drinking, even if the alcohol intake is generally higher in men than in women. On the other hand, increased risks of male breast cancer were inconsistently reported in alcoholics or patients with liver cirrhosis. We have investigated the role of alcohol drinking in male breast cancer using data collected in a population-based case-control study on seven rare cancers, conducted in Denmark, France, Germany, Italy, and Sweden. METHODS: The cases were 74 histologically verified male breast cancer patients aged 35-70 years. The controls (n = 1432) were selected from population registers, and frequency-matched to the cases by age group and geographic area. To check for consistency, a separate analysis was conducted using as controls the patients with a rare cancer other than male breast recruited simultaneously in the European study (n = 519 men). RESULTS: Based on population controls, the risk of developing breast cancer in men increased by 16% (95% CI: 7-26%) per 10 g alcohol /day (p
PubMed ID
15280636 View in PubMed
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Balancing sensitivity and specificity: sixteen year's of experience from the mammography screening programme in Copenhagen, Denmark.

https://arctichealth.org/en/permalink/ahliterature137879
Source
Cancer Epidemiol. 2011 Oct;35(5):393-8
Publication Type
Article
Date
Oct-2011
Author
Nicolai Utzon-Frank
Ilse Vejborg
My von Euler-Chelpin
Elsebeth Lynge
Author Affiliation
Institute of Public Health, University of Copenhagen, Østre Farimagsgade 5, DK 1014 Copenhagen K, Copenhagen, Denmark. nicolaiuf@gmail.com
Source
Cancer Epidemiol. 2011 Oct;35(5):393-8
Date
Oct-2011
Language
English
Publication Type
Article
Keywords
Aged
Breast Neoplasms - diagnosis - mortality - prevention & control
Carcinoma, Ductal, Breast - diagnosis - mortality - prevention & control
Carcinoma, Intraductal, Noninfiltrating - diagnosis - mortality - prevention & control
Denmark
Early Detection of Cancer
Female
Humans
Mammography
Mass Screening
Middle Aged
Prognosis
Sensitivity and specificity
Survival Rate
Time Factors
Abstract
To report on sensitivity and specificity from 7 invitation rounds of the organised, population-based mammography screening programme started in Copenhagen, Denmark, in 1991, and offered biennially to women aged 50-69. Changes over time were related to organisation and technology.
Individualized data were retrieved on outcome of screening mammography, assessment, surgery, and interval cancers. European Guideline performance indicators were calculated, supplemented with false positive and interval cancer rates per 1000 screens. False positive tests were divided into those sorted out at assessment (Type 1) and at surgery (Type 2).
In total, 1392 invasive breast cancers/ductal carcinoma in situ cases (DCIS) were diagnosed, giving an overall detection rate of 7.6 per 1000 screens. Of 5178 false positive tests, 4666 were Type 1 and 512 Type 2. The 468 interval cancers constituted 25% of all breast cancers (=screen detected+interval cancer). Almost all outcome measures were well within the desirable level of the European Guidelines. Risk of Type 2 false positive tests was positively associated with detection rate especially at initial screen, and interval cancer rate was negatively associated with detection rate. This association was decoupled after introduction of high resolution ultrasound and stereotactic breast biopsies, resulting in a Benign-to-Malignant-Ratio (BMR) of 1:11.40.
Mammography screening is a delicate balance between benefits and risks. Increase in detection rate came at cost of increase in risk of benign biopsies. Introduction of new technologies broke this pattern and a slight increase in detection rate coincided with an unprecedentedly low BMR.
PubMed ID
21239242 View in PubMed
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Benefit-to-harm ratio of the Danish breast cancer screening programme.

https://arctichealth.org/en/permalink/ahliterature286271
Source
Int J Cancer. 2017 Aug 01;141(3):512-518
Publication Type
Article
Date
Aug-01-2017
Author
Anna-Belle Beau
Elsebeth Lynge
Sisse Helle Njor
Ilse Vejborg
Søren Nymand Lophaven
Source
Int J Cancer. 2017 Aug 01;141(3):512-518
Date
Aug-01-2017
Language
English
Publication Type
Article
Keywords
Aged
Breast Neoplasms - diagnosis - epidemiology - mortality
Carcinoma, Ductal, Breast - diagnosis - epidemiology - mortality
Carcinoma, Intraductal, Noninfiltrating - diagnosis - epidemiology - mortality
Denmark - epidemiology
Early Detection of Cancer
Female
Follow-Up Studies
Humans
Incidence
Mammography
Medical Overuse
Middle Aged
Neoplasm Invasiveness
Prognosis
Survival Rate
Abstract
The primary aim of breast cancer screening is to reduce breast cancer mortality, but screening also has negative side-effects as overdiagnosis. To evaluate a screening programme, both benefits and harms should be considered. Published estimates of the benefit-to-harm ratio, the number of breast cancer deaths prevented divided by the number of overdiagnosed breast cancer cases, varied considerably. The objective of the study was to estimate the benefit-to-harm ratio of breast cancer screening in Denmark. The numbers of breast cancer deaths prevented and overdiagnosed cases [invasive and ductal carcinoma in situ (DCIS)] were estimated per 1,000 women aged 50-79, using national published estimates for breast cancer mortality and overdiagnosis, and national incidence and mortality rates. Estimations were made for both invited and screened women. Among 1,000 women invited to screening from age 50 to age 69 and followed until age 79, we estimated that 5.4 breast cancer deaths would be prevented and 2.1 cases overdiagnosed, under the observed scenario in Denmark of a breast cancer mortality reduction of 23.4% and 2.3% of the breast cancer cases being overdiagnosed. The estimated benefit-to-harm ratio was 2.6 for invited women and 2.5 for screened women. Hence, 2-3 women would be prevented from dying from breast cancer for every woman overdiagnosed with invasive breast cancer or DCIS. The difference between the previous published ratios and 2.6 for Denmark is probably more a reflection of the accuracy of the underlying estimates than of the actual screening programmes. Therefore, benefit-to-harm ratios should be used cautiously.
Notes
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PubMed ID
28470685 View in PubMed
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Birth weight, childhood body mass index, and height in relation to mammographic density and breast cancer: a register-based cohort study.

https://arctichealth.org/en/permalink/ahliterature261926
Source
Breast Cancer Res. 2014;16(1):R4
Publication Type
Article
Date
2014
Author
Zorana J Andersen
Jennifer L Baker
Kristine Bihrmann
Ilse Vejborg
Thorkild I A Sørensen
Elsebeth Lynge
Source
Breast Cancer Res. 2014;16(1):R4
Date
2014
Language
English
Publication Type
Article
Keywords
Adolescent
Aged
Birth weight
Body Height
Body mass index
Breast - physiology
Breast Neoplasms - diagnosis - epidemiology
Child
Cohort Studies
Denmark - epidemiology
Female
Humans
Mammary Glands, Human - abnormalities
Mammography
Middle Aged
Risk
Risk factors
Abstract
High breast density, a strong predictor of breast cancer may be determined early in life. Childhood anthropometric factors have been related to breast cancer and breast density, but rarely simultaneously. We examined whether mammographic density (MD) mediates an association of birth weight, childhood body mass index (BMI), and height with the risk of breast cancer.
13,572 women (50 to 69?years) in the Copenhagen mammography screening program (1991 through 2001) with childhood anthropometric measurements in the Copenhagen School Health Records Register were followed for breast cancer until 2010. With logistic and Cox regression models, we investigated associations among birth weight, height, and BMI at ages 7 to 13?years with MD (mixed/dense or fatty) and breast cancer, respectively.
8,194 (60.4%) women had mixed/dense breasts, and 716 (5.3%) developed breast cancer. Childhood BMI was significantly inversely related to having mixed/dense breasts at all ages, with odds ratios (95% confidence intervals) ranging from 0.69 (0.66 to 0.72) at age 7 to 0.56 (0.53 to 0.58) at age 13, per one-unit increase in z-score. No statistically significant associations were detected between birth weight and MD, height and MD, or birth weight and breast cancer risk. BMI was inversely associated with breast cancer, with hazard ratios of 0.91 (0.83 to 0.99) at age 7 and 0.92 (0.84 to 1.00) at age 13, whereas height was positively associated with breast cancer risk (age 7, 1.06 (0.98 to 1.14) and age 13, 1.08 (1.00 to 1.16)). After additional adjustment for MD, associations of BMI with breast cancer diminished (age 7, 0.97 (0.88 to 1.06) and age 13, 1.01 (0.93 to 1.11)), but remained with height (age 7, 1.06 (0.99 to 1.15) and age 13, 1.09 (1.01 to 1.17)).
Among women 50?years and older, childhood body fatness was inversely associated with the breast cancer risk, possibly via a mechanism mediated by MD, at least partially. Childhood tallness was positively associated with breast cancer risk, seemingly via a pathway independent of MD. Birth weight was not associated with MD or breast cancer in this age group.
Notes
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PubMed ID
24443815 View in PubMed
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Body mass index and participation in organized mammographic screening: a prospective cohort study.

https://arctichealth.org/en/permalink/ahliterature272285
Source
BMC Cancer. 2015;15:294
Publication Type
Article
Date
2015
Author
Sophie Sell Hellmann
Sisse Helle Njor
Elsebeth Lynge
My von Euler-Chelpin
Anja Olsen
Anne Tjønneland
Ilse Vejborg
Zorana Jovanovic Andersen
Source
BMC Cancer. 2015;15:294
Date
2015
Language
English
Publication Type
Article
Keywords
Body mass index
Breast Neoplasms - diagnosis
Cohort Studies
Early Detection of Cancer - methods
Female
Humans
Mammography - methods
Middle Aged
Obesity - epidemiology
Patient Participation
Postmenopause
Premenopause
Prospective Studies
Risk factors
Sweden - epidemiology
Thinness - epidemiology
Abstract
Breast cancer is the leading cancer among women, and early diagnosis is essential for future prognosis. Evidence from mainly cross-sectional US studies with self-reported exposure and outcome found positive association of body mass index (BMI) with non-participation in mammographic screening, but hardly addressed the influence of potential effect-modifiers. We studied the association between objective measures of BMI and participation in mammographic screening in a Danish prospective cohort, and explored the influence of menopausal status, hormone therapy (HT), previous screening participation, and morbidities on this relationship.
A total of 5,134 women from the Diet, Cancer, and Health cohort who were invited to population based mammographic screening in Copenhagen were included in analysis. Women were 50-64 years old at inclusion (1993-97) when their height and weight were measured and covariates collected via questionnaire. Odds ratios (OR) and 95% confidence intervals (CI) for the association between BMI and mammographic screening participation were estimated by logistic regression, adjusted for other breast cancer risk factors and morbidities. Effect modification was evaluated by an interaction term and tested by Wald test.
Underweight (BMI
Notes
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PubMed ID
25880028 View in PubMed
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Breast cancer incidence after the introduction of mammography screening: what should be expected?

https://arctichealth.org/en/permalink/ahliterature16388
Source
Cancer. 2006 Mar 29;
Publication Type
Article
Date
Mar-29-2006
Author
Anne Louise Svendsen
Anne Helene Olsen
My von Euler-Chelpin
Elsebeth Lynge
Author Affiliation
Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.
Source
Cancer. 2006 Mar 29;
Date
Mar-29-2006
Language
English
Publication Type
Article
Abstract
BACKGROUND: A prevalence peak is expected in breast cancer incidence when mammography screening begins, but afterward the incidence still may be elevated compared with prescreening levels. It is important to determine whether this is due to overdiagnosis (ie, the detection of asymptomatic disease that would otherwise not have arisen clinically). In the current study, the authors examined breast cancer incidence after the introduction of mammography screening in Denmark. METHODS: Denmark has 2 regional screening programs targeting women ages 50 years to 69 years. The programs were initiated in 1991 and 1993, respectively. No screening takes place in the 13 other Danish regions. Data regarding incident breast cancers detected between 1979 and 2001 were retrieved from the Danish Cancer Registry for each screening region and for the rest of Denmark, and time trends in rates for women ages 50 years to 69 years were compared. From 1 program, individual screening data were used to analyze breast cancer incidence in women who were never screened, those who were screened for the first time, or those who previously were screened. RESULTS: The incidence of breast cancer was found to have increased regardless of screening. In the screening regions, a marked prevalence peak was observed, and the incidence hereafter was compatible with the level indicated by the 95% confidence limits for the regression curves for the rates in the prescreening period, taking into account the artificial ageing in the program, the influx of newcomers, and variations in the data. Women who had undergone previous screening were found to have the same incidence of breast cancer as women who were never screened. CONCLUSIONS: The data from the current study do not provide evidence of overdiagnosis of invasive breast cancer in the 2 Danish screening programs or, if overdiagnosis was found to occur, it was only of limited magnitude. Cancer 2006. (c) 2006 American Cancer Society.
PubMed ID
16572411 View in PubMed
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Breast cancer mortality in Copenhagen after introduction of mammography screening: cohort study.

https://arctichealth.org/en/permalink/ahliterature17263
Source
BMJ. 2005 Jan 29;330(7485):220
Publication Type
Article
Date
Jan-29-2005
Author
Anne Helene Olsen
Sisse H Njor
Ilse Vejborg
Walter Schwartz
Peter Dalgaard
Maj-Britt Jensen
Ulla Brix Tange
Mogens Blichert-Toft
Fritz Rank
Henning Mouridsen
Elsebeth Lynge
Author Affiliation
Institute of Public Health, University of Copenhagen, Blegdamsvej 3, DK-2200 Copenhagen N, Denmark. a.h.olsen@pubhealth.ku.dk
Source
BMJ. 2005 Jan 29;330(7485):220
Date
Jan-29-2005
Language
English
Publication Type
Article
Keywords
Aged
Breast Neoplasms - mortality - prevention & control
Cohort Studies
Comparative Study
Denmark - epidemiology
Female
Follow-Up Studies
Humans
Mammography - mortality
Mass Screening - methods - mortality
Middle Aged
Regression Analysis
Research Support, Non-U.S. Gov't
Risk factors
Abstract
OBJECTIVES: To evaluate the effect on breast cancer mortality during the first 10 years of the mammography service screening programme that was introduced in Copenhagen in 1991. DESIGN: Cohort study. SETTING: The mammography service screening programme in Copenhagen, Denmark. PARTICIPANTS: All women ever invited to mammography screening in the first 10 years of the programme. Historical, national, and historical national control groups were used. MAIN OUTCOME MEASURES: The main outcome measure was breast cancer mortality. We compared breast cancer mortality in the study group with rates in the control groups, adjusting for age, time period, and region. RESULTS: Breast cancer mortality in the screening period was reduced by 25% (relative risk 0.75, 95% confidence interval 0.63 to 0.89) compared with what we would expect in the absence of screening. For women actually participating in screening, breast cancer mortality was reduced by 37%. CONCLUSIONS: In the Copenhagen programme, breast cancer mortality was reduced without severe negative side effects for the participants.
Notes
Comment In: BMJ. 2005 Apr 30;330(7498):1024; author reply 102515860834
Comment In: BMJ. 2005 Apr 30;330(7498):1024; author reply 102515860832
Comment In: BMJ. 2005 Apr 30;330(7498):1024; author reply 102515860833
Comment In: BMJ. 2005 Jan 29;330(7485):205-615677633
PubMed ID
15649904 View in PubMed
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Breast cancer mortality in Norway after the introduction of mammography screening.

https://arctichealth.org/en/permalink/ahliterature124944
Source
Int J Cancer. 2013 Jan 1;132(1):208-14
Publication Type
Article
Date
Jan-1-2013
Author
Anne Helene Olsen
Elsebeth Lynge
Sisse H Njor
Merethe Kumle
Marit Waaseth
Tonje Braaten
Eiliv Lund
Author Affiliation
Department of Community Medicine, University of Tromsø, Tromsø, Norway.
Source
Int J Cancer. 2013 Jan 1;132(1):208-14
Date
Jan-1-2013
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Breast Neoplasms - diagnosis - mortality - radiography
Early Detection of Cancer - methods
Female
Follow-Up Studies
Humans
Mammography - methods
Mass Screening - methods
Middle Aged
Norway - epidemiology
Abstract
An organized mammography screening program was gradually implemented in Norway during the period 1996-2004. Norwegian authorities have initiated an evaluation of the program. Our study focused on breast cancer mortality. Using Poisson regression, we compared the change in breast cancer mortality from before to during screening in four counties starting the program early controlling for change in breast cancer mortality during the same time in counties starting the program late. A follow-up model included death in all breast cancers diagnosed during the follow-up period. An evaluation model included only breast cancers diagnosed in ages where screening was offered. The study group had been invited for screening one to three times and followed for on average of 5.9 years. In the follow-up model, 314 breast cancer deaths were observed in the study group, and 523, 404 and 638, respectively, in the four control groups. The ratio between the changes in breast cancer mortality between early and late starting counties was 0.93 (95% confidence interval [CI] 0.77-1.12). In the evaluation model, this ratio was 0.89 (95% CI: 0.71-1.12). In Norway, where 40% of women used regular mammography prior to the program, the implementation of the organized mammography screening program was associated with a statistically nonsignificant decrease in breast cancer mortality of around 11%.
Notes
Comment In: Int J Cancer. 2013 Apr 1;132(7):1721-222933058
Comment In: Int J Cancer. 2013 Apr 1;132(7):1723-422933134
Comment In: Int J Cancer. 2013 Apr 1;132(7):172722933244
Comment In: Int J Cancer. 2013 Apr 1;132(7):1725-622933188
PubMed ID
22532175 View in PubMed
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