Effectiveness of screening on breast cancer in the city of Utrecht the DOM-project.
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Aged↗
Biomedical subjects
H J Collette
Publications and source records attributed to H J Collette.
Obesity and subcutaneous fat patterning in relation to breast cancer in postmenopausal women participating in the Diagnostic Investigation of Mammary Cancer Project.
Associations of body fat and body fat distribution with breast cancer were studied in 16,355 postmenopausal women with a natural menopause, aged 49 to 68 years, participating in a breast cancer screening project (the Diagnostic Investigation of Mammary Cancer [DOM] project in Utrecht, The Netherlands). One hundred nineteen women had breast cancer detected at first screening. Fat distribution was assessed by contrasting groups of subscapular and triceps skinfold thickness. No relationship between fat distribution and breast cancer was found. After adjustment for age, women in the highest quartile of Quetelet's index (QI) (weight/height2) had an odds ratio of 1.65 (95% confidence interval [CI], 0.97 to 2.81) compared with women in the the lowest quartile (test for trend, P less than 0.05). For subscapular skinfold and triceps skinfold, the odds ratios were 2.23 (95% CI, 1.28 to 3.91) and 2.01 (95% CI, 1.21 to 3.32), respectively, comparing the highest with the lowest quartile. The authors conclude that in postmenopausal women, overall obesity is associated with increased risk of breast cancer, whereas fat distribution, as measured by contrasting groups of subscapular and triceps skinfold thicknesses, is not related to breast cancer.
Adipose Tissue↗
Body measurements, estrogen availability and the risk of human breast cancer: a case-control study.
Recent studies on lifestyle-related mechanisms involved in cardiovascular risk offer important clues for a better understanding of breast-cancer epidemiology. Central body-fat distribution promoted by an affluent dietary intake and a sedentary lifestyle over many years is related to elevated serum triglycerides and free fatty acids, with lower levels of sex-hormone-binding globulin (SHBG). The resulting greater availability of estradiol not bound to SHBG could help to explain the high breast-cancer incidence in Western industrialized countries. We conducted a case-control study comparing 225 women aged 38 to 75 years with operable (stage I or II) breast cancer and 441 women of the same age having no breast cancer who participated in a population-based breast-cancer screening program. Body fatness, as measured by body mass index (BMI), fat distribution as measured by waist-to-hip girth ratio (WHR), body height, serum lipids, SHBG and the available fraction of estradiol were analyzed in a conditional logistic regression, together with family history for breast cancer, reproductive history and smoking. Post-menopausal cases showed no difference in body fatness (BMI), but a significant preponderance of central adiposity (WHR). In contrast, pre-menopausal cases were significantly leaner, but had a similar body-fat distribution as compared with controls. In all women, WHR, and less strongly BMI, was positively correlated with serum levels of triglycerides and available estradiol fractions. An independent, positive linear correlation between body height and relative risk (RR) was observed. Moreover, a significant correlation between SHBG and menarcheal age was seen in cases, but not in controls. These data support our hypothesis that lifestyle relates to breast-cancer risk by metabolic-endocrine mechanisms which modulate the availability of individual sex-steroid concentrations in plasma. The findings of height as a risk factor and adult SHBG levels being correlated with menarcheal age suggest that lifestyle factors promoting breast-cancer development already act around puberty. The leanness of pre-menopausal cases awaits further explanation.
Adult↗
Breast cancer after a negative screen: follow-up of women participating in the DOM Screening Programme.
First-round screening results for women participating in the DOM project (a screening programme for early detection of breast cancer) are described for the age groups 40-49 and 50-64 at entry. In the younger age group, a low pick-up rate (1.96 per 1000) in proportion to the expected incidence rate in the absence of screening (1.46 per 1000) was found. For the older age group, these rates were 4.25 and 2.03, respectively, per 1000. Interval cancers occurred (relatively) more frequently in younger women. After 2 years the ratio between interval-cancers and screen-detected tumours was about 1:1 in the younger age group and 1:2.5 in the older age group. These different results can be caused by too low a sensitivity of mammography and/or a higher tumour growth rate at a young age. The sensitivity of the screen at various periods of follow-up, was compared: a rapidly decreasing sensitivity of mammography was seen for women under the age of 50, in contrast to a slower decrease for women over this age. This rapid decrease may be caused by a relatively high tumour growth rate in younger women.
Adult↗
Evaluation of a breast cancer screening programme--the DOM project.
In several studies it has been shown that breast cancer screening by means of mammography reduces breast cancer mortality. To ensure that when organising a service screening programme the aim is reached, it is necessary to control and monitor the process. This is possible by several methods. In this study, disease-free intervals and survival rates were used as monitoring tools. The DOM project, a breast cancer screening programme for women aged 50-64 years old at intake, started at the end of 1974. All breast cancer cases diagnosed between 1973 and 1989 were followed up to 1991. It is clear that disease-free interval and survival rates are proper predictors of the effects of screening on breast cancer mortality.
Breast Neoplasms↗
Further evidence of benefits of a (non-randomised) breast cancer screening programme: the DOM project.
STUDY OBJECTIVE: The aim was to demonstrate the benefits of breast cancer screening on mortality. DESIGN: The study was an evaluation of a breast cancer screening programme by means of different approaches: (1) a case-control study, breast cancer deaths being the cases; (2) comparing the numbers of breast cancer deaths in screened and unscreened women; (3) comparing breast cancer mortality before and after start of the programme; (4) comparing breast cancer mortality in different large cities; (5) comparing screening activity with mortality reduction. SETTING: The setting was a breast cancer screening programme in the city of Utrecht, the DOM project, for women aged 50-64 years old at intake, birth cohort 1911-1925. The programme started in 1974, and there were five screening rounds up to 1984. Participation rate in the first round was 72% (14,697 women). MAIN RESULTS: (1) Screening was protective against dying from breast cancer, odds ratio 0.52, with a stronger effect in older women and no evidence of confounding; (2) risk ratio of dying from breast cancer for women in the response group was the same as the odds ratio, 0.52; (3) breast cancer death rate after the start of the project was nearly 20% lower than before the project started; after correcting for women who could not have benefited from screening the reduction was 33%; (4) a rise in breast cancer mortality in birth cohort 1911-1925 seen in other large cities without a screening programme due to aging of the cohort was not seen in the city of Utrecht; (5) mortality reduction followed the screening activity with a time lag of approximately 5 years. CONCLUSIONS: Early diagnosis of breast cancer by mammography reduces breast cancer mortality in women 50-64 years old at intake; different approaches to the evaluation of the project give different estimates of the screening effect, making clear that the effect depends on the intensity of the programme.
Breast Neoplasms↗
Breast cancer screening and cost-effectiveness; policy alternatives, quality of life considerations and the possible impact of uncertain factors.
Mammographic screening for women aged 50-70 is effective in reducing breast cancer mortality, but the impact on quality of life and the attainable mortality reduction remain to be discussed. The consequences of expanding screening programmes to include women in other age groups are uncertain. We have predicted the effects and costs for 5 popular screening variants, differing in age group and screening interval, on the basis of our analysis of the Dutch screening trials and of the reported mortality reductions in other trials. We have also investigated the influence of a large number of uncertain factors. Screening for women aged 50 and over with a 2- or 3-year interval is very cost-effective and will result in reductions of respectively 16% or 10% in breast cancer mortality in a real population. Variation of most variables keeps the cost-effectiveness (CE) ratio limited to the range of US $3,000 to 5,000 per life-year gained. A 2- to 3-fold change in CE ratio would only occur if the extreme estimates of mortality reduction in the Swedish screening trials were applied. The impact on quality of life (QoL) is limited: for the 2-yearly screening policy for women aged 50-70, the cost per Quality-Adjusted Life-Year (QALY) gained is 4,050, whereas the cost per life-year gained is US $3,825. The CE ratio for 2-yearly screening of women aged 40-70 is 5,400, but the additional cost per additional life-year gained is US $35,000. It would be preferable by far to extend the screening programme to women over the age of 70 or to shorten the screening interval for women aged 50-70. Screening performances, the demand for mammograms outside screening and the possibility of a survival improvement irrespective of screening have a strong impact on QoL and CE.
Adult↗
[Mass screening for breast cancer in women younger than 50; a literature review of the probable effect on mortality].
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Adult↗
[Efficacy of mass screening for breast cancer; reduced mortality nationally and internationally].
Breast cancer screening trials in several countries have proved to reduce breast cancer mortality. However, the trials show considerable differences in the extent of this reduction. The Swedish projects in Kopparberg/Ostergötland and Malmö are the most similar to the Dutch situation. The confidence intervals of the effect estimates of both projects are large. A critical review of all differences cannot yet lead to a conclusion on the difference in the estimated effects of both trials. Assuming equal mammographic quality in both projects, a reduction of 33% in breast cancer mortality for women in the age-group of 50 to 70 years seems a good estimate for similar projects. This assumption applied to a Dutch nationwide project, it will eventually lead to a reduction in breast cancer mortality of 16% for the entire population. In the year 2015 about 700 women will not die of breast cancer who would have without screening.
Adult↗
A model for breast cancer screening.
A model for breast cancer screening has been developed. When the appropriate screening policy is specified, the model reproduces the detection rates and the incidence of interval cancers as observed in the recent screening projects in Utrecht and Nijmegen, the Netherlands. The model-predicted mortality rate reduction is in accordance with the results of the Kopparberg/Ostergötland randomized trial in Sweden. Key parameters of the model are the duration of the preclinical stages and the sensitivity of mammography. The average duration is approximately 2 years at age 40 and increases to approximately 5 years at age 70. The sensitivity is high (approximately 95%) for tumors larger than 1 cm. The model is used in the prospective evaluation of effects and costs of various screening policies.
Adult↗
Systolic blood pressure and cardiovascular mortality among 13,740 Dutch women.
Prospective data of cardiovascular mortality in relation to the systolic blood pressure of women are scarce, especially when combined with other risk factors. The association between systolic blood pressure and cardiovascular mortality was therefore studied in a 10-year follow-up of a population of 13,740 Dutch women, born between 1911 and 1925 who participated in a population-based breast cancer screening project (the DOM Project). Age-adjusted mortality rates over the 10-year follow-up period suggest a J-shaped pattern of cardiovascular mortality according to level of systolic blood pressure. Age-adjusted total cardiovascular, coronary, and cerebrovascular mortality rate ratios were significantly greater than 1.0 among women with elevated systolic blood pressure. Within categories of other risk factors (obesity index, diabetes mellitus, current smoking, and use of antihypertensive medicines) the age-adjusted cardiovascular rate ratios did not show confounding by any of these variables. A very high increase in cardiovascular mortality was observed among hypertensive diabetic women. This study shows that elevated systolic blood pressure is associated with increased rates of cardiovascular mortality for women in this age group.
Body Mass Index↗
The cost-effectiveness of breast cancer screening.
The costs and effects of different invitation schedules of breast cancer screening are compared. The effect estimates are based on trials from the USA, Sweden and the Netherlands. The cost estimates use registration data, file studies and organization charts. The calculations were performed with the MISCAN computer simulation package, which is developed especially for the evaluation of mass screening programmes. Screening women of 50-70 years at 2-yearly intervals is a relatively cost-effective schedule. In a real population, it will reduce breast cancer mortality by 12%. Screening of women under 50 is probably far less cost-effective. Screening induces a considerable shift towards breast-conserving therapy. Although a 12% mortality reduction may seem low, in absolute numbers this represents more than the total mortality from, e.g., cervical cancer. Moreover, cost per death prevented or per life-year saved is much lower than for most other medical interventions for which cost-effectiveness ratios are known, screening for cervical cancer included.
Aged↗
Incidence and risk factors of Parkinson's disease in The Netherlands.
The incidence and some risk factors of Parkinson's disease were investigated in a study performed in The Netherlands. The study was based on a disease register of the Sentinel Stations, which provide a complete ascertainment of new patients with Parkinson's disease in 60 general practices in The Netherlands. The incidence rate of Parkinson's disease in The Netherlands is estimated to be 11/100,000 person-years for men and 12/100,000 person-years for women. Risk factors for Parkinson's disease were investigated in a case-control study in which 86 cases, with the diagnosis of Parkinson's disease confirmed by a neurologist, were compared with 172 reference subjects, matched for age and gender. Cigarette smoking was associated with a lower risk of Parkinson's disease (relative risk 0.6, 95% confidence interval 0.3-1.0). No association was observed between Parkinson's disease and severe head trauma with loss of consciousness, or surgery with total anaesthesia.
Female↗
A prospective study on corpus luteum function and breast cancer risk.
A case-control study incorporated within a cohort study was undertaken to test the hypothesis that anovulation or decreased luteal function is associated with increased risk of breast cancer. A large population (n = 12,000) of apparently healthy women aged 40-49 collected a specimen of urine on day 22 of 3 consecutive menstrual cycles, or, in cases of amenorrhea, on 3 arbitrarily chosen days. These samples were stored at -20 degrees C. Subsequent screening of the women by mammography revealed 34 cases of breast cancer, and over the next 4 years a further 34 cases were reported to the cancer registry. Urine samples from 53 of these cases were assayed for pregnanediol and creatinine, and the results were compared with those for an equal number of matched controls. No differences between these groups were found in the pregnanediol/creatinine ratio. We conclude that our results do not support the hypothesis that women with luteal insufficiency are at increased risk for breast cancer. However, since breast cancer patients tend to have a later menopause than controls, the possibility cannot be excluded that breast cancer patients continue to have ovulatory cycles for a longer period during reproductive life. Such a finding--opposite to the working hypothesis--would complicate the interpretation of the results.
Adult↗
A cross-sectional study of age-related loss of mineral content of phalangeal bone in men and women.
The bone mineral content of the second phalanx of the second digit was studied by quantitative microdensitometry. It is concluded that age-dependent loss of bone is a generalised phenomenon in men and women that occurs at different rates at different ages. In women, an accelerated rate of bone loss is observed between 50 and 57 years of age; in men such an acceleration is observed after 68 years of age. It appears that in a selected "ideal" population (with no disease or medication that may influence bone metabolism) the rate of bone mineral loss in women of 50-57 years of age is greater than in an unselected normal population. Furthermore, especially in the 50-57 years age group, the rate of loss at the mid-shaft of the phalanx in women is higher than at a site 25% from the proximal end. In men the rate of bone mineral loss at the 25% site exceeds that at midshaft, especially in the 68-75 year age group.
Absorptiometry, Photon↗
Breast cancer screening, with particular reference to the concept of 'high risk' groups.
An overview is presented of the salient aspects of the DOM-project of breast cancer screening carried out in the city of Utrecht, the Netherlands. Results on stage at diagnosis, case-fatality, and mortality rates suggest that the program has been effective. Attention is devoted to the issue whether knowledge about risk factors for breast cancer is helpful in making a screening program more effective or efficient. It is concluded that such knowledge is of limited importance.
Breast Neoplasms↗
Mammogram interpretation by physician assistants.
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Female↗
[Prospective studies of risk factors for cerebrovascular accidents in women].
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Aged↗