Human papillomavirus self‐sampling for screening nonattenders: Opt‐in pilot implementation with electronic communication platforms

In organized cervical screening programs, typically 25% of the invited women do not attend. The Copenhagen Self‐sampling Initiative (CSi) aimed to gain experiences on participation among screening nonattenders in the Capital Region of Denmark. Here, we report on the effectiveness of different communication platforms used in the pilot with suggestions for strategies prior to a full‐implementation. Moreover, an innovative approach using self‐sampling brushes with unique radio frequency identification chips allowed for unprecedented levels patient identification safety. Nonattenders from the capital region of Denmark were identified via the organized national invitation module. Screening history was obtained via the nationwide pathology registry. Twenty‐four thousand women were invited, and as an alternative to the regular communication platforms (letter and phone), women could request a home test via a mobile‐friendly webpage. Instruction material and video‐animation in several languages were made available online. Chi‐square test was used to test differences. Out of all invited, 31.7% requested a home test, and 20% returned it to the laboratory. In addition, 10% were screened at the physician after receiving the invitation. Stratified by screening history, long‐term unscreened women were less likely to participate than intermittently screened women (28% vs. 16%, p < 0.001). Of all contacts received, 64% (63–65) came via letter, and 31% (95CI: 30–32%) via webpage/mobile‐app. Self‐sampling was well‐accepted among nonattenders. Adopting modern technology‐based platforms into the current organized screening program would serve as a convenient communication method between health authority and citizens, allowing easy access for the citizen and reducing the work load in administrating self‐sampling approaches.     

Which patient- and physician-related factors are associated with guideline adherent initiation of adjuvant endocrine therapy? Results of the prospective multi-centre cohort study BRENDA II

Background

We analysed factors that might influence patients’ and physicians’ decisions against the initiation of guideline adherent adjuvant endocrine therapy (ET).

Methods

In a prospective multi-centre study, including four certified breast cancer centres in Germany, patients with primary breast cancer were included from 2009 to 2012. Patients completed a questionnaire prior to surgery, adjuvant therapy, and 6 months after adjuvant therapy. This questionnaire assessed health-related quality of life (QoL), psychiatric co-morbidity, demographic characteristics, and the intensity of fear for ET. Guideline adherence was classified based on an algorithm derived from international guidelines. The tumour board’s (TB) decisions against or for ET was documented. The TB was blinded regarding the guideline results.

Results

In 666 patients, adjuvant ET was indicated according to the guideline recommendations. The TB decided in 92.3 % (n = 615) of those that adjuvant ET was indicated. TB’s decision against ET was associated with the younger age of patients (OR = 0.5; 95 % CI 0.3–0.9) and poor QoL (OR = 1.7; 95 % CI 1.0–2.8). In 93 patients, ET was not indicated according to the guidelines, and the TB decided in 84 of those not to prescribe ET. The TB decided in 93.4 % of the cases according to the guidelines. Of the patients, where the TB prescribed ET, 5 % (n = 31) decided against ET. This decision was associated with fear of ET (OR = 2.2; 95 % CI 1.0–5.2) and higher age (OR 9; 95 % CI 1.0–48.1). Psychiatric co-morbidity (OR = 1.8; 95 % CI 0.7–4.2), poor QoL (OR = 0.4; 95 % CI 0.2–1.2), and education (OR = 1.2; 95 % CI 0.5–2.6) were not associated with the decision.

Discussion

Guideline adherent implementation of adjuvant ET is high. Physicians’ decision against ET is mainly associated with patients’ younger age and poor quality of life, whereas patients’ decision, once the TB decided to initiate ET and if ET is indicated by guidelines, is associated with higher age and fear of ET.

     

Cardiac late effects after modern 3D-conformal radiotherapy in breast cancer patients: a retrospective cohort study in Germany (ESCaRa)

Breast Cancer Research and Treatment - Radiotherapy (RT) was identified as a risk factor for long-term cardiac effects in breast cancer patients treated until the 1990s. However, modern techniques...     

The risk of urinary incontinence after partial urethral resection in patients with anterior vulvar cancer

Objective

The number of women with vulvar carcinoma located in the anterior fourchette in immediate proximity to the urethral opening has increased. A retrospective analysis was performed in order to evaluate the risk of urinary incontinence after tumor-resection, standard inguinal lymphadenectomy and additional partial urethral resection.

Study design

Between 2002 and 2007, 19 women with vulvar carcinomas located close to the urethral opening and consequently treated by additional partial urethral resection of up to 1.5 cm, were evaluated for urinary loss postoperatively by standard incontinence questionnaire. All patients complaining about some kind of urinary loss underwent urodynamic measurement. Results were compared with 21 controls (women with anterior vulvar cancer treated without urethral resection).

Results

Five of 19 women (26%) of the study group complained about urinary disturbances and received urodynamic evaluation. Ninety-five percent of the patients (18/19 women) were continent by urodynamic criteria; in one woman the measurement was unreliable. One patient in the control group (1/21 women) complained of an increase of urge symptoms that had been present preoperatively.

Conclusions

Twenty-six percent of our patients after partial urethral resection reported incontinence symptoms, though this was not always confirmed by urodynamics. We conclude that the risk of urinary stress incontinence after partial urethral resection in anterior vulvar carcinoma is acceptable.     

A randomized, double-blind, placebo-controlled, phase 3 trial comparing SMS 201-995 pa LAR plus tamoxifen versus tamoxifen plus placebo in women with locally recurrent or metastatic breast cancer]

A randomized, double-blind, placebo-controlled, phase 3 trial comparing SMS 201-995 pa LAR plus tamoxifen versus tamoxifen plus placebo in women with locally recurrent or metastatic breast cancer. PATIENTS AND METHODS: Numerous studies have proved the efficacy of tamoxifen treatment in women with receptor-positive breast cancer. Preclinical and phase I/II-studies showed that tumor control can be improved if Octreotid is added. In this randomized controlled double blind phase III study women received 20 mg tamoxifen daily and either 160 mg Octreoid-Depot i. m. injection once a month or a placebo injection. Until 1998 a total of 263 women were randomized. RESULTS: The study medication was tolerated well by all patients in the treatment group (n = 133). The most frequent moderate side effects were diarrhea (n = 73), nausea (n = 26), abdominal pain (n = 19), bone pain (n = 24) and fatigue (n = 20). No patient dropped out because of these side effects. Surprisingly, several complete remissions occured. Neither the total survival nor the progression free survival was significantly different between groups. Therefore the study was stopped before the originally planned number of patients (n = 416) had been enrolled. CONCLUSION: Octreotid plus tamoxifen does not improve tumor control. It is necessary to define subgroups that might benefit from Octreotid.     

Comparative analysis of micrometastasis to the bone marrow and lymph nodes of node-negative breast cancer patients receiving no adjuvant therapy.

PURPOSE: In node-negative patients, of whom up to 30% will recur within 5 years after diagnosis, markers are still needed that identify patients at high enough risk to warrant further adjuvant treatment. In the present study we analyzed whether a correlation exists between microscopic tumor cell spread to bone marrow and to lymph nodes and attempted to determine which route is clinically more important. PATIENTS AND METHODS: According to a prospective design, bone marrow aspirates and axillary lymph nodes of level I (n = 1,590) from 150 node-negative patients with stage I or II breast cancer were analyzed immunocytochemically with monoclonal anticytokeratin (CK) antibodies. We investigated associations with prognostic factors and the effect of micrometastasis on patients' prognosis. RESULTS: CK-positive cells in bone marrow aspirates were present in 44 (29%) of 150 breast cancer patients, whereas only 13 patients (9%) had such positive findings in lymph nodes; simultaneous microdissemination to bone marrow and lymph nodes was seen in merely two patients. No correlation of bone marrow micrometastases with other risk factors was assessed. Reduced 4-year distant disease-free and overall survival were each associated with a positive bone marrow finding (P =.032 and P =.014, respectively) but not with lymph node micrometastasis. Multivariate analysis revealed an independent prognostic effect of bone marrow micrometastasis on survival, with a hazards ratio of 6.1 (95% confidence interval, 1.2 to 31.3) for cancer-related death (P =.031) in our series. CONCLUSION: Immunocytochemical detection of micrometastatic cells in bone marrow but not in lymph nodes is an independent prognostic risk factor in node-negative breast cancer that may have implications for surgery and stratification into adjuvant therapy trials.     

Difficulties falling asleep among adolescents: Social inequality and time trends 1991–2018

Sleep problems in adolescence are increasingly common, and associated with adverse health and psychological outcomes. Adolescents’ sleep problems may be related to the family’s socioeconomic status, but studies are few and no study has examined whether social inequality in sleep problems changes as sleep problems become increasingly common. This study examined trends in difficulties falling asleep among adolescents in Denmark, whether this sleep problem was associated with socioeconomic status, and whether this association changed from 1991 to 2018. The study applied data from eight comparable surveys among 11–15 year olds in Denmark 1991–2018, the Danish arm of the international Health Behaviour in School‐aged Children study, N = 30,002. The prevalence of daily difficulties falling asleep increased from 7.0% to 13.4% in 1991–2018 with higher frequencies among girls and younger adolescents. The odds ratio (95% confidence interval) for daily difficulties was 1.14 (1.05–1.24) in middle and 1.52 (1.37–1.69) in low compared with high socioeconomic status. The absolute social inequality in difficulties falling asleep was persistent in 1991–2018 whereas the relative social inequality may have decreased. The increasing prevalence and the social inequality in difficulties falling asleep among adolescents is a serious public health concern that calls for more attention and efforts.