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Stokholm RN, Stenholt L, Lauridsen HH, Edwards A, Andersen B, Larsen MB. The validity of instruments to measure knowledge in population-based cancer screening targeting individuals at average risk - A systematic review. Prev Med 2024; 182:107940. [PMID: 38513839 DOI: 10.1016/j.ypmed.2024.107940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/08/2024] [Accepted: 03/18/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVES Relevant knowledge is essential for informed choices about (non)participation in population-based cancer screening. Many instruments have been proposed to assess residents' knowledge about cancer screening programmes but their measurement properties are unknown. This systematic review aims to identify and critically evaluate the measurement properties of instruments to measure knowledge about cancer screening in individuals eligible for population-based screening. METHODS A literature search was undertaken in PubMed, PsycINFO, Embase, CINAHL, Scopus and Web of Science in August 2023. The review included any study reporting one or more measurement properties of the questionnaire or sub-scale used measuring knowledge of cancer screening including breast, colorectal and/or cervical cancer screening. Studies including males aged 45 or older and females aged 20 or older were included. Two independent reviewers screened the articles and assessed the included articles using the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN). RESULTS We included 24 instruments, which varied in number and characteristics of items. All instruments were assessed as having an inadequate instrument development. The results of structural validity, internal consistency, criterion validity and reliability were assessed as indeterminate, while construct validity and responsiveness were assessed as sufficient. CONCLUSION This systematic review identified no instruments to measure knowledge about cancer screening where the measurement properties were sufficiently evaluated. There is a lack of focus on content validity and structural validity, and further validation of the instruments is needed. The results indicate a lack of shared understanding or agreement of what constitutes relevant knowledge about cancer screening.
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Affiliation(s)
- Rikke Nicoline Stokholm
- Department of Public Health Programmes and University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark; Department of Clinical Medicine, Aarhus University, Denmark.
| | | | - Henrik Hein Lauridsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
| | - Adrian Edwards
- Department of Public Health Programmes and University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark; Division of Population Medicine, School of Medicine, Cardiff University, UK
| | - Berit Andersen
- Department of Public Health Programmes and University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
| | - Mette Bach Larsen
- Department of Public Health Programmes and University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
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Laschke ADL, Blaakær J, Jensen CF, Larsen MB. Differences in the referral process from general practice to resident specialists in gynaecology depending on density of specialists and patients' socioeconomic status. Scand J Prim Health Care 2023:1-10. [PMID: 37837435 DOI: 10.1080/02813432.2023.2268663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 10/04/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND There are significant differences in the densities of resident specialists in gynaecology (RSGs) in various regions of Denmark. It is unclear whether this disparity affects gynaecological patients' experience of the referral process and whether it differs in terms of their socioeconomic status (SES). OBJECTIVE To examine gynaecological patients' experiences of the referral process to an RSG concerning RSG density and patients' SES. DESIGN Cross-sectional questionnaire and registry-based study. SETTING In Denmark, general practitioners (GPs) serve as gatekeepers of secondary care and are responsible for referrals to resident specialists as well as inpatient and outpatient hospital care. SUBJECTS A total of 2917 patients who consulted an RSG participated in this study. MAIN OUTCOME MEASUREMENTS Patients' experiences of referral to an RSG, waiting times, involvement, and how they experienced the referral process. RESULTS Patients who lived in the highest density RSG region were referred to an RSG more promptly after the onset of symptoms, had to visit their GP less frequently to obtain a referral to the RSG, and rarely received a gynaecological examination by their GP compared with those living in regions with lower RSG densities. Moreover, their waiting times were shorter, and more often, the patients themselves proposed to be referred to an RSG. The findings show that RSG density had a greater impact on women's experiences than SES. CONCLUSION To allow equal access to specialist care, RSG density must be equal across all regions in the country.
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Affiliation(s)
- Alexander D L Laschke
- Speciallægeselskabet Alexander Laschke ApS, Aabenraa, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jan Blaakær
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Obstetrics and Gynaecology, Odense University Hospital, Odense C, Denmark
| | | | - Mette Bach Larsen
- Department of Public Health Programmes, Randers Regional Hospital, University Research Clinic for Cancer Screening, Randers, Denmark
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Laschke A, Blaakaer J, Jensen CF, Larsen MB. Danish women's preferences regarding gynecological examination support international recommendations: A cross-sectional study. Int J Gynaecol Obstet 2023; 162:1068-1076. [PMID: 37158417 DOI: 10.1002/ijgo.14828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Gynecological examinations (GEs) are challenging for many women. Several recommendations and guidelines have emerged, partly based on common sense and clinicians' consensus. However, there is a lack of knowledge regarding women's opinions. Therefore, this study aimed to describe women's preferences and experiences in relation to GEs and investigate whether they are dependent on their socioeconomic status. METHODS In Denmark, GEs are typically performed by general practitioners or resident specialists in gynecology (RSGs) in gynecological hospital departments. This cross-sectional questionnaire and register study included approximately 3000 randomly selected patients who visited six RSGs from January 1, 2020, to March 1, 2021. The main outcome measurement involved women's preferences and experiences regarding GEs. RESULTS Overall, 37% of the women thought that a changing room was important, 20% preferred a garment to cover themselves, 18% preferred a separate examination room, and 13% thought that the presence of a chaperone was important. Compared with working and retired women, more women outside the workforce felt insufficiently informed, considered their experience with RSGs unprofessional, and found GEs painful. CONCLUSION Our results support existing recommendations regarding GEs and the related environment, confirming that privacy and modesty are factors to take into consideration as they are of concern for a relatively large group of women. Thus, providers should focus on women outside the workforce, because this group appears to feel vulnerable in this environment.
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Affiliation(s)
- Alexander Laschke
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Speciallaegeselskabet Alexander Laschke ApS, Aabenraa, Denmark
| | - Jan Blaakaer
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Obstetrics and Gynaecology, Odense University Hospital, Odense, Denmark
| | | | - Mette Bach Larsen
- Department of Public Health Programmes, Randers Regional Hospital, University Research Clinic for Cancer Screening, Randers, Denmark
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4
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Graversen SB, Nannsen AØ, Bjerg L, Larsen MB, Andersen B, Laurberg T. The impact of diabetes on cancer detection during the prevalence round of a national screening program for colorectal cancer. Diabet Med 2023; 40:e15043. [PMID: 36655559 DOI: 10.1111/dme.15043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/21/2022] [Accepted: 01/10/2023] [Indexed: 01/20/2023]
Abstract
AIMS Diabetes is associated with a higher risk of colorectal cancer (CRC) and inferior survival after CRC. Screening may enable the early detection of CRC. We aimed to assess the impact of diabetes on cancer detection and disease stage during the prevalence round of a national CRC screening program. METHODS We performed a register-based cohort study based on the randomized procedure for inviting Danish residents aged 50-74 years to the prevalence round of national CRC screening program in 2014-2017. By comparing the random half of the population who had been invited by 1 May 2016 with the not yet invited half, the effect of screening was assessed by the detection of CRC and disease stage among individuals with and without diabetes. Further, the impact of diabetes on the screening participation rate was calculated. RESULTS By randomisation, 504,673 individuals had been invited to the CRC screening by 1 May 2016, and 549,359 individuals had not yet been invited. The diabetes prevalence was 10% in both groups. When comparing those not yet invited to those invited, the effect of screening on the number of detected cancers per 100,000 individuals was higher in those with diabetes (from 207 to 494 cancers) than in those without diabetes (from 147 to 364 cancers), and screening resulted in overall higher proportions of stage I cancer. Among those invited to screening, the participation rate was 9.1% lower (95% CI: 8.7%-9.5%) in individuals with versus without diabetes. CONCLUSIONS Despite a lower participation rate, the effect of CRC screening was higher in individuals with diabetes.
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Affiliation(s)
| | | | - Lasse Bjerg
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus N, Denmark
- Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - Mette Bach Larsen
- Department of Public Health Programmes, University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers NØ, Denmark
| | - Berit Andersen
- Department of Public Health Programmes, University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers NØ, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Tinne Laurberg
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus N, Denmark
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Laschke ADL, Blaakær J, Jensen CF, Larsen MB. Danish general practitioners as gatekeepers for gynaecological patients in regions with different density of resident specialists in gynaecology: in which situations and to whom do they refer? A cross-sectional study. Scand J Prim Health Care 2023; 41:52-60. [PMID: 36633427 PMCID: PMC10088933 DOI: 10.1080/02813432.2023.2165085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND There are large differences in the density of Resident Specialists in Gynaecology (RSG) in the various regions of Denmark. It is unknown if this inequality affects the General Practitioner (GP) referral patterns of gynaecological patients. OBJECTIVE To investigate the GP referral patterns of gynaecological patients to the RSG or to the Hospital/Outpatient Clinic (HOC) in specific situations according to the regional density of RSGs. Moreover, to examine whether GPs prefer to refer to the HOC or to the RSG, or whether they were treated by the GP depending on the density of RSGs, specifically, in six benign gynaecological diagnoses. DESIGN A cross-sectional questionnaire survey. SETTING In Denmark, GPs serve as gatekeepers to secondary care, being responsible for referrals to resident specialists and in- and outpatient hospital care. SUBJECTS Five hundred Danish GPs were randomly selected and invited to take part in the questionnaire study. Main outcome measurements: Referral patterns: Own treatment, RSG, or HOC. RESULTS GPs prefer to refer their gynaecologic patients to RSGs rather than to HOCs. In addition, the study shows the higher the density of RSGs, the more gynaecological patients are referred to the RSG. This also applies to the six diagnoses examined. CONCLUSION To allow patients' equal access to specialist care, the density of RSGs must be equal all over the country.
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Affiliation(s)
- Alexander D L Laschke
- Speciallægeselskabet Alexander Laschke ApS, Aabenraa, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Jan Blaakær
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
- Department of Obstetrics and Gynaecology, Odense University Hospital, Odense C, Denmark
| | | | - Mette Bach Larsen
- Department of Public Health Programmes, Randers Regional Hospital, University Research Clinic for Cancer Screening, Randers, Denmark
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Kirkegaard P, Larsen MB, Andersen B. “It's cancer screening after all”. Barriers to cervical and colorectal cancer screening and attitudes to promotion of self-sampling kits upon attendance for breast cancer screening. J Med Screen 2022; 30:74-80. [PMID: 36541340 PMCID: PMC10149879 DOI: 10.1177/09691413221137852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objectives To explore barriers to cervical and colorectal cancer screening and attitudes to promotion of self-sampling kits upon attendance for breast cancer screening. Methods Interview study with women who had not responded to one or more invitations to cervical or colorectal cancer screening. A semi-structured interview guide was used and interviews were audio recorded and transcribed verbatim. Concepts from Temporal Motivation Theory were used to structure and analyse the data. Results Twenty-two women were interviewed. Screening was highly valued but the women perceived screening for cervical cancer and colorectal cancer as more troublesome to participate in, compared with participation in breast cancer screening. The lack of a pre-booked appointment or a suggested deadline attenuated the perceived value of cervical and colorectal cancer screening and this further increased procrastination. Promotion of self-sampling kits for cervical and colorectal cancer screening upon attendance for breast cancer screening was considered a feasible way to increase salience of both types of screening. Conclusion A high number of micro steps and absence of a deadline in cervical and colorectal cancer screening diverted attention away from screening participation in cervical and colorectal cancer screening. The main facilitator could be reduction of micro actions, proposing a suggested deadline, and promotion of self-sampling kits when attending breast cancer screening to increase salience and a renewed attention to all three screening programmes.
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Affiliation(s)
- Pia Kirkegaard
- Department of Public Health Programmes, University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark
| | - Mette Bach Larsen
- Department of Public Health Programmes, University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark
| | - Berit Andersen
- Department of Public Health Programmes, University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark
- Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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Larsen MB, Hedelund M, Flander L, Andersen B. The impact of pre-notifications and reminders on participation in colorectal cancer screening - A randomised controlled trial. Prev Med 2022; 164:107229. [PMID: 36057390 DOI: 10.1016/j.ypmed.2022.107229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/28/2022] [Accepted: 08/28/2022] [Indexed: 11/29/2022]
Abstract
This study aimed to test whether participation in colorectal cancer (CRC) screening can be increased by combining the standard invitation procedure with a pre-notification and/or an extra reminder. In a non-blinded randomised controlled trial nested in a population-based CRC screening programme employing the faecal immunochemical test, Group I received a three-staged invitation procedure (pre-notification, invitation and one reminder), Group II received a three-staged invitation procedure (invitation and two reminders) and Group III received a four-staged invitation procedure (pre-notification, invitation and two reminders). The control group received the invitation and one reminder (usual procedure). A total of 59,041 participants were included in the analyses. Overall participation rates increased from 66.9% in the control group to 69.8% in the four-staged invitation procedure corresponding to an increase in overall participation rate of 2.9% (95% CI: 1.8 to 4.0). In the age group 50-59 years, the four-staged invitation procedure increased the participation rate by 4.0% (95% CI: 2.4 to 5.6). An extra reminder increased participation with 2.7% (95% CI: 1.1; 4.2) for males compared to 1.1% (95% CI: -0.3; 2.5) for females. In conclusion, the four-staged invitation procedure was the most effective invitation procedure indicating that multiple invitation procedures are most effective, especially in the youngest age group. If a three-staged invitation procedure is applied, a second reminder should be preferred over a pre-notification. Trial registration The project was registered at ClinicalTrials.gov on 26 February 2020 and patient enrolment began in August 2020. ClinicalTrials.gov Identifier: NCT04292366.
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Affiliation(s)
- Mette Bach Larsen
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Central Denmark Region, Skovlyvej 15, DK-8930 Randers, NO, Denmark.
| | - Mette Hedelund
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Central Denmark Region, Skovlyvej 15, DK-8930 Randers, NO, Denmark
| | - Louisa Flander
- University of Melbourne, School of Population and Global Health, The University of Melbourne, Victoria 3010, Australia
| | - Berit Andersen
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Central Denmark Region, Skovlyvej 15, DK-8930 Randers, NO, Denmark; Department of Clinical Medicine, Aarhus University, Incuba Skejby, Building 2, Palle Juul-Jensens Boulevard 82, DK-8200 Aarhus N, Denmark
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Gustafson LW, Larsen MB, Hammer A, Petersen LK, Andersen B, Bor P. Levels of anxiety in women ≥ 45 years undergoing diagnostic large loop excision of the transformation zone: a longitudinal study. BJOG 2022; 130:192-200. [PMID: 36161454 PMCID: PMC10091992 DOI: 10.1111/1471-0528.17299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 08/09/2022] [Accepted: 08/21/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE TO MEASURE ANXIETY LEVELS IN WOMEN ≥ 45 YEARS UNDERGOING DIAGNOSTIC LARGE LOOP EXCISION OF THE TRANSFORMATION ZONE (LLETZ) AT THE FIRST COLPOSCOPY VISIT.: DESIGN: LONGITUDINAL STUDY.: SETTING: THREE COLPOSCOPY CLINICS IN CENTRAL DENMARK REGION.: POPULATION OR SAMPLE: WOMEN ≥45 YEARS UNDERGOING DIAGNOSTIC LLETZ.: METHODS: WOMEN COMPLETED THE STATE TRAIT ANXIETY INVENTORY (STAI) AND SHORT FORM-12 (MENTAL AND PHYSICAL HEALTH) QUESTIONNAIRES BEFORE, IMMEDIATELY AFTER, AND ONE AND SIX MONTHS AFTER LLETZ.: Main Outcome Measures STAI STATE MEDIAN SCORES WERE CALCULATED AND STRATIFIED BY HEALTH STATUS, LETTER WITH INFORMATION ABOUT SCREENING RESULT, AND LLETZ RESULTS.: RESULTS: OF 109 ELIGIBLE WOMEN, 11 WERE EXCLUDED LEAVING 98 WOMEN FOR FINAL ANALYSES. RESPONSE RATES RANGED FROM 84.7 - 100%. OVERALL, STATE ANXIETY LEVELS WERE LOW, HOWEVER A DECREASE WAS OBSERVED FROM BEFORE TO IMMEDIATELY AFTER LLETZ (33.4 VS. 29.3, P<0.001). THE ANXIETY LEVELS REMAINED STABLE UP TO SIX MONTHS AFTER LLETZ. WOMEN WITH POOR MENTAL HEALTH WERE MORE LIKELY TO HAVE HIGHER ANXIETY LEVELS COMPARED TO WOMEN WITH GOOD MENTAL HEALTH (BEFORE LLETZ: RR 3.77 (95% CONFIDENCE INTERVAL (CI): 2.12-6.70), ONE MONTH AFTER LLETZ: RR 3.37 (95% CI: 1.59 - 7.15), SIX MONTHS AFTER LLETZ: RR 1.93 (95% CI: 1.06 - 3.51)).: CONCLUSIONS: Overall, colposcopy and diagnostic LLETZ in women ≥45 years were not associated with high anxiety. The anxiety levels were highest before colposcopy, and the women seemed to experience an immediate relief. Women with poor mental health had the highest anxiety level throughout the study, which might call for special attention.
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Affiliation(s)
- Line Winther Gustafson
- Randers, Denmark.,Department of Public Health Programmes, Randers Regional Hospital, Department of Clinical Medicine, University Research Clinic for Cancer Screening, Aarhus University, Denmark.,Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Mette Bach Larsen
- Randers, Denmark.,Department of Public Health Programmes, Randers Regional Hospital, University Research Clinic for Cancer Screening, Denmark
| | - Anne Hammer
- Herning, Denmark.,Department of Obstetrics and Gynaecology, NIDO - Centre for Research and Education, Gødstrup Hospital, Department of Clinical Medicine, Aarhus University, Denmark
| | - Lone Kjeld Petersen
- Odense, Denmark.,Department of Obstetrics and Gynaecology, Odense University Hospital and Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark, Denmark
| | - Berit Andersen
- Randers, Denmark.,Department of Public Health Programmes, Randers Regional Hospital, Department of Clinical Medicine, University Research Clinic for Cancer Screening, Aarhus University, Denmark
| | - Pinar Bor
- Randers, Denmark.,Department of Obstetrics and Gynaecology, Randers Regional Hospital and Department of Clinical Medicine, Aarhus University, Denmark
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Helgestad ADL, Larsen MB, Njor S, Tranberg M, Petersen LK, Andersen B. Three birds with one stone: a protocol for a randomised intervention study to increase participation in cervical and colorectal cancer screening among women attending breast cancer screening. BMJ Open 2022; 12:e062824. [PMID: 36137619 PMCID: PMC9511607 DOI: 10.1136/bmjopen-2022-062824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The participation rate is higher in breast cancer screening than in cervical cancer (CCU) and colorectal cancer (CRC) screening. In this cluster-randomised study, we aim to evaluate an intervention offering home-based CCU and CRC screening to women when attending breast cancer screening if they are overdue for CCU and/or CRC screening. METHODS AND ANALYSIS On intervention days, one of the five breast cancer screening units in the Central Denmark Region will be randomly allocated to intervention, whereas the remaining units will serve as control. Women attending breast cancer screening in the intervention unit will be offered information regarding their CCU and CRC screening history, and, if overdue, they will be offered self-sampling screening kits. For CCU screening, women aged 50-64 years will be offered a vaginal self-sampling kit for human papillomavirus testing. For CRC screening, women aged 50-69 years will be offered a kit to obtain a faecal immunochemical test. Women attending the control units will receive only standard care.After the intervention, a survey will be sent to all women in the intervention and control group, asking about their experience while attending breast cancer screening.Primary outcomes will be difference in the coverage in CCU and CRC screening 6 months after intervention between the intervention and the control group, and difference in participation rates 6 months after intervention for those who were overdue for CCU and/or CRC screening at the time of the intervention. ETHICS AND DISSEMINATION The project is listed in the record of processing activities for research projects in the Central Denmark Region (R. No.: 1-16-02-217-21). According to the Danish Consolidation Act on Research Ethics Review of Health Research Project, this study was not notifiable to the Committee (R. No.: 1-10-72-1-21). The findings will be disseminated in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER NCT05022511.
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Affiliation(s)
- Anne Dorte Lerche Helgestad
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mette Bach Larsen
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark
| | - Sisse Njor
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mette Tranberg
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark
| | - Lone Kjeld Petersen
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
- Open Patient data Explorative Network (OPEN), Department of Clinical Medicine, University of Southern Denmark, Odense, Denmark
| | - Berit Andersen
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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10
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Njor SH, Larsen MB, Søborg B, Andersen B. Colorectal cancer mortality after randomized implementation of FIT-based screening - a nationwide cohort study. J Med Screen 2022; 29:241-248. [DOI: 10.1177/09691413221102212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective Evidence of reduction in colorectal cancer (CRC) mortality following CRC screening based on the faecal immunochemical test (FIT) is insufficient. This study aimed to analyse if CRC mortality was reduced after implementing FIT-based screening. Setting The Danish national CRC screening programme. Methods This nationwide cohort study included residents aged 50–71 years invited to the prevalence round of the screening programme. Invitation order was decided by randomising on birth month; the first two birth months to be invited were classified as invited and the five last were classified as not-yet-invited and given a pseudo invitation data. Follow-up was from (pseudo)invitation date until 31 December 2017, emigration or death. Relative risk (RR) of CRC death was calculated with 95% confidence intervals (CIs). Results A total of 897,812 residents were included (29% invited and 71% not-yet-invited). The median follow-up was 3.3 years. The RR of CRC death at end of follow-up was 0.83 (95% CI 0.66; 1.03) among those invited to screening compared with those not yet invited. For men aged 60–71 years, this RR was 0.68 (95% CI 0.49; 0.94). For those participating in screening compared with a similar group of not-yet-invited residents, the RR was 0.71 (95% CI 0.46–1.08). For male participants aged 60–71 years, this RR was 0.49 (95% CI 0.27−0.89). For women and men aged 50–59 years, RRs were small and statistically non-significant. Conclusion This nationwide study showed that even within a median follow-up of only 3.3 years, implementing FIT-based CRC screening reduced CRC mortality among older men.
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Affiliation(s)
- Sisse Helle Njor
- Department of Public Health Programmes, Cancer Screening, Randers Regional Hospital, Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mette Bach Larsen
- Department of Public Health Programmes, Cancer Screening, Randers Regional Hospital, Randers, Denmark
| | - Bo Søborg
- Department of Public Health Programmes, Cancer Screening, Randers Regional Hospital, Randers, Denmark
| | - Berit Andersen
- Department of Public Health Programmes, Cancer Screening, Randers Regional Hospital, Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Larsen MB, Stokholm R, Kirkegaard P, Laursen HS, Gabel P, Andersen B. Making decisions on your own: Self-administered decision aids about colorectal cancer screening - A systematic review and meta-analyses. Patient Educ Couns 2022; 105:534-546. [PMID: 34376303 DOI: 10.1016/j.pec.2021.07.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 06/15/2021] [Accepted: 07/22/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To provide a systematic review of self-administered decision aids (DAs) for citizens invited to participate in colorectal cancer screening synthesizing the effectiveness of self-administered DAs on informed choice or the components hereof; knowledge, attitudes, and participation. METHODS The literature search was undertaken in PubMed, CINAHL, PsycINFO, Embase and Scopus and last updated 19 March 2021. Results were presented by narrative synthesis, meta-analyses and vote counting based on direction of effect. RESULTS Fourteen studies of fair methodological quality were included. One study reported on informed choice and 13 studies reported on the components. Self-administered DAs increased participation and knowledge whereas it was inconclusive with regard to attitudes towards screening. The studies were very heterogeneous with different comparators, outcomes and means of measurement. CONCLUSION This systematic review showed a potential for self-administered DAs to support informed choice in colorectal cancer screening, especially by increasing knowledge. PRACTICE IMPLICATIONS It seems reasonable to consider informed choice to be one of the main outcomes of self-administered DAs. Yet there is a need for consensus on how to measure informed choice in cancer screening, especially a validated measurement of knowledge defining what constitutes 'adequate knowledge'.
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Affiliation(s)
- Mette Bach Larsen
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, DK-8930 Randers NO, Denmark.
| | - Rikke Stokholm
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, DK-8930 Randers NO, Denmark.
| | - Pia Kirkegaard
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, DK-8930 Randers NO, Denmark.
| | - Henrik Sehested Laursen
- Medical Library, Regional Hospital Central Jutland, Heibergs Alle 5A, DK-8800 Viborg, Denmark.
| | - Pernille Gabel
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, DK-8930 Randers NO, Denmark.
| | - Berit Andersen
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, DK-8930 Randers NO, Denmark; Department of Clinical Medicine, Aarhus University, Incuba Skejby, Building 2, Palle Juul-Jensens Boulevard 82, DK-8200 Aarhus N, Denmark.
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12
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Flander L, Dekker E, Andersen B, Larsen MB, Steele RJ, Malila N, Sarkeala T, van der Vlugt M, de Klerk C, Knottnerus B, Bertels L, Woudstra A, Spaander MCW, Fransen M, Heinavaara S, Dillon M, Ait Ouakrim D, Jenkins M. What can We Learn From High-Performing Screening Programs to Increase Bowel Cancer Screening Participation in Australia? Cancer Control 2022; 29:10732748221121383. [PMID: 35969473 PMCID: PMC9381723 DOI: 10.1177/10732748221121383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Colorectal cancer (CRC) is the second most diagnosed cancer in men and women and second most common cause of cancer death in Australia; Australia’s CRC incidence and mortality are among the world’s highest. The Australian National Bowel Cancer Screening Program began in 2006; however, only 33% of those approached for the first time by the Program between 2018 and 2019 returned the kit. Of the 5.7 million kits sent during this period, only 44% were returned. Our aim was to identify practices and features of national bowel cancer screening programs in countries with similar programs but higher screening participation, to identify potential interventions for optimising Australian CRC screening participation. Methods We searched published and grey literature for CRC screening programs reporting at least 50% screening participation using postal invitation and free return of iFOBT home kits. Interviews were conducted with cancer registry staff and academic researchers, focused on participant and practitioner engagement in screening. Results National programs in Netherlands, Scotland, Denmark, and Finland reported over 50% screening participation rates for all invitation rounds. Shared characteristics include small populations within small geographic areas relative to Australia; relatively high literacy; a one-sample iFOBT kit; national registration systems for population cancer screening research; and screening program research including randomised trials of program features. Conclusions Apart from the one-sample kit, we identified no single solution to persistent Australian low uptake of screening. Research including randomised trials within the program promises to increase participation. Impact This screening program comparison suggests that within-program intervention trials will lead to increased Australian screening participation.
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Affiliation(s)
- Louisa Flander
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, 85084The University of Melbourne, Parkville, VIC, Australia
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, 26066Amsterdam UMC, AZ Amsterdam, Netherlands
| | - Berit Andersen
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, 53198Randers Regional Hospital, Randers, Denmark.,Department of Clinical Medicine, Aarhus University, Denmark
| | - Mette Bach Larsen
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, 53198Randers Regional Hospital, Randers, Denmark
| | - Robert J Steele
- Ninewells Hospital & Medical School, 3042University of Dundee, Dundee, UK
| | - Nea Malila
- Finnish Cancer Registry, Helsinki, Finland
| | | | - Manon van der Vlugt
- Department of Gastroenterology and Hepatology, 26066Amsterdam UMC, AZ Amsterdam, Netherlands
| | - Clasine de Klerk
- Department of Gastroenterology and Hepatology, 26066Amsterdam UMC, AZ Amsterdam, Netherlands
| | - Bart Knottnerus
- 8123Netherlands Institute for Health Services Research (Nivel), Utrecht, Netherlands
| | - Lucinda Bertels
- 113896Erasmus School of Health Policy and Management, Rotterdam, Netherlands
| | - Anke Woudstra
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Mirjam Fransen
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute 1105AZ Amsterdam, Netherlands
| | | | - Mary Dillon
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, 85084The University of Melbourne, Parkville, VIC, Australia.,Department of Information and Service Management, 4321Aalto University, Finland
| | - Driss Ait Ouakrim
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, 85084The University of Melbourne, Parkville, VIC, Australia
| | - Mark Jenkins
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, 85084The University of Melbourne, Parkville, VIC, Australia
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13
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Larsen MB, Bachmann HH, Søborg B, Laurberg T, Emmertsen KJ, Laurberg S, Andersen B. Prevalence of self-reported abdominal symptoms among 50-74-years-old men and women eligible for colorectal cancer screening -a cross-sectional study. BMC Cancer 2021; 21:910. [PMID: 34376179 PMCID: PMC8356437 DOI: 10.1186/s12885-021-08657-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/27/2021] [Indexed: 12/22/2022] Open
Abstract
Background Screening is defined as the identification of unrecognized disease in an apparently healthy population. Symptomatic individuals are recommended to contact a physician instead of participating in screening. However, in colorectal cancer (CRC) screening this approach may be problematic as abdominal symptoms are nonspecific. This study aimed at identifying the prevalence of self-reported abdominal symptoms among screening-eligible men and women aged 50–74 years. Methods This cross-sectional survey study included 11,537 individuals aged 50–74 years invited for CRC screening from 9 to 23 September 2019. Descriptive statistics of responders experiencing alarm symptoms of CRC, Low Anterior Resection Syndrome Score (LARS) and the Patient Assessment of Constipation-Symptoms (PAC-SYM) were derived. The association between abdominal symptoms and demographic and socioeconomic variables were estimated by prevalence ratio (PR) using a Poisson regression model with robust variance. Results A total of 5488 respondents were included. The respondents were more likely women, of older age, Danish, cohabiting and had higher education and income level compared to non-respondents. Abdominal pain more than once a week was experienced by 12.0% of the respondents. Of these, 70.8% had been experiencing this symptom for >1 month. Fresh blood in the stool was experienced by 0.7% and of these 82.1% for >1 month. About one third of those experiencing alarm symptoms more than once a week for >1 month had not consulted a doctor. A total of 64.1% of the respondents had no LARS, 21.7% had minor LARS and 14.2% had major LARS. The median PAC-SYM score was 0.33 (Interquartile range (IQR): 0.17;0.75), the median abdominal score was 0.50 (IQR: 0.00;1.00), median rectal score 0.00 (IQR:0.00;0.33) and median stool score 0.40 (IQR: 0.00;0.80). Men and those aged 65–74 reported less symptoms than women and those aged 50–64 years, respectively. Conclusions This study illustrated that abdominal symptoms were frequent among screening-eligible men and women. This should be taken into account when implementing and improving CRC screening strategies. A concerning high number of the respondents experiencing alarm symptoms had not consulted a doctor. This calls for attention to abdominal symptoms in general and how those with abdominal symptoms should participate in CRC screening. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08657-z.
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Affiliation(s)
- Mette Bach Larsen
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, NO, DK-8930, Randers, Denmark.
| | - Heidi Heinsen Bachmann
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, NO, DK-8930, Randers, Denmark
| | - Bo Søborg
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, NO, DK-8930, Randers, Denmark
| | - Tinne Laurberg
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Hedeager 3, DK-8200, Aarhus N, Denmark
| | - Katrine J Emmertsen
- Department of Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 35, DK-8200, Aarhus N, Denmark.,Department of Surgery, Randers Regional Hospital, Skovlyvej 1, NO, DK-8930, Randers, Denmark
| | - Søren Laurberg
- Department of Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 35, DK-8200, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Incuba Skejby, Building 2, Palle Juul-Jensens Boulevard 82, DK-8200, Aarhus N, Denmark
| | - Berit Andersen
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, NO, DK-8930, Randers, Denmark.,Department of Clinical Medicine, Aarhus University, Incuba Skejby, Building 2, Palle Juul-Jensens Boulevard 82, DK-8200, Aarhus N, Denmark
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14
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Larsen MB, Vejborg I, Njor SH. Participation in breast cancer screening among breast cancer survivors -A nationwide register-based cohort study. Breast 2020; 54:31-36. [PMID: 32898786 PMCID: PMC7486472 DOI: 10.1016/j.breast.2020.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/13/2020] [Accepted: 08/20/2020] [Indexed: 01/22/2023] Open
Abstract
The aim of this study was to analyse if breast cancer survivors without other breast imaging surveillance attend population-based screening differently than women not previously diagnosed with breast cancer. Further, to analyse if any differences depended on the women's age and years since previous cancer diagnosis. The study was a register-based retrospective cohort study of all women invited to participate in the national breast cancer screening programme in 2015-2016. Participation rates were calculated for breast cancer survivors without breast imaging within 21 months (2-4 years, 4-6 years, 6-10 years and more than 10 years after diagnosis) and for women without previous breast cancer. Relative differences in participation rates between the two groups were calculated. A total of 679,990 women were included in the study (2.6% breast cancer survivors). For breast cancer survivors, participation rates increased with increasing number of years since the previous cancer diagnosis peaking at 80.3% if the cancer diagnosis was more than 10 years ago. For women with no previous breast cancer, participation rate was 80.3%. The relative difference in participation was highest close to the breast cancer diagnosis and for the youngest women participation rates remained lower among breast cancer survivors even more than 10 years after the diagnosis. In conclusion, regardless of age and years since previous breast cancer diagnosis, breast cancer survivors had lower or similar participation rates than women with no previous cancer diagnosis. This indicated that as many as one fifth of the breast cancer survivors are at risk of inadequate surveillance.
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Affiliation(s)
- Mette Bach Larsen
- Department of Public Health Programmes, Randers Regional Hospital, Central Denmark Region, Skovlyvej 15, DK-8930, Randers, NO, Denmark.
| | - Ilse Vejborg
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen K, Denmark.
| | - Sisse Helle Njor
- Department of Public Health Programmes, Randers Regional Hospital, Central Denmark Region, Skovlyvej 15, DK-8930, Randers, NO, Denmark.
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15
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Gabel P, Larsen MB, Edwards A, Kirkegaard P, Andersen B. Effectiveness of a decision aid for colorectal cancer screening on components of informed choice according to educational attainment: A randomised controlled trial. PLoS One 2020; 15:e0241703. [PMID: 33170877 PMCID: PMC7654753 DOI: 10.1371/journal.pone.0241703] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 10/13/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The decision to take up colorectal cancer screening has to be made on informed grounds balancing benefits and harms. Self-administered decision aids can support citizens in making an informed choice. A self-administered web-based decision aid targeting citizens with lower educational attainment has been evaluated within the target population. However, the effectiveness in the general screening population remains unexplored. The aim of this study was to evaluate the effectiveness of a web-based decision aid for colorectal cancer screening on components of informed choice among previous non-participants in colorectal cancer screening. METHODS AND FINDINGS The study was designed as a parallel randomised controlled trial among non-participants in colorectal cancer screening in Central Denmark Region (men and women aged 53-74 years). Respondents to baseline and follow-up questionnaires comprised the study population (n = 1,723). The intervention group received the decision aid electronically along with the second reminder. The control group received only the second reminder. The main outcomes (knowledge, attitudes, uptake and decisional conflict) were obtained through questionnaires data and from the Danish Colorectal Cancer Screening Database. The decision aid increased the uptake rate by 8 percentage points (95% CI: 3.4;12.6) but had no effect on either knowledge (scale score differences: 0.09; 95% CI: -0.05;0.24) or attitudes (0.45; 95% CI: -0.00;0.91). Decisional conflict decreased by 1.69 scale points (95% CI: -3.18;-0.20). The effect was similar across educational attainment levels. CONCLUSIONS The web-based decision aid offers a feasible way to provide individualised screening information in a "one size fits all" approach that may hold the potential to increase informed CRC screening uptake. TRIAL REGISTRATION ClinicalTrials.gov registration number: NCT03253888.
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Affiliation(s)
- Pernille Gabel
- Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark
| | - Mette Bach Larsen
- Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark
- * E-mail:
| | - Adrian Edwards
- Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Pia Kirkegaard
- Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark
| | - Berit Andersen
- Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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16
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Njor SH, Vejborg I, Larsen MB. Breast cancer survivors' risk of interval cancers and false positive results in organized mammography screening. Cancer Med 2020; 9:6042-6050. [PMID: 32608178 PMCID: PMC7433834 DOI: 10.1002/cam4.3182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Breast cancer survivors are increasing followed for new breast cancers / recurrences by mammography screening only. We aimed at assessing how often breast cancer survivors get a false positive or false negative result at mammography screening. METHODS All mammography screenings performed between 2007 and 2017 in the Danish national mammography screening programme were included. Screenings in women with a breast cancer diagnosis prior to invitation were included in the "breast cancer survivors" group, while remaining screenings were included in the "no previous breast cancer" group. We compared the proportion of false positive screenings and the proportion of breast cancers detected at screening among breast cancer survivors and women without previous breast cancer. The analyses were further stratified according to whether the women had a diagnostic breast imaging in the 21 months prior to the screening. RESULTS At initial screenings, breast cancer survivors had a significant lower false positive risk than other women, while the risk was similar at subsequent screenings. Breast cancer survivors had a significant lower proportion of breast cancers detected at screening compared to other women. This was true both for women who had a diagnostic breast imaging in the 21 months prior to screening and those who did not. CONCLUSION This study shows that breast cancers survivors have a smaller amount of their new breast cancers detected at mammography screening, when compare to the amount of new breast cancers detected at mammography screening among women without previous breast cancer. The lower sensitivity does not seem to be due to different behavior among breast cancer survivors.
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Affiliation(s)
- Sisse Helle Njor
- Department of Public Health Programmes, Regional Hospital Randers, Randers, Denmark.,Department of Clinical Medicine, Aarhus University, aarhus, Denmark
| | - Ilse Vejborg
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Mette Bach Larsen
- Department of Public Health Programmes, Regional Hospital Randers, Randers, Denmark
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17
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Larsen MB, Njor S, Jensen TM, Ingeholm P, Andersen B. Answer to: Letter to the editor regarding 'Potential for prevention: a cohort study of colonoscopies and removal of adenomas in a FIT-based colorectal cancer screening programme'. Scand J Gastroenterol 2020; 55:761. [PMID: 32491942 DOI: 10.1080/00365521.2020.1774801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- M B Larsen
- Department of Public Health Programmes, Randers Regional Hospital, Central Denmark Region, Randers, Denmark
| | - S Njor
- Department of Public Health Programmes, Randers Regional Hospital, Central Denmark Region, Randers, Denmark
| | - T M Jensen
- Department of Internal Medicine, Horsens Regional Hospital, Horsens, Denmark
| | - P Ingeholm
- Department of Pathology, Herlev Hospital, Capital Region of Denmark, Herlev, Denmark
| | - B Andersen
- Department of Public Health Programmes, Randers Regional Hospital, Central Denmark Region, Randers, Denmark
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18
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Horshauge PM, Gabel P, Larsen MB, Kirkegaard P, Edwards A, Andersen B. The association between health literacy and colorectal cancer screening uptake in a publicly funded screening program in Denmark: Cross-sectional study. Prev Med Rep 2020; 19:101132. [PMID: 32551215 PMCID: PMC7287294 DOI: 10.1016/j.pmedr.2020.101132] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 05/13/2020] [Accepted: 05/23/2020] [Indexed: 02/07/2023] Open
Abstract
There are multiple reasons for not participating in colorectal cancer screening, but the role of health literacy in screening uptake is not well understood. The aims of this study were to determine the association between health literacy and colorectal cancer screening uptake and to explore whether socioeconomic and -demographic characteristics and worry and attitude variables modify this association. In a cross-sectional study, 10,030 53-74-year-old randomly selected citizens resident in Central Denmark Region received a questionnaire assessing health literacy using the European Health Literacy Survey Short Scale 16-item. Data on colorectal cancer screening uptake were obtained from the Danish Colorectal Cancer Screening database, and socioeconomic and -demographic data were linked from Statistics Denmark. The response rate was 71% (n = 7142). Odds ratio (OR) for uptake was 1.06 (95% confidence interval (CI): 0.96, 1.19) for problematic health literacy and 1.00 (95% CI: 0.87, 1.16) for inadequate health literacy, when using adequate health literacy as the reference value. The association was not modified by socioeconomic or -demographic characteristics, worry or attitude. No association was found between health literacy and colorectal cancer screening uptake. Future research needs to clarify which dimensions of health literacy may predict screening uptake and how it is best measured.
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Affiliation(s)
- Petricia Marie Horshauge
- Department of Public Health Programmes, Randers Regional Hospital, Denmark.,Department of Clinical Medicine, Aarhus University, Denmark
| | - Pernille Gabel
- Department of Public Health Programmes, Randers Regional Hospital, Denmark
| | - Mette Bach Larsen
- Department of Public Health Programmes, Randers Regional Hospital, Denmark
| | - Pia Kirkegaard
- Department of Public Health Programmes, Randers Regional Hospital, Denmark
| | - Adrian Edwards
- Department of Public Health Programmes, Randers Regional Hospital, Denmark.,Division of Population Medicine, School of Medicine, Cardiff University, UK
| | - Berit Andersen
- Department of Public Health Programmes, Randers Regional Hospital, Denmark.,Department of Clinical Medicine, Aarhus University, Denmark
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19
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Badre-Esfahani S, Larsen MB, Seibæk L, Petersen LK, Blaakær J, Andersen B. Low attendance by non-native women to human papillomavirus vaccination and cervical cancer screening - A Danish nationwide register-based cohort study. Prev Med Rep 2020; 19:101106. [PMID: 32426214 PMCID: PMC7226879 DOI: 10.1016/j.pmedr.2020.101106] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 04/21/2020] [Accepted: 04/23/2020] [Indexed: 12/02/2022] Open
Abstract
Background Cervical cancer is preventable through human papillomavirus vaccination and cervical cancer screening. However, possibly due to systemic, individual (e.g. low socio-economic staus) and socio-cultural barriers, it is likely that non-natives, especially non-westerns, are more prone to attend neither vaccination nor screening (combined non-attendance). This is disturbing as the non-native population in Denmark is predicted to rise to 21% by 2060. We aimed to investigate differences in combined non-attendance by nativity and region of origin, and to analyse the association between country of origin and combined non-attendance adjusted for socio-economic status. Setting 1.6.2007–31.12.2016 Denmark. Methods Logistic regression was performed to estimate crude and adjusted odds ratios with 95% confidence intervals for combined non-attendance. Results 170,158 women were included. Overall combined non-attendance was 11.8% [11.7–12.0]; 10.0% [9.8–10.1] for native women and 27.1% [26.4–27.7] for non-native women, with highest degrees among Middle-Eastern and North-Africans (30.1% [29.2–30.9]). Even when adjusted for socio-economics, women from Middle-East and North-Africa had substantially higher odds of combined non-attendance than natives (adj. OR = 7.5 [6.3–8.9] for Somali women). Conclusion Denmark has a relatively low degree of combined non-attendance. However, cervical cancer preventive programmes seem to be better tailored to the needs of native women and do not appear to cater sufficiently to the needs of the fast-growing non-native populations, particularly not to the needs of Middle-Eastern and North African women. In order to secure more just cervical cancer prevention, future studies are recommended to develop tailored intervention sensitive to the need of non-native women.
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Affiliation(s)
- S Badre-Esfahani
- Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, DK-8930 Randers, NO, Denmark.,Department of Gynaecology and Obstetrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - M B Larsen
- Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, DK-8930 Randers, NO, Denmark
| | - L Seibæk
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| | - L K Petersen
- Department of Gynaecology and Obstetrics, Odense University Hospital, J. B. Winsløws Vej 2, DK-5000 Odense C, Denmark.,OPEN Open Patient Data Explorative Network, University of Southern Denmark, Odense, Denmark
| | - J Blaakær
- Department of Gynaecology and Obstetrics, Odense University Hospital, J. B. Winsløws Vej 2, DK-5000 Odense C, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - B Andersen
- Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, DK-8930 Randers, NO, Denmark
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20
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Gustafson LW, Gabel P, Hammer A, Lauridsen HH, Petersen LK, Andersen B, Bor P, Larsen MB. Validity and reliability of State-Trait Anxiety Inventory in Danish women aged 45 years and older with abnormal cervical screening results. BMC Med Res Methodol 2020; 20:89. [PMID: 32326886 PMCID: PMC7178932 DOI: 10.1186/s12874-020-00982-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/16/2020] [Indexed: 01/22/2023] Open
Abstract
Background State Trait Anxiety Inventory (STAI) scale was developed in the 1980’s and has been widely used both in clinical settings and in research. However the Danish version of STAI has not been validated. The aim of this study was to assess the validity and reliability of STAI - state anxiety scale in Danish women aged 45 years and older with abnormal cervical cancer screening results. Methods Women ≥45 years referred with an abnormal cervical cytology and healthy volunteers (n = 12) underwent cognitive interview after completing STAI. Further, STAI was sent out in an electronic questionnaire to women (n = 109) seen at the gynecological department with abnormal cervical cancer screening test during 2018. Validity and reliability of STAI was evaluated according to the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist by examining internal consistency, test-retest reliability, measurement error, floor and ceiling, construct validity and content validity. Results In the cognitive interviews the content validity was evaluated to be very good. The internal consistency of the scale was excellent with Cronbach’s α = 0.93. Test-retest reliability was good with an intra-class correlation coefficient of 0.80 and the systematic difference between test-retest results was negligible. The construct validity was good. Conclusion To our best knowledge, this is the first validation study of the Danish translation of STAI-state anxiety scale. This version of STAI demonstrates an acceptable reliability and validity when used in a gynecological setting.
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Affiliation(s)
- L W Gustafson
- Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark. .,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - P Gabel
- Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark
| | - A Hammer
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Obstetrics and Gynecology, Herning Regional Hospital, Herning, Denmark
| | - H H Lauridsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - L K Petersen
- Open Patient Data Explorative Network (OPEN) and Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - B Andersen
- Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - P Bor
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Obstetrics and Gynecology, Randers Regional Hospital, Randers, Denmark
| | - M B Larsen
- Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark
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Gabel P, Edwards A, Kirkegaard P, Larsen MB, Andersen B. The LEAD trial-The effectiveness of a decision aid on decision making among citizens with lower educational attainment who have not participated in FIT-based colorectal cancer screening in Denmark: A randomised controlled trial. Patient Educ Couns 2020; 103:359-368. [PMID: 31451360 DOI: 10.1016/j.pec.2019.08.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/21/2019] [Accepted: 08/18/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES This trial tested the effectiveness of a self-administered web-based decision aid, targeted at citizens with lower educational attainment, on informed choice about colorectal cancer screening participation as assessed by group levels of knowledge, attitudes and uptake. METHODS The randomised controlled trial was conducted among 2702 screening-naïve Danish citizens, 53-74 years old, with lower educational attainment. Baseline questionnaire respondents (62%) were allocated to intervention and control groups. Intervention group citizens received the decision aid. Outcomes were informed choice, worries and decisional conflict. RESULTS Analyses were conducted among 339 eligible citizens. The mean difference in knowledge score change between intervention and control group was 0.00 (95% confidence interval (CI): -0.38;0.38). Trends towards more positive screening attitudes (mean difference in score change: 0.72, 95% CI: -0.38;1.81) and higher screening uptake (7.6%, 95% CI:-2.2;17.4%) were observed. Worries (-0.33, 95% CI: -0.97;0.32) and decisional conflict (mean difference: -3.5, 95%CI: -7.0;-0.1) were slightly reduced. CONCLUSIONS The decision aid did not affect informed choice or knowledge. However, there were trends towards increased screening uptake and more positive screening attitudes. PRACTICE IMPLICATIONS Being a simple intervention and easily administered, the decision aid could represent a cost-effective way of enhancing screening uptake, and some elements of informed decision-making.
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Affiliation(s)
- Pernille Gabel
- Department of Public Health Programmes, Randers Regional Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark.
| | - Adrian Edwards
- Department of Public Health Programmes, Randers Regional Hospital, Denmark; Division of Population Medicine, School of Medicine, Cardiff University, UK.
| | - Pia Kirkegaard
- Department of Public Health Programmes, Randers Regional Hospital, Denmark.
| | - Mette Bach Larsen
- Department of Public Health Programmes, Randers Regional Hospital, Denmark.
| | - Berit Andersen
- Department of Public Health Programmes, Randers Regional Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark.
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22
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Badre-Esfahani S, Larsen MB, Seibæk L, Petersen LK, Blaakær J, Støvring H, Andersen B. Non-Adherence To Childhood HPV Vaccination Is Associated With Non-Participation In Cervical Cancer Screening - A Nationwide Danish Register-Based Cohort Study. Clin Epidemiol 2019; 11:969-980. [PMID: 31814770 PMCID: PMC6853196 DOI: 10.2147/clep.s203023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 09/05/2019] [Indexed: 01/13/2023] Open
Abstract
Background The combination of organized cervical cancer screening and childhood HPV vaccination programs has the potential to eliminate cervical cancer in the future. However, only women participating in both programs gain the full protection, and combined non-attenders remain at high risk of developing cervical cancer. Our aim was to analyze the association between non-adherence to HPV vaccination and non-participation in cervical cancer screening for the total population and stratified by native background and parental education. Participants Women born in 1993 eligible for both childhood HPV vaccination and first cervical cancer screening. Analysis Logistic regression models were used to estimate the odds ratio (OR) of non-participation in cervical cancer screening with 95% confidence intervals (CI). Stratified and adjusted logistic regression models were used along with the Wald test in order to test for interaction. Results 24,828 women were included in the study. Among vaccinated women, 61.4% participated in cervical cancer screening; only 39.0% of unvaccinated women participated in cervical cancer screening. Unvaccinated and unscreened women were often non-native and had the lowest socio-economic status, whereas vaccinated and screened women were often native and had the highest socio-economic status. The adjusted OR for non-participation in cervical cancer screening was 2.07 [95% CI: 1.88–2.28] for unvaccinated compared to vaccinated women. After stratifying by country of origin, unvaccinated natives had the highest adjusted OR of not participating in cervical cancer screening compared to non-native women from both western and non-western countries (adjusted ORs of 2.2 [95% CI: 2.0–2.4], 1.3 [95% CI: 0.6–2.8], and 1.5 [95% CI: 1.1–2.0], respectively) (Wald test p=0.019). Conclusion Among natives, non-adherence to HPV vaccination and non-participation in screening seem to be signs of generally poor health-preventive behavior, whereas among non-natives from non-western countries, non-attendance in HPV vaccination and cervical cancer screening seem to be influenced by unrelated factors. Therefore, a differentiated and culturally sensitive approach is needed to enhance overall cervical cancer preventive behavior across different nativities.
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Affiliation(s)
- Sara Badre-Esfahani
- Department of Clinical Medicine, Aarhus University, Aarhus C DK-8000, Denmark.,Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus N DK-8200, Denmark
| | - Mette Bach Larsen
- Department of Clinical Medicine, Aarhus University, Aarhus C DK-8000, Denmark
| | - Lene Seibæk
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus N DK-8200, Denmark
| | - Lone Kjeld Petersen
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense C DK-5000, Denmark
| | - Jan Blaakær
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense C DK-5000, Denmark
| | - Henrik Støvring
- Department of Public Health, Aarhus University, Aarhus C DK-8000, Denmark
| | - Berit Andersen
- Department of Clinical Medicine, Aarhus University, Aarhus C DK-8000, Denmark
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Larsen MB, Njor SH, Jensen TM, Ingeholm P, Andersen B. Potential for prevention: a cohort study of colonoscopies and removal of adenomas in a FIT-based colorectal cancer screening programme. Scand J Gastroenterol 2019; 54:1008-1014. [PMID: 31397598 DOI: 10.1080/00365521.2019.1647282] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Introduction: Evidence suggests that colorectal cancer (CRC) screening using guaiac faecal occult blood tests (gFOBT) reduces the CRC burden by facilitating timely removal of adenomas. Yet, the faecal immunochemical test (FIT) is being implemented in many countries. The aim of this study was to analyse the risk of having adenomas detected when invited for FIT-based screening as compared to those not yet invited. Material and Methods: The study was designed as a register-based retrospective cohort study. The potential for prevention was estimated as number of individuals who had no adenomas, non-advanced adenomas, and advanced adenomas detected per 1000 invited/not yet invited individuals and the relative risk (RR) of each of the three outcomes. Results: A total of 1,359,340 individuals were included, 29.6% of whom had been invited and 70.4% had not yet been invited to participate in CRC screening. Compared with the not yet invited population, the invited group had a RR of no adenomas of 2.28 (2.22-2.34) and a RR of advanced adenomas of 7.41 (6.93-7.91). The RR of colonoscopy was 2.93 (2.87-2.99) for the invited population compared with the not yet invited population. Conclusion: The RR of having a colonoscopy was three times higher among those invited compared to those not yet invited for CRC screening and twice as often those who had been invited compared to those not yet invited had no adenomas detected. Still, the risk of advanced adenomas was more than seven times higher among the invited population, indicating that the screening programme holds great potential for reducing the CRC burden. Abbreviations: CI: Confidence interval; CRC: Colorectal cancer; FIT: Faecal immunochemical test; ICD: International Classification of Disease; RR: Relative risk.
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Affiliation(s)
- Mette Bach Larsen
- Department of Public Health Programmes, Randers Regional Hospital, Central Denmark Region , Randers , Denmark
| | - Sisse Helle Njor
- Department of Public Health Programmes, Randers Regional Hospital, Central Denmark Region , Randers , Denmark
| | | | - Peter Ingeholm
- Department of Pathology, Herlev Hospital, Capital Region of Denmark , Herlev , Denmark
| | - Berit Andersen
- Department of Public Health Programmes, Randers Regional Hospital, Central Denmark Region , Randers , Denmark
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Baumann A, Andersen B, Østergaard L, Larsen MB. Sense & sensibility: Decision-making and sources of information in mothers who decline HPV vaccination of their adolescent daughters. Vaccine X 2019; 2:100020. [PMID: 31384740 PMCID: PMC6668232 DOI: 10.1016/j.jvacx.2019.100020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 03/11/2019] [Accepted: 04/02/2019] [Indexed: 11/25/2022] Open
Abstract
A good first and overall impression is key to vaccine uptake. GP recommendation increases the likelihood of HPV vaccination. Mothers with a higher educational level are likely to accept HPV vaccination. Fathers taking part in the decision increases the likelihood of HPV vaccination. Valuing news and media stories decreases the likelihood of HPV vaccination.
Background Vaccination against human papillomavirus (HPV) has been part of the Danish Childhood Vaccination Programme (CVP) since 2009 and initially had a high uptake. Following an intense public debate on the alleged side-effects to the vaccine in 2015, coverage rates declined dramatically leaving the current coverage at 54%. The main aim of this study was to identify differences in the sources of information and factors of importance in mothers’ decision to have or not to have their adolescent daughters vaccinated against HPV. Methods This cross-sectional study was based on survey and register data from 3,558 mothers of daughters born in 2003 living in the Central Denmark Region. The survey examined, among others, sources of information and factors of value in the decision-making process. Socioeconomic register data were retrieved from Statistics Denmark. Pearson's chi-squared test was used to determine differences in socioeconomic distribution between both respondents and non-respondents, and mothers who had their daughters vaccinated versus those who did not. Associations between vaccination status and various events were estimated using logistic regression. Results A strong association was found between vaccine uptake and general practitioner (GP) recommendation (odds ratio (OR) 0.17, 95% confidence interval (CI) 0.10; 0.30), seeking GP guidance (OR 0.63, 95% CI 0.50; 0.78) and agreeing with the daughter’s father to vaccinate (OR 0.60, 95% CI 0.37; 0.96). Inversely, vaccination decline was associated with a negative first impression of HPV vaccination (OR 4.05, 95% CI 3.28; 5.00), valuing media stories (OR 3.57, 95% CI 2.63; 4.85) and distrusting the first source of information (OR 2.49, 95% CI 1.92; 3.23). Conclusions The results indicate that the impression left behind by information sources is more important in determining vaccination status than the information sources themselves, indicating that mothers are liable to make healthcare decisions based on sensibility rather than sense.
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Affiliation(s)
- Astrid Baumann
- Department of Public Health Programmes, Randers Regional Hospital, Denmark
| | - Berit Andersen
- Department of Public Health Programmes, Randers Regional Hospital, Denmark
| | - Lars Østergaard
- Department of Infectious Diseases, Aarhus University Hospital, Denmark
| | - Mette Bach Larsen
- Department of Public Health Programmes, Randers Regional Hospital, Denmark
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25
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Gabel P, Larsen MB, Kirkegaard P, Edwards A, Andersen B. The LEAD trial - the effectiveness of a decision aid on decision making among citizens with lower educational attainment who have not participated in FIT-based colorectal cancer screening in Denmark: study protocol for a randomized controlled trial. Trials 2018; 19:543. [PMID: 30305114 PMCID: PMC6180588 DOI: 10.1186/s13063-018-2921-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 09/17/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Colorectal cancer screening participation is a preference-sensitive choice, in which trade-offs between benefits and harms must be made by individual citizens. Often the decision is made without any contact with healthcare professionals. Citizens with lower educational attainment tend to participate less in colorectal cancer screening than citizens with average educational attainment. Further, they tend to have lower levels of knowledge about colorectal cancer screening. Providing lower educational attainment citizens with a targeted decision aid embracing their diverse information needs might increase these citizens' ability to make informed decisions. The aim of this trial is to test the effectiveness of such a newly developed self-administered decision aid. METHODS The LEAD (Lower Educational Attainment Decision aid) trial will be conducted as a two-arm randomized controlled trial among 10,000 50-74-year-old citizens, resident in the Central Denmark Region not yet invited to take up colorectal cancer screening. Citizens will receive a baseline questionnaire. Respondents will be allocated into the intervention or the control groups. Citizens in the intervention group will receive the decision aid whereas the control group will not. Those who return a stool sample within 45 days after receiving the screening invitation and those with medium or higher educational attainment are excluded. Both groups will receive a follow-up questionnaire 90 days after being invited to colorectal cancer screening. A historic cohort consisting of 5000 50-74-year-old citizens resident in the Central Denmark Region, having received their screening invitation in the beginning of 2017 will be included. This cohort will receive a follow-up questionnaire 6-9 months after they received the screening invitation. Informed choice will be evaluated by assessing levels of knowledge, attitudes, and screening uptake. Analyses will be conducted as intention-to-treat analyses. Additionally, differences between levels of worry and decisional conflict between groups will be assessed as secondary outcomes. DISCUSSION This trial will evaluate whether a targeted decision aid is a feasible way of enhancing informed choice among lower educational attainment citizens in colorectal cancer screening. Further, it may guide decisions about providing information material in cancer screening in general. TRIAL REGISTRATION ClinicalTrials.gov, NCT03253888 . Registered on 17 August 2017.
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Affiliation(s)
- Pernille Gabel
- Department of Public Health Programmes, Randers Regional Hospital, Central Denmark Region, Skovlyvej 15, 8930, Randers NØ, Denmark.
- Faculty of Health, Aarhus University, Aarhus, Denmark.
| | - Mette Bach Larsen
- Department of Public Health Programmes, Randers Regional Hospital, Central Denmark Region, Skovlyvej 15, 8930, Randers NØ, Denmark
| | - Pia Kirkegaard
- Department of Public Health Programmes, Randers Regional Hospital, Central Denmark Region, Skovlyvej 15, 8930, Randers NØ, Denmark
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Berit Andersen
- Department of Public Health Programmes, Randers Regional Hospital, Central Denmark Region, Skovlyvej 15, 8930, Randers NØ, Denmark
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26
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Larsen MB, Njor S, Ingeholm P, Andersen B. Effectiveness of Colorectal Cancer Screening in Detecting Earlier-Stage Disease-A Nationwide Cohort Study in Denmark. Gastroenterology 2018; 155:99-106. [PMID: 29626451 DOI: 10.1053/j.gastro.2018.03.062] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 03/15/2018] [Accepted: 03/28/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Most studies of the effectiveness of screening for colorectal cancer (CRC) using the fecal occult blood test tested the guaiac fecal occult blood test. However, the fecal immunochemical test (FIT) is now commonly used in screening. We aimed to evaluate the effectiveness of FIT-based screening for CRC on the number of incident CRC diagnoses and stage at diagnosis for individuals in Denmark who were invited for screening vs not yet invited. METHODS We collected data for this register-based retrospective cohort study during the first 16 months of the prevalence round of a FIT-based CRC screening program (March 1, 2014 through June 30, 2015). A total of 402,826 residents of Denmark (50-72 years old) were randomly invited to undergo CRC screening within the study period, and 956,514 were invited thereafter. We obtained information on CRC diagnosis, date, and stage at diagnosis from the Danish Colorectal Cancer Group database. Cancer incidence per 100,000 invited/not yet invited individuals was calculated, along with the relative risk (RR) of CRC among invited compared with not yet invited individuals. RESULTS CRC incidence during the study period was 339.4/100,000 invited individuals and 169.6/100,000 not yet invited individuals. CRC incidence increased with age among invited and not yet invited individuals. For invited women compared with not yet invited women, the RR of being diagnosed with stage I CRC was 3.39 (95% CI, 2.61-4.39), with stage II CRC was 2.16 (95% CI, 1.71-2.72), with stage III CRC was 1.37 (95% CI, 1.08-1.75), and with stage IV CRC was 0.92 (95% CI, 0.68-1.23). For invited men compared with not yet invited men, the RR of being diagnosed with stage I CRC was 3.71 (95% CI, 2.97-4.64); with stage II CRC was 2.26 (95% CI, 1.84-2.77), with stage III CRC was 1.88 (95% CI, 1.53-2.30), and with stage IV CRC was 1.20 (95% CI, 0.95-1.52). CONCLUSIONS In analyzing data from a register-based cohort study in Denmark, we found that inviting individuals to undergo FIT-based CRC screening led to detection of almost 2-fold more cases of CRC than not inviting participants. The significant increase of CRC incidence among those invited for screening indicates a need for awareness of treatment capacity in countries introducing FIT-based CRC screening.
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Affiliation(s)
- Mette Bach Larsen
- Department of Public Health Programmes, Randers Regional Hospital, Central Denmark Region, Randers NØ, Denmark.
| | - Sisse Njor
- Department of Public Health Programmes, Randers Regional Hospital, Central Denmark Region, Randers NØ, Denmark
| | - Peter Ingeholm
- Department of Pathology, Herlev Hospital, Capital Region of Denmark, Herlev, Denmark
| | - Berit Andersen
- Department of Public Health Programmes, Randers Regional Hospital, Central Denmark Region, Randers NØ, Denmark
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27
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Gabel P, Kirkegaard P, Larsen MB, Edwards A, Andersen B. Developing a Self-Administered Decision Aid for Fecal Immunochemical Test-Based Colorectal Cancer Screening Tailored to Citizens With Lower Educational Attainment: Qualitative Study. JMIR Form Res 2018; 2:e9. [PMID: 30684402 PMCID: PMC6334704 DOI: 10.2196/formative.9696] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/15/2018] [Accepted: 04/03/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Citizens with lower educational attainments (EA) take up colorectal cancer screening to a lesser degree, and more seldom read and understand conventional screening information than citizens with average EAs. The information needs of citizens with lower EA are diverse, however, with preferences ranging from wanting clear recommendations to seeking detailed information about screening. Decision aids have been developed to support citizens with lower EA in making informed decisions about colorectal cancer screening participation, but none embrace diverse information needs. OBJECTIVE The aim of this study was to develop a self-administered decision aid for participation in fecal immunochemical test-based colorectal cancer screening. The decision aid should be tailored to citizens with lower EA and should embrace diverse information needs. METHODS The Web-based decision aid was developed according to an international development framework, with specific steps for designing, alpha testing, peer reviewing, and beta testing the decision aid. In the design phase, a prototype of the decision aid was developed based on previous studies about the information needs of lower EA citizens and the International Patient Decision Aid Standards guidelines. Alpha testing was conducted using focus group interviews and email correspondence. Peer review was conducted using email correspondence. Both tests included both lower EA citizens and health care professionals. The beta testing was conducted using telephone interviews with citizens with lower EA. Data were analyzed using thematic analysis. RESULTS The developed decision aid presented information in steps, allowing citizens to read as much or as little as wanted. Values clarification questions were included after each section of information, and answers were summarized in a "choice-indicator" on the last page, guiding the citizens toward a decision about screening participation. Statistics were presented in both natural frequencies, absolute risk formats and graphically. The citizens easily and intuitively navigated around the final version of the decision aid and stated that they felt encouraged to think about the benefits and harms of colorectal cancer screening without being overloaded with information. They found the decision aid easy to understand and the text of suitable length. The health care professionals agreed with the citizens on most parts; however, concerns were raised about the length and readability of the text. CONCLUSIONS We have developed a self-administered decision aid presenting information in steps. We involved both citizens and health care professionals to target the decision aid for citizens with lower EA. This decision aid represents a new way of communicating detailed information and may be able to enhance informed choices about colorectal cancer screening participation among citizens with lower EA.
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Affiliation(s)
- Pernille Gabel
- Department of Public Health Programmes, Randers Regional Hospital, Central Denmark Region, Randers NØ, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Pia Kirkegaard
- Department of Public Health Programmes, Randers Regional Hospital, Central Denmark Region, Randers NØ, Denmark
| | - Mette Bach Larsen
- Department of Public Health Programmes, Randers Regional Hospital, Central Denmark Region, Randers NØ, Denmark
| | - Adrian Edwards
- Department of Public Health Programmes, Randers Regional Hospital, Central Denmark Region, Randers NØ, Denmark.,Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Berit Andersen
- Department of Public Health Programmes, Randers Regional Hospital, Central Denmark Region, Randers NØ, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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Kirkegaard P, Edwards A, Larsen MB, Andersen B. Waiting for diagnostic colonoscopy: a qualitative exploration of screening participants' experiences in a FIT-based colorectal cancer screening program. Patient Prefer Adherence 2018; 12:845-852. [PMID: 29844660 PMCID: PMC5963479 DOI: 10.2147/ppa.s154959] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Participants in population-based screening for colorectal cancer (CRC) may experience increased anxiety immediately after a positive screening test, but research in this area is limited. The objective of this study was to explore how screening participants experience a positive test result and cope with the pre-diagnostic waiting period in a CRC screening program. MATERIALS AND METHODS Screening participants with a positive fecal immunochemical test (FIT) result were identified in the Danish national CRC program before they attended diagnostic colonoscopy. Sixteen screening participants were selected for an interview in their own homes, using a semi-structured interview guide. Transcribed data were analyzed thematically. RESULTS The most prominent themes were symptom appraisal and communication strategies. Most participants attributed the positive FIT result showing blood in the stool to pre-existing non-malignant conditions but a few were very worried about the FIT result and the outcome of the colonoscopy. Communication strategies included discussions with family or friends about the positive FIT result and the upcoming colonoscopy, or containing information until the colonoscopy had provided the definitive diagnostic result. There was no apparent need for communication with health care professionals during the pre-diagnostic waiting period. CONCLUSION The pre-diagnostic waiting period between positive FIT result and colonoscopy in a population-based screening program may cause worry for some participants, potentially to require support, but most people consider it unconcerning. Screening providers should communicate to all screening participants in written form that negative emotional responses may occur after a positive screening result. This is particularly important in screening programs using self-sample kits without the presence of a health care professional to reassure the few participants who may experience significant anxiety.
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Affiliation(s)
- Pia Kirkegaard
- Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark
- Correspondence: Pia Kirkegaard, Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, 8930 Randers NØ, Denmark, Tel +45 7842 0261, Fax +45 7842 4345, Email
| | - Adrian Edwards
- Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Mette Bach Larsen
- Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark
| | - Berit Andersen
- Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Gabel P, Larsen MB, Nielsen PB, Svendstrup DB, Andersen B. Satisfaction, discomfort, obligations, and concerns in population-based breast cancer screening: cross-sectional study in a Danish population. BMC Health Serv Res 2017; 17:489. [PMID: 28709436 PMCID: PMC5513139 DOI: 10.1186/s12913-017-2438-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 07/06/2017] [Indexed: 11/27/2022] Open
Abstract
Background Potential barriers to breast cancer screening adherence include patient satisfaction, as well as pain, feeling obliged to participate, and other concerns that might compromise the level of satisfaction. The present study aimed to assess the overall satisfaction of Danish citizens with their breast cancer screening experiences, as well as their level of discomfort, concerns, and feelings of obligation to participate. Furthermore, we analyzed the associations between overall satisfaction and the remaining outcomes. Methods Questionnaires were mailed to 3000 women in the Central Denmark Region who received screening examination results in the fall of 2013. The questionnaire assessed satisfaction (overall, telephone hot-line, and web-based self-service), discomfort (pain and boundaries of modesty), concerns (at invitation, while waiting for results, and after receiving results), and feelings of obligation to participate. Background information was retrieved from Statistics Denmark. Pearson’s chi-square test was used to test differences in outcomes and demographic characteristic distributions between respondents and non-respondents and highly satisfied vs. less satisfied participants. Prevalence ratios (PR) with 95% CI were assessed using Poisson regression with robust variance, to estimate associations between satisfaction and the remaining outcomes. Results Among the participants, 70.3% and 29.4%, respectively, reported really good and good impressions of the screening program. Lower satisfaction was associated with feeling pain (prevalence ratio (PR), 0.82), feeling that modesty boundaries were transgressed (PR, 0.79), experiencing screening-induced concerns (PR, 0.84), and feeling obliged to participate (PR, 0.96). Of the participants, 36.2% and 12.9%, respectively, felt very much and moderately obliged to participate. A total of 72.6% reported no screening-induced concerns, including 73.3% of those with negative screening results and 38.1% of those with positive screening results. Conclusions Overall satisfaction with breast cancer screening was very high, but discomfort, feelings of obligation, and concerns were associated with lower satisfaction levels. A continuing focus on high service in breast cancer screening is important for achieving the highest benefit from the program. This includes initiatives to employ the least painful techniques, to respect the patients’ modesty as much as possible, and to deliver fast screening results and thus minimize concerns among women awaiting results. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2438-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pernille Gabel
- Department of Public Health Programmes, Regional Hospital Randers, Skovlyvej 15, DK-8930, Randers NØ, Denmark.
| | - Mette Bach Larsen
- Department of Public Health Programmes, Regional Hospital Randers, Skovlyvej 15, DK-8930, Randers NØ, Denmark
| | | | | | - Berit Andersen
- Department of Public Health Programmes, Regional Hospital Randers, Skovlyvej 15, DK-8930, Randers NØ, Denmark
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Larsen MB, Mikkelsen EM, Rasmussen M, Friis-Hansen L, Ovesen AU, Rahr HB, Andersen B. Sociodemographic characteristics of nonparticipants in the Danish colorectal cancer screening program: a nationwide cross-sectional study. Clin Epidemiol 2017; 9:345-354. [PMID: 28721099 PMCID: PMC5500541 DOI: 10.2147/clep.s139168] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Fecal occult blood tests are recommended for colorectal cancer (CRC) screening in Europe. Recently, the fecal immunochemical test (FIT) has come into use. Sociodemographic differences between participants and nonparticipants may be less pronounced when using FIT as there are no preceding dietary restrictions and only one specimen is required. The aim of this study was to examine the associations between sociodemographic characteristics and nonparticipation for both genders, with special emphasis on those who actively unsubscribe from the program. METHODS The study was a national, register-based, cross-sectional study among men and women randomized to be invited to participate in the prevalence round of the Danish CRC screening program between March 1 and December 31, 2014. Prevalence ratios (PRs) were used to quantify the association between sociodemographic characteristics and nonparticipation (including active nonparticipation). PRs were assessed using Poisson regression with robust error variance. RESULTS The likelihood of being a nonparticipant was highest in the younger part of the population; however, for women, the association across age groups was U-shaped. Female immigrants were more likely to be nonparticipants. Living alone, being on social welfare, and having lower income were factors that were associated with nonparticipation among both men and women. For both men and women, there was a U-shaped association between education and nonparticipation. For both men and women, the likelihood of active nonparticipation rose with age; it was lowest among non-western immigrants and highest among social welfare recipients. CONCLUSION Social inequality in screening uptake was evident among both men and women in the Danish CRC screening program, even though the program is free of charge and the screening kit is based on FIT and mailed directly to the individuals. Interventions are needed to bridge this gap if CRC screening is to avoid aggravating existing inequalities in CRC-related morbidity and mortality.
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Affiliation(s)
- Mette Bach Larsen
- Department of Public Health Programmes, Randers Regional Hospital, Central Denmark Region, Randers NO
| | - Ellen M Mikkelsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Central Denmark Region, Aarhus N
| | - Morten Rasmussen
- Digestive Disease Center K, Bispebjerg Hospital, The Capital Region of Denmark, Copenhagen NV
| | - Lennart Friis-Hansen
- Department of Clinical Biochemistry, Nordsjællands Hospital, The Capital Region of Denmark, Hillerød
| | - Anders U Ovesen
- Department of Surgical Gastroenterology, Aalborg University Hospital, North Denmark Region, Aalborg
| | - Hans Bjarke Rahr
- Department of Surgery, Vejle Hospital, Region of Southern Denmark, Vejle, Denmark
| | - Berit Andersen
- Department of Public Health Programmes, Randers Regional Hospital, Central Denmark Region, Randers NO
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Larsen MB, Mikkelsen EM, Jeppesen U, Svanholm H, Andersen B. The influence of total hysterectomy in a cervical cancer screening population: a register-based cross-sectional study. BMC Health Serv Res 2017. [PMID: 28633673 PMCID: PMC5477757 DOI: 10.1186/s12913-017-2371-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND High coverage of a screening program is essential to program success. Many European screening programs cover only 10-80% of their target population. A possible explanation for the low coverage may be that some women in the screening population have had a total hysterectomy, thus they are not at risk of cervical cancer. The aim of this study was to identify the prevalence of hysterectomy in the target population of the Danish National Cervical Cancer Screening Program (NCCSP) and to recalculate coverage after excluding women with total hysterectomy. Furthermore, to analyze the association between hysterectomy and sociodemographic factors within the screening population. METHODS A population-based cross-sectional study using register data on all women in the target population of the NCCSP on January 12, 2012 (women born January 12, 1947, to January 12, 1986). The total coverage included women with hysterectomy in the target population whereas the recalculated coverage was calculated excluding women with total hysterectomy. To test the differences between the total coverage and the recalculated coverage, a two-sample z-test between the proportion of covered hysterectomized women and the proportion of covered non-hysterectomised women were used. A logistic regression model adjusted for age and sociodemographic characteristics was used to analyze the association between sociodemographic factors and total hysterectomy. RESULTS The coverage among women aged 26-49 years and 55-64 years were 77.4% and 72.7%, respectively. The recalculated coverage was 78.2% (26-49 years) and 79.4% (55-64 years). Recalculating the coverage did not result in coverage higher than 82.7% at any age. The effect of excluding women with total hysterectomy increased with age, reaching its maximum of 8 % points for the oldest women. Women with higher socioeconomic status (higher education and higher disposable income) had lower odds of being hysterectomized compared to other women. Also, immigrants and descendants had lower odds of being hysterectomized compared to ethnic Danes. CONCLUSIONS Excluding women with total hysterectomy only partly explained the low coverage of the NCCSP. Thus, initiatives must be made to improve acceptability of and accessibility to the NCCSP, especially in the youngest and the oldest women.
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Affiliation(s)
- Mette Bach Larsen
- Department of Public Health Programs, Randers Regional Hospital, Skovlyvej 1, 8930, Randers, NØ, Denmark.
| | - Ellen M Mikkelsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé, 43-45 8200, Aarhus N, Denmark
| | - Ulla Jeppesen
- Department of Gynaecology and Obstetrics, Randers Regional Hospital, Skovlyvej 1, 8930, Randers, NØ, Denmark
| | - Hans Svanholm
- Department of Public Health Programs, Randers Regional Hospital, Skovlyvej 1, 8930, Randers, NØ, Denmark.,Department of Pathology, Randers Regional Hospital, Skovlyvej 1, 8930, Randers, NØ, Denmark
| | - Berit Andersen
- Department of Public Health Programs, Randers Regional Hospital, Skovlyvej 1, 8930, Randers, NØ, Denmark
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Larsen MB, Gabel P, Andersen B. Effectiveness of self-administered decision aids for people invited to participate in colorectal cancer screening: a systematic review protocol. ACTA ACUST UNITED AC 2017. [DOI: 10.11124/jbisrir-2016-002966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Larsen MB, Svanholm H, Andersen B. An adverse event in a well-established cervical cancer screening program: an observational study of 19,000 females unsubscribed to the program. J Healthc Leadersh 2016; 8:61-69. [PMID: 29355205 PMCID: PMC5741009 DOI: 10.2147/jhl.s114462] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction In Denmark, an organized approach to cervical cancer screening has had national coverage since 1998. However, in 2013, it was discovered that 19,000 females had been unsubscribed from the Danish National Cervical Cancer Screening Program and had thus not received invitations or reminders as recommended by the health authorities. The study aims to report the essence of this adverse event and describe the outcomes of reestablishing invitations in terms of participation rates and screening results. Furthermore, patient compensations to affected females diagnosed with cervical cancer and coverage in the mass media was reported. Methods An observational study based on information from the Danish Pathology Databank, the Department of Public Health Programs, and Infomedia (a Danish database of media coverage) was carried out. Results A total of 19,106 females were affected. Of those still in the screening age, 37.7% had been tested within 3 years or 5 years despite not receiving any invitation. A total of 21.6% reconfirmed their status as unsubscribed. Of the remaining females, 55.6% were tested within a year, and 94.6% of these test results were normal. Among females aged >64 years, 12.7% accepted the offer of a final screening test. Totally, 90% of these tests were normal. Nineteen females diagnosed with cervical cancer were compensated by the Danish Patient Compensation Association with a total of €693,000, ranging from €8,900 to €239,700. Coverage of cervical cancer screening in the mass media increased from 25 items in the 3 months prior to this adverse event to 590 items in the month when it became public. Conclusion Even though more than one-third of the affected females were tested despite not receiving regular invitations to participate in the screening program, lacking invitations were ranked alongside other adverse events in the health care system if cancer diagnoses were delayed.
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Affiliation(s)
| | - Hans Svanholm
- Department of Public Health Programmes.,Department of Pathology, Randers Regional Hospital, Randers, Denmark
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Kirkegaard P, Mortensen GL, Mortensen SL, Larsen MB, Gabel P, Andersen B. Making decisions about colorectal cancer screening. A qualitative study among citizens with lower educational attainment. Eur J Public Health 2015; 26:176-81. [PMID: 26541860 DOI: 10.1093/eurpub/ckv207] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Few decision aids (DAs) have been developed to support an informed choice to citizens with lower educational attainment about colorectal cancer screening. The aim of this study was to identify information needs and preferences for formats and content in a DA for this group of citizens. METHODS Four focus groups were conducted among Danish men and women aged 50-74 years with lower educational attainment. A semi-structured interview guide was developed to explore participants' perceptions about colorectal cancer screening and wishes for a DA. The interviews were transcribed and analysed using an ethnographic approach. RESULTS The participants appreciated information about the causes, symptoms, incidence and mortality of colorectal cancer compared with other common cancers. The majority preferred the information to be presented in a clear and simple way with numbers and figures kept to a minimum. Values clarification exercises were not found useful. Receiving a screening kit to collect a sample of faeces along with the invitation letter was seen by the participants as a clear request from the health authorities to get screened. However, the overall message in the DA was perceived as ambiguous by the participants as it both recommended screening and seemed to disclaim responsibility for it. CONCLUSION The results are relevant to a discussion of the delicate balance between participants' call for a clear recommendation, and the purpose of a DA to present options in a neutral and balanced way. This discussion is relevant beyond the group of citizens with lower educational attainment.
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Affiliation(s)
- Pia Kirkegaard
- 1 Department of Public Health Programmes, Randers Regional Hospital, Denmark 2 Research Unit for General Practice, School of Public Health, Aarhus University, Denmark
| | | | | | - Mette Bach Larsen
- 1 Department of Public Health Programmes, Randers Regional Hospital, Denmark
| | - Pernille Gabel
- 1 Department of Public Health Programmes, Randers Regional Hospital, Denmark
| | - Berit Andersen
- 1 Department of Public Health Programmes, Randers Regional Hospital, Denmark
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Tranberg M, Larsen MB, Mikkelsen EM, Svanholm H, Andersen B. Erratum to: Impact of opportunistic testing in a systematic cervical cancer screening program: a nationwide registry study. BMC Public Health 2015; 15:893. [PMID: 26369568 PMCID: PMC4570088 DOI: 10.1186/s12889-015-2158-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 08/14/2015] [Indexed: 12/04/2022] Open
Affiliation(s)
- Mette Tranberg
- Department of Public Health Programs, Randers Regional Hospital, Skovlyvej 1, Randers, DK-8930 NØ, Denmark.
| | - Mette Bach Larsen
- Department of Public Health Programs, Randers Regional Hospital, Skovlyvej 1, Randers, DK-8930 NØ, Denmark
| | - Ellen M Mikkelsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, Aarhus N, DK-8200, Denmark
| | - Hans Svanholm
- Department of Pathology, Randers Regional Hospital, Skovlyvej 1, Randers, DK-8930 NØ, Denmark
| | - Berit Andersen
- Department of Public Health Programs, Randers Regional Hospital, Skovlyvej 1, Randers, DK-8930 NØ, Denmark
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Jørgensen MJ, Maindal HT, Larsen MB, Christensen KS, Olesen F, Andersen B. Chlamydia trachomatis infection in young adults - association with concurrent partnerships and short gap length between partners. Infect Dis (Lond) 2015. [PMID: 26211606 DOI: 10.3109/23744235.2015.1071916] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Sexually transmitted infections (STIs) continue to be highly prevalent in young people. New understanding of sexual risk behaviour is essential for future preventive initiatives. Studies based on self-reported STI history indicate that gap length between sexual partnerships is an important determinant in STI transmission, but little is known about the impact of concurrent partnerships and short gap length. This study aimed to examine the significance of concurrent partnerships and short gap length between serially monogamous partnerships in Chlamydia trachomatis-infected individuals compared to the general population. METHODS A Danish cross-sectional study was conducted among individuals aged 15-29 years with a verified C. trachomatis infection and a sample of the background population. Participants answered a web-based questionnaire on sexual behaviour. Associations were identified in multivariate analyses. RESULTS In total, 36% of the included young adults reported that they had two or more partners within the last year. Concurrent partnerships were frequent (46%), and the gap length between serially monogamous partnerships tended to be short (median gap length, 64 days, interquartile interval (IQI) = 31, 122). A strong association was found between concurrent partnerships (odds ratio (OR) = 12.5, 95% confidence interval (CI) = 7.7-20.4), short gap length between serially monogamous partnerships (OR = 10.0, 95% CI = 5.7-17.4) and having a verified C. trachomatis infection. CONCLUSIONS C. trachomatis infection was strongly associated with concurrent partnerships or short gap length between serially monogamous partnerships. These findings have considerable implications for public health policy. Both types of risk factors should be considered in future preventive interventions aiming to reduce the spread of C. trachomatis infections.
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Affiliation(s)
- Marianne Johansson Jørgensen
- a From the Department of Public Health Programs , Randers Regional Hospital , Randers , Denmark.,b Research Unit for General Practice , Aarhus C , Denmark
| | - Helle Terkildsen Maindal
- c Section for Health Promotion and Health Services, Department of Public Health , Aarhus University , Aarhus C , Denmark
| | - Mette Bach Larsen
- a From the Department of Public Health Programs , Randers Regional Hospital , Randers , Denmark
| | | | - Frede Olesen
- b Research Unit for General Practice , Aarhus C , Denmark
| | - Berit Andersen
- a From the Department of Public Health Programs , Randers Regional Hospital , Randers , Denmark
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Tranberg M, Larsen MB, Mikkelsen EM, Svanholm H, Andersen B. Impact of opportunistic testing in a systematic cervical cancer screening program: a nationwide registry study. BMC Public Health 2015; 15:681. [PMID: 26194007 PMCID: PMC4508820 DOI: 10.1186/s12889-015-2039-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 07/08/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Systematic screening for precancerous cervical lesions has resulted in decreased incidence and mortality of cervical cancer. However, even in systematic screening programs, many women are still tested opportunistically. This study aimed to determine the spread of opportunistic testing in a systematic cervical cancer screening program, the impact of opportunistic testing in terms of detecting cytological abnormalities and examine the associations between sociodemography and opportunistic testing. METHODS A nationwide registry study was undertaken including women aged 23-49 years (n = 807,624) with a cervical cytology between 2010 and 2013. The women were categorised into: 1) screening after invitation; 2) routine opportunistic testing, if they were either tested more than 9 months after the latest invitation or between 2.5 years and 3 years after the latest cervical cytology and 3) sporadic opportunistic testing, if they were tested less than 2.5 years after the latest cervical cytology. Cytological diagnoses of women in each of the categories were identified and prevalence proportion differences (PPD) and 95% confidence intervals (CIs) were used to explore group differences. Associations between sociodemography and undergoing opportunistic testing were established by multinomial logistic regression. RESULTS In total, 28.8% of the cervical cytologies were due to either routine (20.7%) or sporadic (8.1%) opportunistic testing. Among women undergoing routine opportunistic testing, a larger proportion had high-grade squamous intraepithelial abnormalities than invited women (PPD: 0.6%, 95 % CI: 0.03-1.17%). A similar proportion of cytological abnormalities among women undergoing sporadic opportunistic testing and invited women was found. In multivariate analyses, younger age, being single or a social welfare recipient and residence region (North Denmark) were especially associated with opportunistic testing (routine or sporadic). CONCLUSIONS One fourth of cervical cytologies in this study were collected opportunistically. Compared to invited women, women undergoing routine opportunistic testing were more likely to be diagnosed with abnormal cytologies. Hence, routine opportunistic testing might serve as an important supplement to the systematic screening program by covering non-participating women who may otherwise be tested with a delay or not tested at all. Among women tested more often than recommended (sporadic testing), no benefits in terms of detecting more cytological abnormalities were identified.
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Affiliation(s)
- Mette Tranberg
- Department of Public Health Programs, Randers Regional Hospital, Skovlyvej 1, DK-8930, Randers, NØ, Denmark.
| | - Mette Bach Larsen
- Department of Public Health Programs, Randers Regional Hospital, Skovlyvej 1, DK-8930, Randers, NØ, Denmark.
| | - Ellen M Mikkelsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200, Aarhus N, Denmark.
| | - Hans Svanholm
- Department of Pathology, Randers Regional Hospital, Skovlyvej 1, DK-8930, Randers, NØ, Denmark.
| | - Berit Andersen
- Department of Public Health Programs, Randers Regional Hospital, Skovlyvej 1, DK-8930, Randers, NØ, Denmark.
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Larsen MB, Langagergaard V, Larsson H, Mikkelsen EM, Andersen B. [Screening mammography may be a rapid and effective investigation of mamma cancer in asymptomatic women]. Ugeskr Laeger 2014; 176:V03140159. [PMID: 25293859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The purpose of this article was to describe the incidence of mamma cancer and ductal carcinoma in situ (DCIS) two years after a screening mammography in women offered a screening mammography instead of a clinical mammography. The mammography was abnormal for 6.3% of the women, 0.1% had DCIS and 1.0% was diagnosed with mamma cancer. 1.0% of women with a normal mammography were diagnosed with cancer within two years of the mammography. More widespread use of screening mammography may contribute to a rapid and effective investigation of mamma cancer in asymptomatic women.
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Affiliation(s)
- Mette Bach Larsen
- Afdeling for Folkeundersøgelser, Regionshospitalet Randers, Skovlyvej 1, 8930 Rander NØ. E-mail:
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Abstract
Background In this paper, we describe the settings, content, and possibilities of the Danish Cancer in Primary Care (CaP) cohort as well as some of the key findings so far. Further, we describe the future potential of the cohort as an international resource for epidemiological and health services research studies. Methods The CaP cohort comprises information from three Danish subcohorts set up in 2004–2005, 2007–2008, and 2010 on newly diagnosed cancer patients aged 18 years or older. General practitioner (GP)-reported and patient-reported data from six questionnaires generated information on causes and consequences of delayed diagnosis of cancer, and these data were supplemented with complete information on, eg, death, migration, health care utilization, medication use, and socioeconomic data from Denmark’s comprehensive health and administrative registers. The cohort is followed up in terms of emigration, death, hospitalization, medication, and socioeconomics, and data are updated regularly. Results In total, we identified 22,169 verified incident cancer cases. Completed GP questionnaires were returned for 17,566 (79%) of the verified cases, and patient questionnaires were completed by 8,937 (40%) respondents. Patients with participating GPs did not differ from patients with nonparticipating GPs in regard to one-year survival, comorbidity, or educational level. However, compared with nonparticipating GPs, patients listed with participating GPs were more likely to be women, younger, to have a higher disposable income, to have more regional or distant spread of tumors, were also more likely to have breast cancer, and were less likely to have prostate cancer. Responding patients were more likely to be women, aged 45–74 years, and diagnosed with breast cancer or malignant melanoma, and have higher one-year survival rates, more localized tumors, higher educational background, and higher disposable income. Conclusion The cohort is an international resource for epidemiological and health service research, and data are accessible for well defined and approved collaborative studies.
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Affiliation(s)
- Henry Jensen
- Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care, Randers NOE, Denmark ; Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus C, Randers NOE, Denmark
| | - Marie Louise Tørring
- Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care, Randers NOE, Denmark
| | - Mette Bach Larsen
- Department of Public Health Programs, Randers Regional Hospital, Randers NOE, Denmark
| | - Peter Vedsted
- Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care, Randers NOE, Denmark
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Larsen MB, Jensen H, Hansen RP, Olesen F, Vedsted P. Identification of patients with incident cancers using administrative registry data. Dan Med J 2014; 61:A4777. [PMID: 24495885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION On-time identification of incident cancer patients is important in cancer research to ensure quality in cancer treatment and care. Nevertheless, the Danish Cancer Registry (DCR) is updated on an annual basis rather than continuously, and no standardised algorithm exists to enable sampling from administrative data which are updated on a monthly basis. The aim of this study was to develop and validate an algorithm for on-time sampling of incident cancer patients based on administrative data. MATERIAL AND METHODS The study was based on registry and questionnaire data from incident cancer patients' general practitioners (GPs). An algorithm for on-time sampling of incident cancer patients was developed and validated in 2008 (12,747 patients) and further developed and validated in 2010 (7,996 patients). Questionnaire data from the GPs and data from the DCR were used as gold standards. The completeness over time of the 2010 cohort was evaluated. RESULTS Further development of the 2008 algorithm into the 2010 algorithm increased its positive predictive value (PPV) to 95.0%. The PPV of a patient from the 2010 cohort being registered in the DCR was 97.4%. The 2010 algorithm displayed a completeness of 60% in the first month and 95% after four months. CONCLUSION A valid and cost-saving algorithm for on-time sampling of incident cancer patients has been developed with great potential for research and quality assurance. FUNDING This work was funded by the Danish Cancer Society and the Novo Nordisk Foundation. TRIAL REGISTRATION not relevant.
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Affiliation(s)
- Mette Bach Larsen
- Forskningsenheden for Almen Praksis, Aarhus Universitet, Bartholins Allé, Bygn. 1260, 8000 Aarhus C, Denmark.
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Larsen MB, Hansen RP, Sokolowski I, Vedsted P. Agreement between patient-reported and doctor-reported patient intervals and date of first symptom presentation in cancer diagnosis - a population-based questionnaire study. Cancer Epidemiol 2013; 38:100-5. [PMID: 24238619 DOI: 10.1016/j.canep.2013.10.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 10/15/2013] [Accepted: 10/17/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND The concept of delay in cancer diagnosis has been a scientific issue for decades, and there is still no standardised and validated way to measure the time intervals. One of the intervals that are difficult to measure is the patient interval (i.e. the period from the patient's first symptom until the first presentation to the health care system) because dates of symptom onset and first presentation are difficult to establish precisely. Further, since patients may have another experience of the diagnostic pathway than e.g. the general practitioner (GP), a reasonable question remains whether patients and GPs agree on these important milestones. The objective of this study was to analyse the agreement between patient-reported and GP-reported patient intervals and date of first presentation of cancer-related symptom(s) to the GP. METHODS On the basis of a cohort study, we included incident cancer patients from the former Aarhus County from 1 September, 2004 to 31 August, 2005. Both patients and GPs reported the length of the patient interval and the date of the first presentation to the GP with a cancer-related symptom measured by self-administered questionnaires. Agreement was measured using agreement-survival plots and Lin's concordance correlation coefficient (CCC). RESULTS There was full agreement between GP- and patient-reported patient intervals in 21.0% of all the cancer cases. In 50.1% of cases, patients and GPs agreed about the patient interval within a margin of one month. There was full agreement between GP- and patient-reported date of first presentation in 37.5% of the cancer cases and within one week in 52.0% of all the cancer cases. Overall, the agreement on the length of the patient interval was poor (CCC=0.513), but better for patients presenting with alarm symptoms. The agreement was moderate between GP- and patient-reported dates of first presentation (CCC=0.924). CONCLUSION We found that GPs systematically reported a longer patient interval than patients did. We found moderate agreement on reported date of first presentation of symptoms to the GP, meaning that the disagreement in reported patient interval is related to date of first symptom rather than date of first presentation to the GP.
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Affiliation(s)
- Mette Bach Larsen
- Research Unit for General Practice, Aarhus University, Department of Public Health, Bartholins Allé 2, DK-8000 Aarhus C, Denmark; Department of Public Health Programs, Randers Regional Hospital, Skovlyvej 1, DK-8930 Randers NØ, Denmark.
| | - Rikke Pilegaard Hansen
- Research Unit for General Practice, Aarhus University, Department of Public Health, Bartholins Allé 2, DK-8000 Aarhus C, Denmark; Research Centre for Cancer Diagnosis in Primary Care, Aarhus University, Department of Public Health, Bartholins Allé 2, DK-8000 Aarhus C, Denmark
| | - Ineta Sokolowski
- Research Unit for General Practice, Aarhus University, Department of Public Health, Bartholins Allé 2, DK-8000 Aarhus C, Denmark
| | - Peter Vedsted
- Research Unit for General Practice, Aarhus University, Department of Public Health, Bartholins Allé 2, DK-8000 Aarhus C, Denmark; Research Centre for Cancer Diagnosis in Primary Care, Aarhus University, Department of Public Health, Bartholins Allé 2, DK-8000 Aarhus C, Denmark
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Abstract
A single-blind, randomized, controlled trial was done to compare the results of carpal tunnel release using classic incision, short incision, or endoscopic technique. In total, 90 consecutive cases were included. Follow-up was 24 weeks. We found a significantly shorter sick leave in the endoscopic group. No significant differences in pain, paraesthesiae, range of motion, pillar pain, and grip strength could be found at 24 weeks of follow-up, although intermediate significant differences were seen, especially in grip strength, in favour of endoscopic technique. No major advantage to using a short incision could be found. There were no serious complications in either group. The results indicate that the endoscopic procedure is safe and has the benefit of faster rehabilitation and return to work.
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Affiliation(s)
- M B Larsen
- Gentofte Hospital, Section of Hand Surgery, Hellerup, Denmark.
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Larsen MB, Sørensen AI, Crone KL, Weis T, Boeckstyns MEH. Carpal tunnel release: a randomized comparison of three surgical methods. J Hand Surg Eur Vol 2013. [PMID: 23340761 DOI: 10.1177/1753193412475247.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A single-blind, randomized, controlled trial was done to compare the results of carpal tunnel release using classic incision, short incision, or endoscopic technique. In total, 90 consecutive cases were included. Follow-up was 24 weeks. We found a significantly shorter sick leave in the endoscopic group. No significant differences in pain, paraesthesiae, range of motion, pillar pain, and grip strength could be found at 24 weeks of follow-up, although intermediate significant differences were seen, especially in grip strength, in favour of endoscopic technique. No major advantage to using a short incision could be found. There were no serious complications in either group. The results indicate that the endoscopic procedure is safe and has the benefit of faster rehabilitation and return to work.
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Affiliation(s)
- M B Larsen
- Gentofte Hospital, Section of Hand Surgery, Hellerup, Denmark.
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Larsen MB, Stephens RW, Brünner N, Nielsen HJ, Engelholm LH, Christensen IJ, Stetler-Stevenson WG, Høyer-Hansen G. Quantification of tissue inhibitor of metalloproteinases 2 in plasma from healthy donors and cancer patients. Scand J Immunol 2005; 61:449-60. [PMID: 15882437 DOI: 10.1111/j.1365-3083.2005.01585.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Tissue inhibitor of metalloproteinases (TIMP)-2 is a highly conserved molecule, which binds both active and latent matrix metalloproteinase (MMP)-2. TIMP-2 is also involved in the activation of MMP-2 on the cell surface. A quantitative enzyme-linked immunosorbent assay (ELISA) was established and optimized for measurement of TIMP-2 in plasma. The capturing antibody in the ELISA was a monoclonal, while the detecting antibody was a chicken polyclonal antibody recognizing the native form of human TIMP-2. The levels of TIMP-2 were measured in ethylenediaminetetraacetic acid (EDTA) and citrate plasma from healthy donors. The median values were determined as 163 ng/ml (n = 186) with a range of 109-253 ng/ml for EDTA plasma and 139 ng/ml (n = 77) with a range of 95-223 ng/ml for citrate plasma. The TIMP-2 concentration in citrate plasma from 15 patients with advanced, stage IV breast cancer had a median value of 160 ng/ml, only slightly higher but statistically distinguishable from the level found in citrate plasma from the healthy donors. In addition, the TIMP-2 concentration in EDTA plasma from colorectal cancer patients revealed a significantly higher level in plasma from patients with Dukes stage A (P = 0.01) compared with patients with more advanced Dukes stages.
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Affiliation(s)
- M B Larsen
- The Finsen Laboratory, Rigshospitalet, Copenhagen, Denmark
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Bassuk AG, Joshi A, Burton BK, Larsen MB, Burrowes DM, Stack C. Alexander disease with serial MRS and a new mutation in the glial fibrillary acidic protein gene. Neurology 2004; 61:1014-5. [PMID: 14557587 DOI: 10.1212/01.wnl.0000082440.42354.d0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- A G Bassuk
- Division of Neurology/Department of Pediatrics, Children's Memorial Hospital, Chicago, IL 60614, USA. abassuk@childrensmemorial. org
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Jensen OB, Skettrup T, Petersen OB, Larsen MB. Diode-pumped intracavity optical parametric oscillator in pulsed and continuous-wave operation. ACTA ACUST UNITED AC 2002. [DOI: 10.1088/1464-4258/4/2/312] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Mortensen OV, Thomassen M, Larsen MB, Whittemore SR, Wiborg O. Functional analysis of a novel human serotonin transporter gene promoter in immortalized raphe cells. Brain Res Mol Brain Res 1999; 68:141-8. [PMID: 10320791 DOI: 10.1016/s0169-328x(99)00083-2] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
To investigate the structural basis for genetic regulation of the human serotonin transporter gene, a 1.8 kb fragment upstream to the cap site was cloned and sequenced. The promoter possesses a polymorphic repeat region with 16 and 14 repeats, respectively. Both were cloned and characterized. The promoter sequence revealed an internal 379 bp fragment not reported in previous publications. This novel fragment contains consensus sequences for several transcription factors including SpI and GATA. DNA from 48 unrelated individuals was PCR amplified, in this region, to test for allelic variations. All were found to possess the additional 379 bp fragment. The integrity of the promoter was furthermore confirmed by genomic Southern blotting. The promoter activity was analyzed by reporter gene assays in neuronal and non-neuronal serotonergic cell lines. In immortalized serotonergic raphe neurons, RN46A, three cis-acting, cell specific, activating elements and a silencer were located. One of the activators and the silencer are located in the repeat region and one activator is positioned in the novel fragment. A fourth activating element was found to be active in both RN46A cells and in a non-neuronal serotonergic cell line, JAR. A 3.5 kb fragment from intron 1 was cloned and found to possess cell specific activity in JAR cells indicating the presence of an alternative promoter in intron 1.
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Affiliation(s)
- O V Mortensen
- Department of Biological Psychiatry, Psychiatric University Hospital, Skovagervej 2, 8240 Risskov, Denmark
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Reddy KS, Larsen MB. A molecular, cytogenetic, and clinical evaluation of mosaic tandem duplication 17p and Charcot-Marie-Tooth type 1A neuropathy. J Med Genet 1998; 35:169-72. [PMID: 9507402 PMCID: PMC1051227 DOI: 10.1136/jmg.35.2.169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
An 8 year old girl with partial duplication of the short arm of chromosome 17 had a mosaic 46,XX,der(17)?del(17)(p12)dup(17) (p11.2p12).ish dup(17)(p11.2p13.3)(D17S 379x2, p53x2, D17S122x2, D17S29+) karyotype. The extent of mosaicism was 20% in lymphoblasts and 100% in fibroblasts. Fluorescence in situ hybridisation (FISH) proved invaluable in defining the abnormality precisely. The cytogenetic morphology by FISH assay ruled out a microdeletion of the Miller-Dieker syndrome (MDS) region. However, there was no MDS deletion but a duplication of this region. The duplication was extensive and included proximal p53 and D17S122, Charcot-Marie-Tooth type 1A (CMT1A), but not D17S29, the Smith-Magenis syndrome (SMS) region. This patient has the clinical features and generalised decreased peripheral nerve conduction velocity characteristic of CMT1A. The clinical management of paediatric cases of mosaic trisomy 17p cases would ential testing for CMT1A duplication. If duplicated, a decrease in nerve conduction velocity (NCV) of the peripheral motor neurones would be necessary to ensure the manifestation of CMT1A neuropathy. The parents of probands with delayed NCV should be counselled about the risk of CMT1A in later life.
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Affiliation(s)
- K S Reddy
- Cytogenetics Laboratory, Quest Diagnostics Incorporated, San Juan Capistrano, CA 92690-6130, USA
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Abstract
Within the past 11 years, 11 patients with opsoclonus and myoclonus, with or without a history of neuroblastoma, have been admitted to Children's Memorial Hospital. Eight of the 11 children had an occult neuroblastoma. Eight children have had subsequent delayed development with motor incoordination and speech delay (7 with neuroblastoma, 1 without). Nine of 11 children initially were treated with ACTH, 1 child was treated with prednisone, and 1 was not treated. Nine of the 10 children who were treated had recurrences of symptoms during the gradual withdrawal or discontinuation of ACTH. Often the ACTH had to be restarted or increased, although several times the episodes were self-limited, not requiring treatment after ACTH was withdrawn. We found prednisone was ineffective in controlling opsoclonus-myoclonus regardless of etiology. The majority of children with opsoclonus-myoclonus, regardless of etiology, have developmental delay, more severe and at a higher rate than previously reported. When a neuroblastoma was present, tumor removal did not improve symptoms. Although limited in size, our study indicates patients with opsoclonus-myoclonus without an associated neuroblastoma have a better chance for normal neurologic development (2/3 versus 1/8).
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Affiliation(s)
- M S Hammer
- Division of Pediatric Neurology, Children's Memorial Hospital, Chicago, IL 60614, USA
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Abstract
The aim of the investigation was to determine the patterns of cerebral involvement on computed tomography (CT) and magnetic resonance (MR) imaging in post-varicella encephalitis. Four children between the ages of 2 and 11 years presented over a 5-year period with a diagnosis of post-varicella encephalitis. Their imaging studies and clinical data were reviewed retrospectively. The medical histories of all four children were noncontributory except for recent bouts of chickenpox 1 week to 3 months prior to hospitalization. Three children presented with parkinsonian manifestations. Bilateral, symmetric hypodense, nonenhancing basal ganglia lesions were found on CT. These areas showed nonenhancing low signal intensity on T1-weighted images and high signal intensity on T2-weighted images on MR. One child presented with diffuse, multiple gray and white matter lesions of similar imaging characteristics; some lesions, however, did enhance. This child had no gait disturbances. Post-varicella encephalitis can produce two patterns of dramatic CT and MR findings. With an appropriate history and clinical findings, varicella as a cause of bilateral basal ganglia or diffuse cerebral lesions can be differentiated from other possible etiologies which include trauma, anoxia, metabolic disorders and demyelinating diseases.
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Affiliation(s)
- C F Darling
- Division of Neuroimaging, Children's Memorial Center, Northwestern University Medical School, Chicago, IL 60614, USA
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