Digital mammography screening: sensitivity of the programme dependent on breast density.

OBJECTIVES: To analyse the impact of breast density on the sensitivity of a population-based digital mammography screening programme (SP) as key evaluation parameter. METHODS: 25,576 examinations were prospectively stratified from ACR category 1 to 4 for increments of 25 % density during independent double reading. SP was calculated as number of screen-detected cancers divided by the sum of screen-detected plus interval cancers (24-months period) per ACR category, related to the first reading (a), second reading (b) and highest stratification if discrepant (c). Chi-square tests were used for comparison. RESULTS: Overall sensitivity of the programme was 79.9 %. SP in ACR 4 (a: 50 %, b: 50 %, c: 50 %) was significantly lower than in ACR 3 (a: 72.9 %, b: 79.4 %, c: 80.7 %, p < 0.001), ACR 2 (a: 83.9 %, b: 85.7 %, c: 83.2 %, p < 0.001) and ACR 1 (a: 100 %, b: 88.8 %, c: 100 %; p < 0.001). Frequencies of ACR 4 were a: 5.0 %, b: 4.3 %, c: 6.9 %. CONCLUSION: Digital mammography screening with independent double reading leads to a high overall SP. In the small group of women with breast density classified as ACR 4 SP is significantly reduced compared to all other ACR categories. KEY POINTS: • Overall sensitivity of a population-based digital mammography screening programme (SP) was 79.9 %. • In women with ACR 1, 2, or 3, SP ranged between 72.9 %-100 %. • ACR 4 was rare in participants (<7 %) and SP was only 50 %. • SP in ACR 4 differed significantly from ACR 3 (p < 0.001).

Reduction of Advanced Breast Cancer Stages at Subsequent Participation in Mammography Screening.

PURPOSE: The decline in advanced breast cancer stages is presumably the most relevant surrogate parameter in mammography screening. It represents the last step in the causal cascade that is expected to affect breast cancer-related mortality. To assess the effectiveness of population-based screening, we analyzed the 2-year incidence rates of advanced breast cancers between women participating in the initial and in the first subsequent round. MATERIALS AND METHODS: The study included data from 19,563 initial and 18,034 subsequent examinations of one digital screening unit (2008 - 2010). Data on tumor stages, detected by screening or within the following interval of two years (2-year incidence), were provided by the epidemiological cancer registry. Rates of all and combined UICC stages 2, 3 and 4 (advanced stages) were reported for a two-year period. Proportions were tested for significance by using chi-square tests (p < 0.001). RESULTS: The 2-year incidence rate of all stages was significantly lower in participants in subsequent screening than in initial screening (0.85 vs. 1.29 per 100 women (%); p < 0.0001). A significantly lower 2-year incidence of advanced stages was observed for subsequent screening compared to initial screening (0.26 % vs. 0.48 %; p = 0.0007). Among women aged 50 to 59 years, the incidence of advanced stages was less clearly different (0.21 % vs. 0.35 %; p = 0.07) than in women aged 60 to 69 years (0.31 % vs. 0.70 %; p = 0.0008). CONCLUSION: During the change from prevalent to incident phase mammography screening, a program impact is seen by a lower 2-year incidence of advanced breast cancers within subsequent compared to initial participants, predominately in women aged 60 to 69 years. KEY POINTS: • The incidence of advanced tumor stages represents the most relevant surrogate parameter for screening effectiveness. • For the first time the 2-year incidence of advanced breast cancer stages after subsequent mammography screening was analyzed. • We observed a significant effect of screening on the 2-year incidence of advanced stages, predominately in the age group 60 to 69 years.

Liver flukes in dogs and treatment with praziquantel.

Opisthorchiid eggs were found in 6 out of 27 (22%) huskies while an ELISA detected antibodies against Opisthorchis felineus and Metorchis bilis in 24 (89%) and 25 (93%) sera taken from these dogs, respectively. All dogs showed an increased activity of glutamate dehydrogenase while aspartate aminotransferase was normal in all samples. Ten weeks after treatment with praziquantel no fluke eggs were found in the faeces from any animal and antibody titres dropped in all animals.

[Changes in the perception of risk factors for stroke in the German population between 1995-1996 and 2000-2001. Results of two representative EMNID surveys]. / Veränderungen in der Wahrnehmung der Risikofaktoren für einen Schlaganfall in der deutschen Bevölkerung zwischen 1995/1996 und 2000/2001. Ergebnisse zweier repräsentativer EMNID-Befragungen.

BACKGROUND AND OBJECTIVE: Stroke is one of the leading causes for death and disability worldwide. A better understanding of the perception of modifiable stroke risk factors in the population is the first step to initiate effective prevention strategies on population level. Changes over 5 years in the risk perception in the general population were investigated by two representative surveys in Germany. METHODS: Nationwide programs to screen voluntary participants for stroke risk were undertaken in 1995-1996 and 2000-2001 by the German Stroke Foundation, in cooperation with the health insurance company BARMER and the Sanofi-Synthelabo Company. As part of these programmes two surveys were performed by TNS-EMNID to collect data on population knowledge. A representative sample of the German population was selected and asked to categorize their perception of stroke risk for common vascular risk factors. RESULTS: A total of 8193 participants were interviewed (4081 in 1995-1996 and 4112 in 2000-2001); 43.5% were (3) 50 years of age and 52.5% were female. Hypertension was rated by 68.3% to be in the highest risk category for stroke, followed by smoking (52.3%), hypercholesterolemia (48.0%), overweight (48.0%), excessive alcohol consumption (32.9%) and diabetes (26.6%). The proportion of participants who graded these factors to be important for stroke occurrence was persistently higher in 2000-2001 than in 1995-1996. CONCLUSION: Perception of modifiable risk factors for stroke increased over a 5-year time period in two representative surveys in Germany. The importance of diabetes mellitus as a risk factor for stroke is especially underestimated in the general population.

Educational level and risk profile of cardiac patients in the EUROASPIRE II substudy.

STUDY OBJECTIVE: To ascertain, whether, conventional risk factors and readiness of coronary patients to modify their behaviour and to comply with recommended medication were associated with education in patients with established coronary heart disease. DESIGN AND METHODS: EUROASPIRE II was a cross sectional survey undertaken in 1999-2000 in 15 European countries to ascertain how effectively recommendations on coronary preventions are being followed in clinical practice. Consecutive patients, men and women

[Classical risk factors for myocardial infarction and total mortality in the community--13-year follow-up of the MONICA Augsburg cohort study]. / Klassische Risikofaktoren für Herzinfarkt und Gesamtsterblichkeit in der Bevölkerung. 13-Jahres-Follow-up der MONICA Augsburg-Kohortenstudie.

PURPOSE: The MONICA (MONItoring of trends and determinants in CArdiovascular disease) project in the region of Augsburg, Southern Germany, is the first population-based cohort study in Germany investigating the association of the risk factors hypertension, hypercholesterolemia and smoking with incident myocardial infarction and total mortality, and to assess their impact at the population level. METHODS: At baseline, 1074 men and 1013 women aged 45-64 years were randomly selected from the population in the Augsburg region and extensively interviewed and examined regarding their cardiovascular risk profile. They were traced over 13 years from 1984-1997. We calculated incidence rates, hazard rate ratios, population attributable risks (PAR), and rate advancement periods (RAP) according to the three risk factors and their combinations. RESULTS: Among men, 107 myocardial infarctions and 204 total mortality events occurred during the study period; in women the number of total mortality cases was 102. The three classical risk factors were associated with incident myocardial infarction in men and with total mortality in men and women over a period of 13 years. Heavily smoking men had a particularly high risk of total mortality (HRR=4.2; 95% CI 2.5-7.0) and myocardial infarction (HRR=3.8; 1.9-7.6). Men with treated hypertension were at equally high risk for both total mortality (HRR=2.4; 1.5-3.7) and myocardial infarction (HRR=2.4; 1.3-4.3). In women, treated hypertension (HRR=2.5; 1.5-4.1) and hypercholesterolemia (HRR=2.0; 1.2-3.3) were most strongly related to total mortality. Regarding the association of risk factor combinations and myocardial infarction among men, the presence of all three risk factors simultaneously (HRR=7.9; 3.6-17.3) and the combination smoking/hypercholesterolemia (HRR=5.8; 3.2-10.5) were particularly hazardous. In total, the three risk factors contributed 54% of the burden of myocardial infarction in the male study population. The rate advancement periods for myocardial infarction related to treated hypertension, hypercholesterolemia and heavy smoking were 10.5, 5.8 and 15.8 years, respectively. CONCLUSIONS: Our results confirm the outstanding impact of the classical risk factors on myocardial infarction and total mortality in a southern German population. Coronary heart disease is largely preventable through risk factor reduction. Therefore, risk factor counselling, education and treatment are crucial to prevent people from developing the disease or dying prematurely.

[Chronic recurrent abdominal pain--significance and success of laparoscopic/pelviscopic adhesiolysis]. / Chronisch rezidivierende abdominale Beschwerden--Bedeutung und Erfolge der laparoskopischen/pelviskopischen Adhäsiolyse.

The report is given about 154 patients, who were operated because of chronic abdominal pain in the lower abdomen 27 (17.5%), suspicion of adhesion 43 (27.9%), of an adnexal tumor 56 (33.8%), of endometriosis 5 (3.2%), sterility 11 (10%), or irreversible contraception 16 (7.2%). 112 patients had to be laparotomized once or several times. 105 women had only adhesion; adhesion and an adnexal tumor were found in 27 patients, 22 women had adhesion and endometriosis. Predominant were adhesions of second graduation, 72 women had these adhesions, nine of 105 patients had adhesions of first graduation, adhesions of third graduation had 24 patients. In the last group there was the greatest number of laparotomies. 95 patients answered the questionnaires six months later. 35 (36.8%) were free from pain, 13 (13.8%) stated a clear improvement, 38 (40%) were temporarily free from pain, and 9 (8.2%) stated unchanged pain. One woman complained postoperatively about clear aggravation of pain.

Effect of Rous associated virus number 7 on lymphoid cells and tissues of the chicken.

Infection of chicks or chick embryos with Rous associated virus number 7 (RAV-7) led to a decreased blastogenic response to Concanavalin A (Con A) by lymphocytes isolated from the spleen and thymus. Chicks infected with RAV-7 8 days after hatch manifested decreased Con A blastogenesis 5 weeks postinfection, while chicks infected in ovo at 10 days of incubation showed an unusual pattern of cell density dependent decreased blastogenesis two weeks post-hatch (three weeks post-infection). Histopathological examination of tissues from RAV-7 infected chicks revealed evidence of lymphoid organ involution and widespread lymphoproliferative lesions by 3 weeks of age. The combination of decreased in vitro lymphoid blastogenesis and in vivo lymphoproliferation suggests that RAV-7 interacts with lymphocytes in a fashion that has not previously been described in the chicken.