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Sökning: WFRF:(Östensson Ellinor)

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  • Andersson, Sonia, et al. (författare)
  • Acceptance of Self-Sampling Among Long-Term Cervical Screening Non-Attenders with HPV-Positive Results : Promising Opportunity for Specific Cancer Education
  • 2019
  • Ingår i: Journal of Cancer Education. - : Springer. - 0885-8195 .- 1543-0154.
  • Tidskriftsartikel (refereegranskat)abstract
    • This study aims to investigate acceptance of vaginal self-sampling for high-risk human papilloma virus (HPV) among long-term screening non-attenders at increased cervical cancer risk and to identify leverage points to promote screening adherence among these women. Forty-three long-term screening non-attenders performed home vaginal self-sampling for HPV, had positive HPV results, and subsequently attended gynecologic examination. Sixteen (37.2%) had high-grade cervical intraepithelial neoplasia (CIN2 or 3), and two had invasive cervical cancer. Forty-one of these women completed a questionnaire concerning Specific Knowledge about HPV, CIN, and cervical cancer, potential barriers to screening and views about self-sampling. Results were compared with 479 women treated for CIN2+ who attended gynecologic follow-up and also performed self-sampling. Significant multivariate predictors of long-term non-attender status compared with referents were low Specific Knowledge, high confidence in self-sampling, and potential barriers-refraining from activity to attend gynecologic examination, needing another's help to attend, and long travel time. Non-attenders citing fear/refraining from gynecologic examination as why they preferred self-sampling significantly more often had lowest Specific Knowledge compared with other non-attenders. All non-attenders could envision themselves doing self-sampling again while only 74% of referents endorsed this statement (p = 0.0003). We conclude that HPV self-sampling is an acceptable option for women at increased cervical cancer risk who have been long-term screening non-attenders. Educational outreach to enhance Specific Knowledge about HPV, CIN and cervical cancer is critical. Those non-attenders who explicitly avoid gynecologic examinations need special attention. Trial Registry: Clinicaltrials.gov NCT02750124.
  • Ranhem, Cecilia, et al. (författare)
  • Expression of LRIG proteins as possible prognostic factors in primary vaginal carcinoma
  • 2017
  • Ingår i: ; 12:8
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Primary vaginal carcinoma (PVC) is a rare malignancy. Established prognostic factors include tumour stage and age at diagnosis. The leucine-rich repeats and immunoglobuline-like domains (LRIG)-1 protein functions as a tumour suppressor, but less is known about the functions of LRIG2 and LRIG3. The present study aimed to evaluate the expression of LRIG proteins and analyse their possible associations with clinical characteristics and survival in a cohort of PVC patients.Methods: We used immunohistochemistry to investigate LRIG1, LRIG2, and LRIG3 expression in tumour samples from a consecutive cohort of 70 PVC patients. The association between LRIG protein expression and clinical characteristics and cancer-specific survival was investigated using univariate and multivariate analyses.Results: The majority of PVC patients (72%) had >50% LRIG1- and LRIG2-positive cells, and no or low LRIG3-positive cells. HPV status was significantly correlated with LRIG1 expression (p = 0.0047). Having high LRIG1 expression was significantly correlated with superior cancer-specific survival in univariate and multivariate analyses. LRIG2 and LRIG3 expression did not significantly correlate with clinical characteristics or survival.Conclusion: LRIG1 expression might be of interest as a prognostic marker in PVC patients, whereas the role of LRIG2 and LRIG3 expression remains to be clarified.
  • Aarnio, Riina, 1971-, et al. (författare)
  • Cost-effectiveness analysis of repeated self-sampling for HPV testing in primary cervical screening: a randomized study
  • 2020
  • Ingår i: ; 20:1
  • Tidskriftsartikel (övrigt vetenskapligt)abstract
    • BackgroundHuman papillomavirus (HPV) testing is recommended in primary cervical screening to improve cancer prevention. An advantage of HPV testing is that it can be performed on self-samples, which could increase population coverage and result in a more efficient strategy to identify women at risk of developing cervical cancer. Our objective was to assess whether repeated self-sampling for HPV testing is cost-effective in comparison with Pap smear cytology for detection of cervical intraepithelial neoplasia grade 2 or more (CIN2+) in increasing participation rate in primary cervical screening.MethodsA cost-effectiveness analysis (CEA) was performed on data from a previously published randomized clinical study including 36 390 women aged 30–49 years. Participants were randomized either to perform repeated self-sampling of vaginal fluid for HPV testing (n = 17 997, HPV self-sampling arm) or to midwife-collected Pap smears for cytological analysis (n = 18 393, Pap smear arm).ResultsSelf-sampling for HPV testing led to 1633 more screened women and 107 more histologically diagnosed CIN2+ at a lower cost vs. midwife-collected Pap smears (€ 228 642 vs. € 781 139). ConclusionsThis study projected that repeated self-sampling for HPV testing increased participation and detection of CIN2+ at a lower cost than midwife-collected Pap smears in primary cervical screening. Offering women a home-based self-sampling may therefore be a more cost-effective alternative than clinic-based screening. 
  • Alder, Susanna, et al. (författare)
  • Incomplete excision of cervical intraepithelial neoplasia as a predictor of the risk of recurrent disease : a 16-year follow-up study
  • 2020
  • Ingår i: ; 222:2, s. 172.e1-172.e12
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Women treated for high-grade cervical intraepithelial neoplasia (CIN, grade 2 or 3) are at elevated risk of developing cervical cancer. Suggested factors identifying women at highest risk for recurrence post-therapeutically include incomplete lesion excision, lesion location, size and severity, older age, treatment modality and presence of high-risk human papilloma virus (hrHPV) after treatment. This question has been intensively investigated over decades, but there is still substantial debate as to which of these factors or combination of factors most accurately predict treatment failure.OBJECTIVES: In this study, we examine the long-term risk of residual/recurrent CIN2+ among women previously treated for CIN2 or 3 and how this varies according to margin status (considering also location), as well as comorbidity (conditions assumed to interact with hrHPV acquisition and/or CIN progression), post-treatment presence of hrHPV and other factors.STUDY DESIGN: This prospective study included 991 women with histopathologically-confirmed CIN2/3 who underwent conization in 2000-2007. Information on the primary histopathologic finding, treatment modality, comorbidity, age and hrHPV status during follow-up and residual/recurrent CIN2+ was obtained from the Swedish National Cervical Screening Registry and medical records. Cumulative incidence of residual/recurrent CIN2+ was plotted on Kaplan-Meier curves, with determinants assessed by Cox regression.RESULTS: During a median of 10 years and maximum of 16 years follow-up, 111 patients were diagnosed with residual/recurrent CIN2+. Women with positive/uncertain margins had a higher risk of residual/recurrent CIN2+ than women with negative margins, adjusting for potential confounders (hazard ratio (HR)=2.67; 95% confidence interval (CI): 1.81-3.93). The risk of residual/recurrent CIN2+ varied by anatomical localization of the margins (endocervical: HR=2.72; 95%CI: 1.67-4.41) and both endo- and ectocervical (HR=4.98; 95%CI: 2.85-8.71). The risk did not increase significantly when only ectocervical margins were positive/uncertain. The presence of comorbidity (autoimmune disease, human immunodeficiency viral infection, hepatitis B and/or C, malignancy, diabetes, genetic disorder and/or organ transplant) was also a significant independent predictor of residual/recurrent CIN2+. In women with positive hrHPV findings during follow-up, the HR of positive/uncertain margins for recurrent/residual CIN2+ increased significantly compared to women with hrHPV positive findings but negative margins.CONCLUSIONS: Patients with incompletely excised CIN2/3 are at increased risk of residual/recurrent CIN2+. Margin status combined with hrHPV results and consideration of comorbidity may increase the accuracy for predicting treatment failure.
  • Silfverschiöld, Maria, et al. (författare)
  • Societal cost of oropharyngeal cancer by human papillomavirus status, cancer stage, and subsite
  • Ingår i: PLoS ONE. - : Public Library of Science. - 1932-6203. ; 14:7
  • Tidskriftsartikel (refereegranskat)abstract
    • Background The incidence of oropharyngeal cancer (OPC) is increasing, particularly human papillomavirus (HPV)-associated OPC. The aim of this study was to specify the total societal cost of OPC by HPV status, cancer stage, and subsite using a bottom-up cost-of-illness approach. Methods We analyzed 121 consecutive patients with OPC from the Southern Health Care Region of Sweden. We estimated the direct medical costs and indirect costs (e.g., disease-related morbidity and premature death) from 1 month prior to OPC diagnosis until 3 years after treatment completion. Results The mean total cost per patient was 103 386 for HPV-positive and 120 244 for HPV-negative OPC. Eighty-one percent of the patients analyzed were HPV-positive: Accordingly, HPV-positive OPC represented 79% of the total cost of OPC. The mean total cost of stage I, II, III, IVA, IVB, and IVC, regardless of HPV status, was 59 424, 57 000, 69 246, 115 770, 234 459, and 21 930, respectively, of which indirect costs were estimated at 22 493 (37.8%), 14 754 (25.9%), 28 681 (41.4%), 67 107 (58%), 166 280 (70.9%), and 0. Tonsillar cancer represented 64% of OPC, with a mean total cost of 117 512 per patient. Conclusion The societal cost of OPC is substantial. HPV-associated OPC comprises 79% of the total cost of this disease. The data presented in this study may be used in analytical models to aid decision makers in determining the potential value of gender-neutral HPV vaccination.
  • Östensson, Ellinor (författare)
  • Health economic aspects of cervical cancer screening
  • 2014
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • Healthcare reform and rising costs are driving demand for resource efficiency to facilitate better-informed healthcare decisions. Health economics represent an interdisciplinary set of tools and concepts to assess the value of everyday decisions, taken in complex healthcare settings, to improve healthcare. Many alternative screening methods are currently available, but knowledge about costs and the value of potential health gains is inadequate. The aims of the thesis were to study the efficiency in the allocation of resources to cervical cancer screening of importance for setting priorities: the cost of the most prevalent Human Papillomavirus (HPV) related diseases namely cervical dysplasia, cervical cancer and genital warts, modeling the cost-effectiveness of cervical cancer screening and exploring knowledge of HPV, compliance with screening and its correlates. In one study, we estimated the costs from a societal perspective, of the HPV-related diseases namely cervical dysplasia, cervical cancer and genital warts. Results provided an estimate of €108 million annually showing a significant economic burden on the Swedish welfare system appointed by the most prevalent HPV-related diseases attributable to HPV 6, 11, 16 and 18 infections. A Markov model was developed to simulate the natural history of HPV, cervical dysplasia and cervical cancer to project the cost-effectiveness of HPV self-sampling within the framework of the Swedish organized screening program. Projected results showed that screening with conventional cytology up to age 35 and thereafter screening with HPV selfsampling at home with five-year time intervals between screening opportunities is potentially cost-effective compared with either no screening or with current cytology based screening practice. A decision analytic model was developed to evaluate cost-effectiveness of follow-up with HPV triage compared with repeat cytology and immediate colposcopy with biopsy on women with index smear diagnosis of ASCUS and LSIL within the Swedish organized screening program. Model results showed that immediate colposcopy with biopsy was a cost effective follow-up strategy compared with the alternatives. Given the improvement in HPV testing techniques at lower costs, HPV triage can become a cost-effective alternative for follow-up of minor cytological abnormalities. A descriptive study approach was used to assess possible barriers to and facilitators of cervical cancer screening by estimating time and travel costs and other direct non-medical costs incurred in clinic-based screening, investigating compliance with screening and reasons for noncompliance, determining women’s knowledge of human papillomavirus (HPV), and investigating correlates of HPV knowledge and compliance with screening. Via selfadministered questionnaires, data were obtained from 1 510 women attending the Swedish organized cervical cancer screening program. The study concluded that time and travel costs of clinic-based screening can be substantial, may influence overall cost effectiveness of screening programs and constitute barriers to screening. Women with knowledge of HPV and who did not take time off work to attend screening were more likely to comply with screening. Altogether, this thesis has contributed new health economic data on the societal cost of HPV related diseases; cervical dysplasia, cervical cancer and genital warts on a national level, and patient-level data of indirect costs and other direct non-medical costs for women attending the Swedish organized screening program. This together with data on women´s knowledge about HPV and their compliance with screening are valuable information for further policy decisions on revising the organized screening program. By assessing the impact of HPVrelated diseases in terms of costs is one important step towards efficient allocation of resources to reduce the economic burden of these diseases. These data are also valuable contribution to economic evaluations, providing information for resource allocation when choosing among different screening methods to reduce disease burden, as well as contributing to knowledge of compliance with population-based preventive health programs.
  • Östensson, Ellinor, et al. (författare)
  • The economic burden of human papillomavirus-related precancers and cancers in Sweden
  • 2017
  • Ingår i: PLoS ONE. - : Public Library of Science. - 1932-6203. ; 12:6
  • Tidskriftsartikel (refereegranskat)abstract
    • High-risk (HR) human papillomavirus (HPV) infection is an established cause of malignant disease. We used a societal perspective to estimate the cost of HR HPV-related cervical, vulvar, vaginal, anal, and penile precancer and cancer, and oropharyngeal cancer in Sweden in 2006, 1 year before HPV vaccination became available in the country. Materials and methods This prevalence-based cost-of-illness study used diagnosis-specific data from national registries to determine the number of HR HPV-related precancers and cancers. The HR HPV-attributable fractions of these diseases were derived from a literature review and applied to the total burden to estimate HR HPV-attributable costs. Direct costs were based on health care utilization and indirect costs on loss of productivity due to morbidity (i.e., sick leave and early retirement) and premature mortality. Results The total annual cost of all HR HPV-attributable precancers and cancers was €94 million (€10.3/inhabitant). Direct costs accounted for €31.3 million (€3.4/inhabitant) of the total annual cost, and inpatient care amounted to €20.7 million of direct costs. Indirect costs made up €62.6 million (€6.9/inhabitant) of the total annual cost, and premature mortality amounted to €36 million of indirect costs. Cervical precancer and cancer was most costly (total annual cost €58.4 million). Among cancers affecting both genders, anal precancer and cancer, and oropharyngeal cancer were the most costly (€11.2 million and €11.9 million, respectively). For oropharyngeal cancer, males had the highest health care utilization and represented 71% of the total annual cost. Penile precancer and cancer was least costly (€2.6 million). Conclusion The economic burden of HR HPV-related precancers and cancers is substantial. The disease-related management and treatment costs we report are relevant as a point of reference for future economic evaluations investigating the overall benefits of HPV vaccination in females and males in Sweden.
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