| 1. |
|
|
| 2. |
|
|
| 3. |
|
|
| 4. |
|
|
| 5. |
- Strander, Björn, 1952, et al.
(författare)
-
Does HPV-status 6-12 months after treatment of high grade dysplasia in the uterine cervix predict long term recurrence?
- 2007
-
Ingår i: Eur J Cancer. ; 43:12, s. 1849-55
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Women once treated for high grade cervical dysplasia have a high long term risk for developing new dysplasia or cancer. OBJECTIVES: To investigate if human papilloma virus (HPV)-negativity after treatment of cervical dysplasia reduces the need for frequent long term follow up. DESIGN: Case/control study based on archival smears. METHODS: Women with cervical intraepithelial neoplasi (CIN)2-3, treated for dysplasia and with recurrence of CIN2+ more than 2 years after treatment were compared with controls without recurrence, matched for age and date of treatment. High risk-HPV-DNA were analysed with PCR from two archival smears per woman. Mean follow up time was 14.6 years. RESULTS: 24% (45/189) of cases and 11% (43/378) of controls were HPV-positive in any of two smears. Odds ratio (OR)=2.5 (1.6-3.8). CONCLUSION: HPV-status 6-12 months after treatment of high grade dysplasia is of limited value for the design of long term follow up.
|
|
| 6. |
- Wiik, J., et al.
(författare)
-
Cervical excisional treatment, HPV infection and risk of preterm delivery - a Swedish population-based study
- 2020
-
Ingår i: Geburtshilfe und Frauenheilkunde. - : © 2020. Thieme. All rights reserved.. - 1438-8804 .- 0016-5751. ; 80:10
-
Tidskriftsartikel (refereegranskat)abstract
- Objective Excisional treatment for cervical intraepithelial neoplasia (CIN) is associated with preterm delivery (PTD). It has been shown that even untreated CIN is associated with PTD. We aimed to explore the magnitude of the associations of CIN with PTD and adverse obstetrical outcome. Methods Retrospective register-based study comprising all women with singleton deliveries in Sweden 1999-2016. Data were retrieved from the Medical Birth Registry and the Swedish National Cervical Screening Registry. Women with normal cytology all life (n = 340,290) were compared to a) women with sign of HPV-infection close to pregnancy (abnormal cytology (n = 11,936) or positive HPV-test (n = 2,587)), b) women treated for CIN before delivery (n = 25,123) and c) women with CIN/carcinoma diagnosed after delivery (n = 34,251) by logistic regression adjusted for socioeconomic and health-related confounders. Results PTD was increased in all groups compared to women with normal cytology all life (4.7 %), with greatest risk for the treated group (9,0 %, OR 1.80 (1.71-1.89)), but also for women with HPV-infection close to pregnancy (5,9 %, OR 1.19 (1.10-1.29)) and CIN/carcinoma after delivery (6,1 %, OR 1.10 (1.04-1.16)). Paired analysis in 5,547 women with deliveries both before and after treatment showed increased risk of PTD after treatment (OR 1.27 (1.07-1.50)). The treated group had increased risk also for preterm prelabour rupture of the membranes (pPROM, OR 2.25 (2.08-2.44)) and chorioamnionitis (2.44 (2.05-2.90)). HPV-infection close to pregnancy was associated with pPROM (OR 1.22 (1.06-1.40)). Conclusions Women with HPV infection close to pregnancy have a small increased risk for PTD and pPROM while excisional treatment increases risks further.
|
|
| 7. |
- Bistoletti, P, et al.
(författare)
-
Screening for cervixcancer kan vara kostnadseffektiv. Kombinationen cellprov och HPV-test skulle ge ytterligare vinster.
- 2005
-
Ingår i: Läkartidningen. - 0023-7205. ; 102:24-25, s. 1874-1879
-
Tidskriftsartikel (refereegranskat)abstract
- En hälsoekonomisk utvärdering av cellprovsscreening för cervixcancer har saknats vad gäller svenska förhållanden. I en modellstudie jämfördes effekter av och kostnader för gynekologisk cellprovskontroll med och utan tillägg av test för humant papillomvirus (HPV). Med cellprovsscreening i åldern 32–60 år vart tredje till vart femte år minskar risken att insjukna i invasiv cervixcancer med 88 procent, och sjukvårdens kostnader halveras jämfört med att inte screena. Med tillägg av ett eller två HPV-test vid 32 års ålder och oförändrad screeningpolicy ökar kostnaderna, och inga hälsovinster kan påvisas. En screeningstrategi med cellprov i kombination med HPV-test vid enbart tre tillfällen i livet – vid 32, 41 och 50 års ålder – kostar mindre och ger, enligt modellen, hälsovinster jämfört med enbart cellprovsscreening i åldern 32–60 år.
|
|
| 8. |
- Edvardsson, H., et al.
(författare)
-
Nationwide Rereview of Normal Cervical Cytologies before High-Grade Cervical Lesions or before Invasive Cervical Cancer
- 2021
-
Ingår i: Acta Cytologica. - : S. Karger AG. - 0001-5547 .- 1938-2650. ; 65:5, s. 377-384
-
Tidskriftsartikel (refereegranskat)abstract
- Sweden has experienced an unexpected >30% increase in cervical cancer incidence among women with normal cytological screening results. We therefore performed a nationwide assessment of false-negative cytology before invasive cervical cancer. The Swedish national cervical screening registry identified 2,150 normal cytologies taken up to 10 years before 903 cases of invasive cervical cancer. The 27 cytological laboratories in Sweden were asked to rereview the slides, and all of them completed the rereview. One thousand nine hundred fifteen slides were retrieved and reviewed. Abnormalities were found in 30% of the slides, and the proportion of slides that had a changed diagnosis on rereview increased on average by 3.9% per sampling year during 2001-2016 (p < 0.03). We also asked for rereview of normal smears taken up to 42 months before a histopathologically diagnosed high-grade squamous intraepithelial lesion (HSIL) or adenocarcinoma in situ (AIS). 19/27 laboratories responded, and out of 6,101 normal smears taken before HSIL/AIS, 5,918 were retrieved and rereviewed. The diagnosis was changed in 25% of cases. In summary, we found an increasing time trend of false-negative smears taken before invasive cervical cancer. This indicates a decreased protection of normal cytology in the screening program supporting earlier findings that this is the main reason behind the recent Swedish increase in cervical cancer. We suggest that optimal cervical cancer control may be promoted by routine nationally coordinated rereview of negative smears before high-grade cervical lesions or invasive cervical cancer. © 2021 The Author(s). Published by S. Karger AG, Basel.
|
|
| 9. |
|
|
| 10. |
|
|
| 11. |
- Strander, B, et al.
(författare)
-
Authors' reply to Jewell
- 2014
-
Ingår i: BMJ (Clinical research ed.). - : BMJ. - 1756-1833. ; 349, s. g7227-
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
|
|
| 12. |
|
|
| 13. |
- Wang, J. R., et al.
(författare)
-
Increase of cervical cancer incidence in Sweden in relation to screening history: population cohort study
- 2020
-
Ingår i: Acta Oncologica. - : Informa UK Limited. - 0284-186X .- 1651-226X. ; 59:8, s. 988-993
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Cervical cancer incidence in Sweden decreased from 24/100,000 in 1965 to 8/100,000 in 2011, but has from 2014 increased to 11/100,000. The increase appears to correlate to screening history. We perform a study of the cancer risk change in relation to screening history over two screening rounds to verify the correlation. Material and methods: We studied the cohorts of all 3,047,850 individual women living in Sweden in each year from 2002-2015. Registry linkages between the Total Population Register, the Swedish National Cervical Screening Registry, the Swedish Cervical Cancer Audit database and the National Quality Register for Gynecological Cancer, defined the incidence rates of invasive cervical cancer comparing time periods 2002-2013 to 2014-2015, in women whose screening history in 2 screening intervals prior to each year were either (i) adequately screened with normal results (almost exclusively cytology, 52% of the population) or (ii) unscreened (13% of the population). We also investigated the incidence increase by time since a normal smear performed in 2002-2012. Results: Among women adequately screened with normal results there was a strong incidence increase in 2014-2015 compared to previous years (Incidence rate ratio (IRR) = 1.59, 95%CI = 1.36-1.85), but no significant increase among unscreened women (IRR = 1.09, 95%CI = 0.94-1.27). There was no increase in incidence 0-2.5 years after a normal smear over the study period (IRR = 1.04, 95% CI = 0.88-1.24), but a strong increase 3-4 years after a normal smear since year 2009 (IRR = 1.52, 95% CI = 1.25-1.84). Conclusion: The results suggest that the overall increase is associated with an increased cancer risk in women adequately screened with normal cytological results. Possibly, precursor lesions missed in one screening round might result in detection of early stage invasive cancer in the subsequent screening.
|
|
| 14. |
- Zackrisson, B., et al.
(författare)
-
A systematic overview of radiation therapy effects in head and neck cancer
- 2003
-
Ingår i: Acta Oncol. - : Informa UK Limited. - 1651-226X .- 0284-186X. ; 42:5-6, s. 443-61
-
Tidskriftsartikel (refereegranskat)abstract
- A systematic review of radiation therapy trials in several tumour types was performed by The Swedish Council of Technology Assessment in Health Care (SBU). The procedures for evaluation of the scientific literature are described separately (Acta Oncol 2003; 42: 357-365). This synthesis of the literature on radiation therapy for head and neck cancer is based on data from 39 randomized trials and 1 meta-analysis. In total, 40 scientific articles are included, involving 20893 patients. The results were compared with those of a similar overview from 1996 including 79 174 patients. The conclusions reached can be summarized as follows: General, non-nasopharynx. Substantial evidence indicates that the tumour effect of radiotherapy can be increased by the concomitant administration of chemotherapeutic agents, particularly cisplatin and 5-fluorouracil. There is moderate evidence of a survival benefit of radiation combined with concomitant chemotherapy compared to radiation alone. However, the results are equivocal. There is substantial evidence in published studies for an increased frequency of severe acute side effects as a result of concomitant chemotherapy and radiotherapy. There are very few studies that allow any estimates of the risk for serious late side effects. There is a weak indication of an increased risk for serious fibrosis. Comment: The general quality of studies and the lack of information on serious side effects indicate a need for large, well-designed clinical studies with a reasonable follow-up. Larynx preservation studies. There is strong evidence that larynx preservation is possible in 50% of the patients surviving for 5 years with hypopharyngeal cancers when treated with neoadjuvant chemotherapy and radical radiotherapy There is a non-significant trend for the overall survival being lower in non-surgically treated patients than in those treated with primary surgery and postoperative radiotherapy Nasopharynx. There is moderate evidence that patients with nasopharyngeal carcinomas of the endemic type benefit from therapy with a combination of chemotherapy and radical radiotherapy. However, the results from the reported studies are equivocal. There is some indication that the acute side effects of radiation are more severe in the concomitant setting than in the neoadjuvant. Comment: There are no data on serious late toxicity. Dose, fractionation schedules. There is some evidence that certain schedules of altered fractionation improve tumour control without increasing severe late side effects. There is some evidence that nervous tissues are more susceptible to damage by altered fractionation. Solid data shows that altered fractionation increases acute side effects. There is moderate evidence that accelerated hyperfractionation may reduce the frequency of serious late side effects while retaining a similar tumour effect as conventional radiotherapy Hypoxic cell sensitizers. Most reported trials reject the usefulness of nitroimidazole derivatives for sensitization of hypoxic tumour cells. There is some evidence that patients with tumours in the pharynx and larynx may benefit from sensitization by nimorazole. Prophylactic treatment of side effects. There is weak evidence that local antibiotics have a clinically significant effect in preventing acute radiotherapy side effects. There is insufficient evidence that radioprotective agents offer clinically significant protection of parotid glands (one study in two publications). There is insufficient evidence that radioprotective agents do not spare tumour tissue. Since the previous report no randomized studies comparing the effectiveness of external beam radiotherapy and brachytherapy have been performed. Both methods are well established and have independently proved to be effective in the treatment of certain head and neck cancers. No conclusion can be drawn regarding their relative effectiveness. Since the previous report no data to guide the use of intraoperative radiotherapy have been identified.
|
|
