How cost-effective is breast cancer screening in different EC countries?

Should the decision to start breast cancer screening in the Netherlands and in the U.K. be followed by other EC countries? This question has been addressed in an exploratory analysis of the differences in cost-effectiveness of breast cancer screening in Spain, France, the U.

Advanced breast cancer and its prevention by screening.

In discussions on breast cancer screening, much attention has been focussed on the possible morbidity generated by screening. Favourable effects like the prevention of advanced disease seem underestimated, probably because quantification is that difficult. To analyse the amount of care and treatment given to women with advanced breast cancer, we report on patients followed from first recurrence until death using patient files and national sources.

[A health survey and a survey of family physician house calls among Turkish and Dutch residents of Rotterdam].

This paper reports the results of a study of the health situation of Turkish and autochthonous citizens of Rotterdam (Holland). A health interview survey was held with a random sample of 250 Turkish citizens (age 19-69) and a matched group of 250 autochthonous citizens. With ten percent of the respondents a second, in-depth interview was held.

Physical characteristics and factors related to sexual development and behaviour and the risk for prostatic cancer.

A case-control study of prostatic cancer was carried out to examine the association between selected physical characteristics and factors related to sexual development and behaviour and the risk for this disease. In consideration of an endocrinologic mechanism for these putative risk factors, the association between selected factors and serum hormone level in a comparison group, free of prostate cancer, was also examined. One-hundred cases and 113 controls were included for study.

The impact of a breast cancer screening programme on quality-adjusted life-years.

Trials have shown that breast cancer screening is effective in reducing breast cancer mortality and gaining life-years. The question is whether taking into account the impact of a screening programme on quality of life would lead to a less positive view. Screening may have effects on quality of life in the short run for women participating and effects in the long run as a result of the expected shift in the number of women experiencing early and advanced phases of the disease, after the initiation of the programme.

Breast cancer screening and cost-effectiveness; policy alternatives, quality of life considerations and the possible impact of uncertain factors.

Mammographic screening for women aged 50-70 is effective in reducing breast cancer mortality, but the impact on quality of life and the attainable mortality reduction remain to be discussed. The consequences of expanding screening programmes to include women in other age groups are uncertain. We have predicted the effects and costs for 5 popular screening variants, differing in age group and screening interval, on the basis of our analysis of the Dutch screening trials and of the reported mortality reductions in other trials.

Euthanasia and other medical decisions concerning the end of life.

This article presents the first results of the Dutch nationwide study on euthanasia and other medical decisions concerning the end of life (MDEL). The study was done at the request of the Dutch government in preparation for a discussion about legislation on euthanasia. Three studies were undertaken: detailed interviews with 405 physicians, the mailing of questionnaires to the physicians of a sample of 7000 deceased persons, and the collecting of information about 2250 deaths by a prospective survey among the respondents to the interviews.

Peripheral hormone levels in controls and patients with prostatic cancer or benign prostatic hyperplasia: results from the Dutch-Japanese case-control study.

The possible relationship between changes in peripheral hormone levels and the occurrence of prostatic pathology was studied in a case-control study, involving estimation of various plasma hormones in 368 Dutch and 258 Japanese men, who were grouped as controls and patients with benign prostatic hyperplasia, focal prostatic carcinoma, or clinically evident prostatic carcinoma. Results of a number of previous, smaller studies concerning interrelationships between hormone levels in elderly men were confirmed within the Dutch and Japanese groups. Plasma levels of testosterone and estradiol were significantly lower in the Japanese men, when compared with those in Dutch men.

[Efficacy of mass screening for breast cancer; reduced mortality nationally and internationally].

Breast cancer screening trials in several countries have proved to reduce breast cancer mortality. However, the trials show considerable differences in the extent of this reduction. The Swedish projects in Kopparberg/Ostergötland and Malmö are the most similar to the Dutch situation.

Orthotopic liver transplantation in The Netherlands. The results and impact of a medical technology assessment.

In 1985 Dutch health care authorities and health insurance companies initiated a large-scale technology assessment (TA) of liver transplantation (LTx) in The Netherlands. The 10-year experience of the existing programme in the University Hospital Groningen was investigated. Topics included were patient flow, selection policies, survival, quality-of-life, costs, need, supply of donor organs and organisational aspects.

A model for breast cancer screening.

A model for breast cancer screening has been developed. When the appropriate screening policy is specified, the model reproduces the detection rates and the incidence of interval cancers as observed in the recent screening projects in Utrecht and Nijmegen, the Netherlands. The model-predicted mortality rate reduction is in accordance with the results of the Kopparberg/Ostergötland randomized trial in Sweden.

A model-based analysis of the HIP project for breast cancer screening.

A computer simulation approach is used to test assumptions about sensitivity of mammography and physical examination, and about the duration of preclinical screen-detectable breast cancer. Values between 50% and 80% for the combined sensitivity of the 2 tests give a good explanation of the results of the HIP randomized trial of breast cancer screening. The mean duration of the preclinical stage can vary from 1.

[Psychosocial aspects of heart transplantation; 4-year experience].

The psychosocial aspects of heart transplantation are described on the basis of the experience gained with these patients in the University Hospital Rotterdam (Dijkzigt) from 1984 to 1988. Quality of life before and after heart transplantation was determined using a comprehensive patient questionnaire. This questionnaire was presented by means of a personal computer.

Breast cancer screening: its impact on clinical medicine.

Breast cancer screening is generally accepted as an effective means of reducing breast cancer mortality in post-menopausal women. In this analysis the impact of nationwide screening on clinical medicine and the effects for the women involved are quantified. Effect estimates are based on results from screening trials in Utrecht (DOM-project) and Nijmegen, and on bi-annual screening of women aged 50-70.

Valuation of health states by the general public: feasibility of a standardized measurement procedure.

In the context of an international collaborative study we tested the feasibility of a utility measurement procedure in the Dutch general population. A postal questionnaire was sent to a random sample of 200 households in a town in the Netherlands (+/- 50,000 inh.).

Linker scanning of the yeast RNA polymerase I promoter.

To define the RNA polymerase I promoter in the rDNA of Saccharomyces cerevisiae more precisely, we have constructed a series of 5'- and 3'-deletion mutants in a novel, plasmid-borne rDNA minigene, that also contains the transcriptional enhancer. Our data show that the Pol I promoter, in this context, extends from position -155 to +27, with 5'-deletions up to -134 and 3'-deletions up to -2 removing essential sequence information. To investigate the internal organization of the yeast Pol I promoter, linker scanning mutants were constructed, that traverse the Pol I promoter region and comprise between 5 and 12 clustered point mutations.

Mortality after nasopharyngeal radium irradiation for eustachian tube dysfunction.

Cause-specific mortality of 2,510 persons treated before 1965 by nasopharyngeal radium irradiation (average exposure, 1,200 mg/min), followed to 1985, was compared to that of 2,199 nonexposed comparison subjects. No excess was found for the exposed group in overall mortality, cancer mortality, or in mortality of cancer of specific sites. A marginal excess (p = .

[Technology assessment of liver transplantation; a study of the liver transplantation program in Groningen 1977-1987].

The liver transplantation programme of the University Hospital of Groningen, the Netherlands, was evaluated on behalf of the Dutch Sick Fund Council. From 1978 to 1987 561 patients were put forward for liver transplantation (LTX). During this period, 76 orthotopic liver transplants were carried out, 8 of which were retransplantations.

The cost-effectiveness of breast cancer screening.

The costs and effects of different invitation schedules of breast cancer screening are compared. The effect estimates are based on trials from the USA, Sweden and the Netherlands. The cost estimates use registration data, file studies and organization charts.

Incidence of diseases of the lower respiratory tract in family practice and low level air pollution.

A simple contact registration in family practices in an urban area in the Netherlands was shown to be a suitable instrument for measuring and analysing the incidence of diseases of the lower respiratory tract. This incidence showed a topographical and a temporal variation. The topographical component was related to the sulphur dioxide (SO2) air pollution in the different districts.