Model of outcomes of screening mammography: spontaneous regression of breast cancer may not be uncommon.
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Biomedical subjects
Publications and source records attributed to Jan Maehlen.
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Serious infection with the bacterium L. monocytogenes mainly manifests as sepsis and/or meningitis. A particular entity is Listeria brain stem encephalitis, which is characterized by progressive brain stem deficits. The condition is fatal unless early treated. The purpose of the present study was to assess the incidence of brain stem encephalitis in a population-based listeriosis material. Medical records from 212 of the 240 patients with serious listeriosis reported in Norway from 1977 to 2000, as well as autopsy material from 8 of these patients, were available. This material was searched for clinical and neuropathological evidence of brain stem infection. Findings indicating brain stem encephalitis were present in 19 of the 172 patients with adult listeriosis (11%) but none of the 40 pregnancy-related listeriosis cases. None of the 19 patients had been diagnosed with Listeria brain stem infection originally. We conclude that brain stem encephalitis is relatively common in this Norwegian listeriosis material.
Brain stem encephalitis is a particular manifestation of infection with the bacterium Listeria monocytogenes. Here, we present the neuropathological findings in 9 such cases. In the brain stem, the inflammatory infiltrates were located predominantly within nuclei and tracts of cranial nerves innervating the oropharynx. These findings support the hypothesis that the food-borne bacterium Listeria monocytogenes invades the brain stem along cranial nerves.
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BACKGROUND: In Norway and Sweden, the introduction of mammography screening programmes has been associated with about a 50% increase in breast cancer incidence for the screened age groups and almost stable incidence in higher age groups. This suggests that mammography screening results in a substantial degree of overdiagnosis. MATERIAL AND METHODS: In a prospective cohort study of the Norwegian mammography programme we recorded the incidence of breast cancer among women aged 50 to 69 years offered mammography screening as well as the incidence of interval cancer among those attending, and breast cancer among those not attending. We used these data to calculate the incidence of cancer detected by screening among those screened. RESULTS: The incidence of invasive cancer at second and third screening is 2.4 times higher than expected. We estimated that only 42% of the screening-detected invasive cancers would have developed into clinical disease in the absence of a screening programme. When ductal carcinoma in situ is added, only 34% of the screening-detected cancers would have developed into clinical disease. INTERPRETATION: Two thirds of breast cancers detected by screening are overdiagnosed.
OBJECTIVE: To determine whether any increase in the incidence of breast cancer in women detected by mammography is compensated for by a drop in the incidence after age 69, years when women are no longer invited for screening. DESIGN: Population based cohort study of incidence of breast cancer during the introduction of nationwide screening programmes. SETTING: Norway and Sweden. PARTICIPANTS: All women aged above 30 years (1.4 and 2.9 million, respectively, in 2000). MAIN OUTCOME MEASURES: Changes in age specific incidence rates of invasive breast cancer associated with the introduction of the screening programmes. RESULTS: As a result of screening the recorded incidence of breast cancer in women aged 50-69 years increased by 54% in Norway and 45% in Sweden. There was no corresponding decline in incidence after the age of 69 years. CONCLUSIONS: Without screening one third of all invasive breast cancers in the age group 50-69 years would not have been detected in the patients' lifetime. This level of overdiagnosis is larger than previously reported.
This study examines the distribution of apolipoprotein E (APOE) alleles in a population of healthy male and female Norwegians (n = 798) below the age of 40. The -491A/T polymorphism of the promoter region of the APOE gene was also examined. A seminested polymerase chain reaction was applied in the genotyping. The results showed that the E3 allele had the highest frequency (0.744), followed by E4 (0.198) and E2 (0.058). The APOE frequencies found in this study differ significantly from those obtained in earlier Norwegian APOE phenotypings. The allele frequencies in the -491 site of the promoter region were 0.845 for the A allele and 0.155 for the T allele. The genotype frequency was highest for AA (0.707), followed by AT (0.277) and TT (0.016). Moreover, the A allele was in linkage disequilibrium to E4.