PubMed · 14512326
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P P Dendy, M J P Brugmans. 2003. Low dose radiation risks.. https://doi.org/10.1259/bjr%2F62523154
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Adjuvant systemic therapy was introduced in the Netherlands as a breast cancer treatment in the early 1980s. In this paper, we describe the trends in the usage of adjuvant systemic treatment in the period 1975-1997 in the Netherlands. The main aim of our study was to assess the effects of adjuvant tamoxifen and polychemotherapy on breast cancer mortality, compared to the effects of the mammography screening programme. The computer simulation model MIcrosimulation SCreening ANalysis, which simulates demography, natural history of breast cancer and screening effects, was used to estimate the effects. Use of adjuvant therapy increased over time, but since 1990 it remained rather stable. Nowadays, adjuvant therapy is given to 88% of node-positive patients aged 50-69 years, while less than 10% of node-negative patients receive any kind of adjuvant treatment. Adjuvant treatment is given independent of the mode of detection (adjusted by nodal status and size). We predict that the reduction in breast cancer mortality due to adjuvant therapy is 7% in women aged 55-74 years, while the reduction due to screening, which was first implemented in women aged 50-69 years in 1990-97, will be 28-30% in 2007. In conclusion, although adjuvant systemic therapy can reduce breast cancer mortality rates, it is anticipated to be less than the mortality reduction caused by mammography screening.
Despite remarkable progress made in the fields of antiviral therapy and virological laboratory diagnosis, infections with the human cytomegalovirus (CMV) still pose considerable problems in certain patient groups. The variety of available test methods - mostly not standardised - with their different test characteristics, sample types etc. is often confusing for the clinician. There is often great uncertainty as to whether a given laboratory result is pathognomonic. In addition, not only is the diagnostic repertoire growing constantly - for instance through genome quantification and measurement of virus-specific T lymphocytes - but also the available antiviral therapeutic options with the need for adequate surveillance. This paper gives an up-to-date overview about the available diagnostic means with their specific advantages and disadvantages. Concrete recommendations regarding a rational and comprehensive, yet economic approach to CMV diagnosis have to be targeted at the individual patient group and specific diagnostic problem; this is beyond the scope of this paper and the reader is referred to the pertinent expert groups' publications. This review article deals with general and fundamental aspects.
The aim of this study was to characterise the hospital burden of fractures in the Swedish population by age and gender. The number of patients and number of fractures were documented according to site of fracture, age, sex and duration of hospital stay for the whole population of Sweden in 1996. Fractures were additionally classified as osteoporotic according to fracture site. In 1996 there were 54,000 admissions for fracture in men and women aged 50 years or more, accounting for 600,000 hospital-bed days. Hip fractures accounted for 63% of admissions for fracture in men and 72% in women, for 69% and 73% of hospital-bed days, respectively. Fractures considered to be osteoporotic accounted for 84% of all hospital-bed days due to fracture in men, and 93% in women. More hospital-bed days were due to osteoporotic fracture than to breast cancer and prostate cancer combined. The number of hospital-bed days due to osteoporotic fracture was between the amount due to ischaemic heart disease and the amount due to stroke.