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PubMed1994

Nationwide study of decisions concerning the end of life in general practice in The Netherlands.

OBJECTIVE: To gain insight into decisions made in general practice about the end of life. DESIGN: Study I: interviews with 405 physicians. Study II: analysis of death certificates with data obtained on 5197 cases in which decisions about the end of life may have been made. Study III: prospective study with doctors from study I: questionnaires used to collect information about 2257 deaths. The information was representative for all deaths in the Netherlands. RESULTS: Over two fifths of all patients in the Netherlands die at home. General practitioners took fewer decisions about the end of life than hospital doctors and doctors in nursing homes (34%, 40%, and 56% of all dying patients, respectively). Specifically, decisions to withhold or withdraw treatment to prolong life were taken less often. Euthanasia or assisted suicide, however, was performed in 3.2% of all deaths in general practice compared with 1.4% in hospital practice. In over half of the cases concerning pain relief or non-treatment general practitioners did not discuss the decision with the patient, mostly because of incapacity of the patient, but in 20% of cases for "paternalistic" reasons. Older general practitioners discussed such decisions less often with their patients. Colleagues were consulted more often if the general practitioner worked in group practice. CONCLUSION: Differences in work situation between general practitioners and hospital doctors and differences between the group of general practitioners contribute to differences in the number and type of decisions about the end of life as well as in the decision making process.

Aged↗
PubMed1995

Programme for preventing perinatal hepatitis B infection through screening of pregnant women and immunisation of infants of infected mothers in The Netherlands, 1989-92. National Hepatitis B Steering Committee.

OBJECTIVES: To launch a programme for the prevention of perinatal infection with hepatitis B in the Netherlands. DESIGN: Routine antenatal screening and intervention programme. SETTING: Community antenatal programme, the Netherlands. SUBJECTS: Infants of mothers who were carriers of hepatitis B detected by routine screening. INTERVENTIONS: Infants of infected mothers received hepatitis B immunoglobulin at birth and four doses of hepatitis B vaccine in conjunction with routine immunisation at 3, 4, 5, and 11 months of age. MAIN OUTCOME MEASURES: Results of screening and immunisation from 1989-92. RESULTS: The coverage of screening increased from 46% in 1989 to 84% in 1992. Hepatitis B surface antigen was detected in 2145 women (0.44%). The coverage of postnatal immunoprophylaxis in 1645 neonates born to mothers who were carriers of hepatitis B was 85% (1391); in 3% (42) there was a delay in administration of immunoglobulin of over 24 hours. In 1991, 96% (537), 95% (532), 94% (525), and 87% (489) of the infants received the first, second, third, and fourth dose of vaccine, respectively. There was considerable variation in the timing of vaccination; 17% (258) of the infants received their first dose more than two weeks late. Of the 59% (583) of infants who received the fourth dose more than two weeks beyond target age, 14% (141) also received their first dose too late. CONCLUSIONS: A prevention programme for perinatal hepatitis B in an area of low prevalence, when incorporated into existing health care, is feasible and achieves satisfactory coverage rates. Intensive follow up is needed to improve adherence to the immunisation schedule.

Age Factors↗
PubMed1996

Outcome of planned home and planned hospital births in low risk pregnancies: prospective study in midwifery practices in The Netherlands.

OBJECTIVE: To investigate the relation between the intended place of birth (home or hospital) and perinatal outcome in women with low risk pregnancies after controlling for parity and social, medical, and obstetric background. DESIGN: Analysis of prospective data from midwives and their clients. SETTING: 54 midwifery practices in the province of Gelderland, Netherlands. SUBJECTS: 97 midwives and 1836 women with low risk pregnancies who had planned to give birth at home or in hospital. MAIN OUTCOME MEASURE: Perinatal outcome index based on "maximal result with minimal intervention" and incorporating 22 items on childbirth, 9 on the condition of the newborn, and 5 on the mother after the birth. RESULTS: There was no relation between the planned place of birth and perinatal outcome in primiparous women when controlling for a favourable or less favourable background. In multiparous women, perinatal outcome was significantly better for planned home births than for planned hospital births, with or without control for background variables. CONCLUSIONS: The outcome of planned home births is at least as good as that of planned hospital births in women at low risk receiving midwifery care in the Netherlands.

Choice Behavior↗
PubMed1997

Dietary pattern and 20 year mortality in elderly men in Finland, Italy, and The Netherlands: longitudinal cohort study.

OBJECTIVE: To investigate the association of dietary pattern and mortality in international data. DESIGN: Cohort study with 20 years' follow up of mortality. SETTING: Five cohorts in Finland, the Netherlands, and Italy. SUBJECTS: Population based random sample of 3045 men aged 50-70 years in 1970. MAIN OUTCOME MEASURES: Food intake was estimated using a cross check dietary history. In this dietary survey method, the usual food consumption pattern in the 6-12 months is estimated. A healthy diet indicator was calculated for the dietary pattern, using the World Health Organisation's guidelines for the prevention of chronic diseases. Vital status was verified after 20 years of follow up, and death rates were calculated. RESULTS: Dietary intake varied greatly in 1970 between the three countries. In Finland and the Netherlands the intake of saturated fatty acids and cholesterol was high and the intake of alcohol was low; in Italy the opposite was observed. In total 1796 men (59%) died during 20 years of follow up. The healthy diet indicator was inversely associated with mortality (P for trend < 0.05). After adjustment for age, smoking, and alcohol consumption, the relative risk in the group with the healthiest diet indicator compared with the group with the least healthy was 0.87 (95% confidence interval 0.77 to 0.98). Estimated relative risks were essentially similar within each country. CONCLUSIONS: Dietary intake of men aged 50-70 is associated with a 20 year, all cause mortality in different cultures. The healthy diet indicator is useful in evaluating the relation of mortality to dietary patterns.

Aged↗
PubMed2004

Risk of complications of pregnancy in women with type 1 diabetes: nationwide prospective study in the Netherlands.

OBJECTIVE: To investigate maternal, perinatal, and neonatal outcomes of pregnancies in women with type 1 diabetes in the Netherlands. DESIGN: Nationwide prospective cohort study. SETTING: All 118 hospitals in the Netherlands. PARTICIPANTS: 323 women with type 1 diabetes who became pregnant between 1 April 1999 and 1 April 2000. MAIN OUTCOME MEASURES: Maternal, perinatal, and neonatal outcomes of pregnancy. RESULTS: 84% (n = 271) of the pregnancies were planned. Glycaemic control early in pregnancy was good in most women (HbA(1c) < or = 7.0% in 75% (n = 212) of the population), and folic acid supplementation was adequate in 70% (n = 226). 314 pregnancies that went beyond 24 weeks' gestation resulted in 324 infants. The rates of pre-eclampsia (40; 12.7%), preterm delivery (101; 32.2%), caesarean section (139; 44.3%), maternal mortality (2; 0.6%), congenital malformations (29; 8.8%), perinatal mortality (9; 2.8%), and macrosomia (146; 45.1%) were considerably higher than in the general population. Neonatal morbidity (one or more complications) was extremely high (260; 80.2%). The incidence of major congenital malformations was significantly lower in planned pregnancies than in unplanned pregnancies (4.2% (n = 11) v 12.2% (n = 6); relative risk 0.34, 95% confidence interval 0.13 to 0.88). CONCLUSION: Despite a high frequency of planned pregnancies, resulting in overall good glycaemic control (early) in pregnancy and a high rate of adequate use of folic acid, maternal and perinatal complications were still increased in women with type 1 diabetes. Neonatal morbidity, especially hypoglycaemia, was also extremely high. Near optimal maternal glycaemic control (HbA1c < or = 7.0%) apparently is not good enough.

Adult↗
PubMed1997

The appropriateness of intention to treat decisions for invasive therapy in coronary artery disease in The Netherlands.

OBJECTIVE: To determine the appropriateness of intention to treat decisions concerning coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA) for patients with coronary artery disease in The Netherlands. DESIGN: Prospective study of intention to treat decisions using a computerised expert system. SETTING: "Presentation" sessions in 10 tertiary referral heart centres in 1992. PATIENTS: 3207 consecutive patients: 1618 CABG and 1589 PTCA candidates. MAIN OUTCOME MEASURE: Percentage of invasive treatment decisions rated appropriate, uncertain, or inappropriate by the expert system. RESULTS: PTCA decisions were common for patients with one-vessel disease and CABG decisions for patients with three-vessel and left main disease. PTCA decisions outnumbered CABG decisions in acute myocardial infarction. Of CABG decisions, 84% were rated appropriate, 12% uncertain, and 4% inappropriate. The proportions for PTCA decisions were 39% appropriate, 31% uncertain, and 29% inappropriate. Type C lesion was the main determinant of inappropriateness of PTCA decisions. If type C lesions were downgraded to type A/B lesions the rate of inappropriate PTCA decisions dropped to 6%. CONCLUSIONS: Clinicians in tertiary referral centres in The Netherlands favoured CABG if vessel disease was extensive or involved the left main artery, and PTCA for patients with less extensive disease and with acute myocardial infarction. Few CABG decisions were inappropriate. The main determinant of inappropriateness of PTCA decisions was its intended use in patients with type C lesions.

Aged↗
PubMed1999

Death on the waiting list for cardiac surgery in The Netherlands in 1994 and 1995.

OBJECTIVE: To describe the causes and circumstances of death regarding patients who died in 1994 and 1995 while on a waiting list for cardiac surgery in the Netherlands. DESIGN: Retrospective multicentre case study. SETTING: 11 Dutch cardiac surgery centres. PATIENTS: All patients reported as dying while on the waiting list for cardiac surgery in 1994 and 1995. MAIN OUTCOME MEASURES: Classification of death by an independent adjudication committee into "erroneously reported", "waiting list related" or "not waiting list related". Death was judged as "waiting list related" if the clinical course would have been substantially different if there had been unrestricted surgical capacity. RESULTS: 138 and 129 deaths were reported in 1994 and 1995, respectively. 43 deaths (16%) were considered as erroneously reported. 181 of the remaining 224 cases were adjudicated as waiting list related. Median time from acceptance for surgery to death was 35 days (interquartile range 14-75 days). 97 of 181 deaths occurred within six weeks following addition to the waiting list. The estimated incidence of death ranged from 1.33 per 1000 patient-weeks during weeks 2-4 to 0.68 per 1000 patient-weeks after 12 weeks. CONCLUSIONS: The causes and circumstances of death are waiting list related for approximately 100 patients per year in the Netherlands. At least half of the deaths may occur within the first six weeks. Waiting lists for cardiac surgery engender high risks for the patients involved.

Cardiac Surgical Procedures↗
PubMed2006

Injury mortality among ethnic minority groups in the Netherlands.

OBJECTIVES: To prepare a comprehensive overview of ethnic differences in injury related mortality in the Netherlands and to determine the role of area income and urbanisation degree. METHODS: Data for the period 1995-2000 were obtained from the population and cause of death registries. Injury related death rates were compared for persons from Turkish, Moroccans, Surinamese, and Antillean/Aruban origin with rates for the native Dutch population. RESULTS: Compared with the native Dutch population, all ethnic minorities combined had an increased mortality for all injuries together (RR = 1.29). Ethnic minorities experienced a significantly higher risk of death from pedestrian accidents (RR = 1.87), drowning (RR = 2.58), poisoning (RR = 1.76), fire and scalds (RR = 1.95), and homicide (RR = 3.24). Mortality for cyclists (RR = 0.53) and motorcycle drivers (RR = 0.47) was significantly lower among ethnic minorities compared with the native Dutch. Adjustment for area income and urbanisation decreased the mortality risk difference for most of the non-traffic injuries, but showed a difference in risk for car driver and passenger accidents (RR = 1.37). Compared with the native Dutch inhabitants, Surinamese and Antillean/Aruban population had a higher risk of total injury mortality (RR = 1.33 and 1.53 respectively), while Turkish and Moroccans had increased risk only for selected conditions. Inequalities in injury mortality were the highest among children and young adults, but persisted in the age group above 50 years old. CONCLUSION: Ethnic differences in injury mortality in the Netherlands strongly depended on type of injury, ethnic group, sex, and age. Policies should be aimed at the prevention of high risk injuries among the most vulnerable ages and ethnic groups.

Accidents↗
PubMed1991

All cause mortality and its determinants in middle aged men in Finland, The Netherlands, and Italy in a 25 year follow up.

STUDY OBJECTIVE: The aims were (1) to compare all cause mortality in population samples of different cultures; and (2) to cross predict fatal event by risk functions involving risk factors usually measured in cardiovascular epidemiology. DESIGN: The study was a 25 year prospective cohort study. The prediction of all cause mortality was made using the multiple logistic equation as a function of 12 risk factors; the prediction of months lived after entry examination was made by the multiple linear regression using the same factors. POPULATION SAMPLES: There were five cohorts of men aged 40-59 years, from Finland (two cohorts, 1677 men), from The Netherlands (one cohort, 878 men), and from Italy (two cohorts, 1712 men). SETTING: The Finnish cohorts came from geographically defined rural areas, the Dutch cohort from a small town in central Holland, and the Italian cohorts from rural villages in northern and central Italy. MEASUREMENTS AND MAIN RESULTS: All cause mortality was highest in Finland (557 per 1000), and lower in The Netherlands (477) and in Italy (475). The solutions of the multiple logistic function showed the significant and almost universal predictive role of certain factors, with rare exceptions. These were age, blood pressure, cigarette smoking, and arm circumference (the latter with a negative relationship). Similar results were obtained when solving a multiple linear regression equation predicting the number of months lived after entry examination as a function of the same factors. The prediction of fatal events in each country, using the risk functions of the others, produced limited errors, the smallest one being -2% and the largest +11%. When solving the logistic model in the pool of all the cohorts with the addition of dummy variables for the identification of nationality, it also appeared that only a small part of the mortality differences between countries is not explained by 12 available risk factors. CONCLUSIONS: A small set of risk factors seems to explain the intercohort differences of 25 year all cause mortality in population samples of three rather different cultures.

Adult↗
PubMed1992

Seasonal variation in mortality in The Netherlands.

STUDY OBJECTIVE: The aim was to describe the pattern of seasonal variation in all cause mortality in The Netherlands, and to analyse the contribution of specific causes of death to the winter excess of all cause mortality. DESIGN: Daily numbers of deaths in The Netherlands, by cause, were obtained for the period 1979-1987. Patterns of variation were analysed using Poisson regression. The model related the observed number of deaths to (1) the number expected for that day on the basis of person-days at risk by age and sex, (2) secular trend, and (3) first and higher order cosine terms where appropriate. MAIN RESULTS: All cause mortality has a bimodal peak in the first months of the year. After that it declines to reach a plateau in late spring. Mortality is lowest at the end of August, after which it rises steeply again. The winter excess of all cause mortality is primarily due to cardiovascular diseases (66%) and respiratory conditions (13%). Cardiovascular mortality peaks before respiratory mortality, suggesting different lag times in the effects of winter. There was an episode of exceptionally high mortality (above the normal winter excess) in early 1986, which was primarily due to cardiovascular diseases (39%) and respiratory conditions (25%). This episode was probably caused by a severe influenza epidemic, and was not followed by a compensatory lowering of mortality. CONCLUSIONS: The pattern of variation of mortality within the year suggests that it is not based on a simple relationship with climatological circumstances, because the latter fluctuate according to a less complex pattern. Cause specific data suggest an instantaneous effect of "winter" on the cardiovascular system, and a delayed effect mediated by respiratory infections.

Cause of Death↗
PubMed1995

Lung cancer: is there an association with socioeconomic status in The Netherlands?

STUDY OBJECTIVE: To evaluate if there are differences in lung cancer incidence between socioeconomic groups in the Netherlands and if so, if smoking habits and other lifestyle characteristics could explain these differences. DESIGN: Prospective cohort study. Baseline measurement included information on socioeconomic status, smoking habits, and other covariates by means of a self-administered questionnaire. Follow up was established by computerised record linkage to cancer registries and a pathology register. SETTING: Population originating from 204 municipalities in The Netherlands. PARTICIPANTS: 58,279 men aged 55-69 years in September 1986. After 3.3 years of follow up 490 microscopically confirmed incident lung cancer cases were detected. MAIN RESULTS: An inverse association between lung cancer risk and highest level of education was found, which persisted after adjustment for age, smoking, dietary intake of vitamin C, beta-carotene and retinol (rate ratio (RR) highest/lowest level of education = 0.52, 95% CI 0.33, 0.82, trend p < 0.001). Men with a lower white collar profession had a significantly lower relative rate of lung cancer compared with blue collar workers (RR = 0.66, 95% CI 0.47, 0.96), but after adjustment for smoking habits this difference was reduced (RR = 0.73, 95% CI 0.51, 1.08). CONCLUSIONS: There is an inverse association between highest level of education and lung cancer, which is still apparent after adjustment for age, smoking, dietary intake of vitamin C, beta-carotene and retinol. The significantly lower lung cancer risk of lower white collar workers compared with the risk of blue collar workers could be partially explained by smoking habits.

Age Factors↗
PubMed1995

Variation in reported prevalences of hypertension in The Netherlands: the impact of methodological variables.

STUDY OBJECTIVE: To estimate the prevalence of hypertension in The Netherlands and to quantify the influence of methodological variables on the reported prevalences. DESIGN: A pooled analysis was performed based on reported age specific prevalences of hypertension. A logistic model was used to estimate the probability of hypertension. MAIN RESULTS: The age standardised prevalence of hypertension varies more than fivefold between studies carried out in The Netherlands. The probability of having hypertension was lower if blood pressure was measured at more than one point in time (Odds ratio 0.44 (OR) (95% confidence interval (95% CI) 0.38, 0.51) for men and 0.47 (0.41, 0.54) for women, and if the study was carried out more recently (OR 0.92 (0.91, 0.93) per year). The probability was higher if the study was carried out in a general practice (OR 1.14 (1.03, 1.27) for men and 1.52 (1.36, 1.69) for women). The inclusion of treated people as hypertensive yields contradictory results for men and women. CONCLUSIONS: The strong variation in prevalence is explained by methodology and by a period effect indicating a decrease of the prevalence of hypertension over time. Whether this decrease is true or caused by confounding due to unknown or unreported methodological variation over time is unknown. For future studies, a standardised method could reduce the influence of methodological variables and thereby the variation in reported prevalences.

Adult↗
PubMed1996

Short term effects of air pollution on emergency hospital admissions for respiratory disease: results of the APHEA project in two major cities in The Netherlands, 1977-89.

STUDY OBJECTIVE: To assess the short term relationship between air pollution and the daily number of emergency hospital admissions for respiratory disease. DESIGN: Data were analysed using autoregressive Poisson regression allowing for overdispersion and controlling for possible confounding factors such as seasonal and other chronological variables, meteorological factors, and influenza epidemics. SETTING: The two major cities in The Netherlands-Amsterdam (694,700 inhabitants) and Rotterdam (576,200 inhabitants). PARTICIPANTS AND MEASUREMENTS: Emergency hospital admissions for respiratory diseases, registered on a daily basis by the National Medical Registration, for the period 1977-89 were used. ICD-9 codes included were: respiratory (460-519), chronic obstructive pulmonary disease (490-492, 494, 496), and asthma (493). The mean (range) of the total daily number of admissions for these three classifications were as follows: 6.70 (0-23), 1.74 (0-9) and 1.13 (0-7) respectively in Amsterdam and 4.79 (0-19), 1.57 (0-9), and 0.53 (0-5) in Rotterdam. Air pollution measurements were provided by the National Institute of Public Health and Environmental Protection. In The Netherlands, air pollution is at a low to moderate ("summer type") or a low ("winter type") level. The levels in Amsterdam and Rotterdam did not differ much for the "summer type". For 1977-89 the mean (range) values of ozone (O3), the "summer type" pollutant (O3-8 h), were 86 (0-252) micrograms/m3 in Amsterdam and 82 (0-286) micrograms/m3 in Rotterdam. The mean (range) of the values "winter type", pollutant, sulphur dioxide (SO2-24 h), were 38 (0-381) micrograms/m3 in Amsterdam and 50 (1-379) micrograms/m3 in Rotterdam. For black smoke (BS-24 h), values were 14 (1-84) micrograms/m3 and 28 (1-144) micrograms/m3 respectively (1986-89). MAIN RESULTS: Ozone had a non-significant positive effect on the number of respiratory emergency admissions in summer in people aged > or = 65 years (relative risk for a 100 micrograms/m3 increase in O3-8 h of 1.127 (0.983, 1.292) in Amsterdam and a significant positive effect of 1.344 (1.097, 1.647) in 1977-81 in Rotterdam). Sulphur dioxide did not show any clear effects; in Amsterdam a significant negative effect was even found. The same was true for nitrogen dioxide in Amsterdam; in Rotterdam, however, nitrogen dioxide showed non-significant positive effects (RR 0.965, 1.342). Black smoke did not show any clear effects in Amsterdam; in Rotterdam it was positively but not significantly related to the number of admissions. CONCLUSIONS: The results show that the relation between short term air pollution and emergency hospital admissions is not always consistent at these rather low levels of daily hospital admissions and of air pollution.

Adolescent↗
PubMed1998

Is immunising all patients with chronic lung disease in the community against influenza cost effective? Evidence from a general practice based clinical prospective cohort study in Utrecht, The Netherlands.

STUDY OBJECTIVE: There is little information on the potential benefit of immunising all patients with chronic lung disease in the community against influenza. The clinical effectiveness and economic benefit was established of the influenza vaccination programme in a general practice based cohort of adult patients with chronic lung disease followed up during the 1995/96 influenza A epidemic. DESIGN: A prospective cohort study from October 1995 to March 1996. SETTING: The study was undertaken in the Utrecht General Practices Network with six large group practices, covering a total population of approximately 50,000 patients in the Netherlands. PATIENTS: Computerised medical records of 1696 patients with chronic lung disease aged over 18 years with an indication for vaccination according to the Dutch GP guidelines were reviewed. MAIN RESULTS: The overall attack rate of any complication, including all cause death, low respiratory tract infection, and acute cardiac disease was 15%. Exacerbations of lung disease were most frequent (13%). Death, pneumonia, and acute cardiac disease were mainly limited to patients > or = 65 years. No effectiveness of the immunisation programme could be established in patients 18-64 years (n = 1066), after controlling for baseline prognosis in multivariable logistic regression analysis. In vaccinees > or = 65 years (n = 630), the occurrence of any complication was reduced by 50% (95% CI 17, 70%). The economic benefit was estimated at 50 Pounds per elderly vaccinee. CONCLUSIONS: This study suggests that in the Netherlands immunisation of elderly patients with chronic lung disease against influenza is effective and cost-saving, hence these patients should be given high priority. More, preferably experimental, studies are needed to establish whether adult lung patients under 65 years in the community will also benefit from vaccination.

Adult↗
PubMed1999

Voluntary euthanasia under control? Further empirical evidence from The Netherlands.

Nineteen ninety-six saw the publication of a major Dutch survey into euthanasia in the Netherlands. This paper outlines the main statistical findings of this survey and considers whether it shows that voluntary euthanasia is under effective control in the Netherlands. The paper concludes that although there has been some improvement in compliance with procedural requirements, the practice of voluntary euthanasia remains beyond effective control.

Empirical Research↗
PubMed1999

Hospice and euthanasia in The Netherlands: an ethical point of view.

This contribution is a report of a two months' participant observation in a Dutch hospice. The goal of the observation was to gain an overview of moral decisions in a hospice in which euthanasia, a tolerated practice in the Netherlands, is not accepted as an option. In an introduction, the development of palliative care in the Netherlands will be briefly presented. Subsequently, various moral decisions that were taken during the participant observation are presented and analysed by means of case reports. Attention is especially drawn to decisions that directly or indirectly relate to euthanasia. These moral decisions will be clarified in the light of the philosophy behind the concept of palliative care as it has evolved since the foundation of St Christopher's Hospice, London in 1967.

Ethics, Medical↗
PubMed1998

Evaluation of the effect of breast cancer screening by record linkage with the cancer registry, The Netherlands.

OBJECTIVE: To evaluate the effect of a breast cancer screening programme by record linkage with the cancer registry. SETTING: Breast cancer screening programme in mid- and southern Limburg, the Netherlands. METHODS: The data files of the breast cancer screening programme and the Maastricht Cancer Registry were linked in order to evaluate the effect of breast cancer screening. Only the first primary breast tumour was included in the evaluation. RESULTS: From 1990 until 1995 90 001 women participated in the first round of the breast cancer screening programme and 64 637 in subsequent rounds. After the introduction of screening the annual number of breast cancer diagnoses increased by almost 50%. The incidence decreased to previous levels after completion of the first screening round. Record linkage detected 219 interval cancers (within two and a half years of a screening), a proportionate incidence of 31% in the first year and 60% in the second year of the two-year interval between screenings. The incidence of node positive breast cancer was 1% lower in 1994 and 15% lower in 1995 than the incidence in the period 1987-90. CONCLUSIONS: Evaluation of the effect of breast cancer screening in the Netherlands can be performed using routinely available cancer registry data. The results of this evaluation seem promising, but further studies are necessary to find ways to reduce the incidence of interval cancer.

Adult↗
PubMed1999

Trends in mammography 1991-96 and the impact of nationwide screening in The Netherlands.

OBJECTIVES: To investigate the impact of the population based breast screening programme on total uptake of mammography in the Netherlands. SETTING: The Netherlands; breast screening programme for women aged 50-69; 21,820 women who participated in the 1991-96 Health Interview Survey (HIS). METHODS: HIS data linked to data related to the start of the screening programme in different municipalities investigating mammography use, reasons for mammography, and further assessment procedures. RESULTS: Among women aged 50-69 the percentage who had recently undergone mammography (in the year of the HIS or two years before) increased from 20% in 1991 to 70% in 1996, which was entirely due to screening. The percentage of women in this age group who had had a recent clinical mammogram (outside the screening programme) varied between 8 and 12% and did not change significantly in municipalities without screening. There was no change in the uptake of mammography among women under 50 years of age. Among women over 70 there was only a small increase in this percentage from 6 to 13%, partially due to screening mammograms. In municipalities in which screening had started, precaution is mentioned as a reason for a recent clinical mammogram among women aged less than 70 more often than in municipalities without screening. Furthermore, mammography performed because of complaints is mentioned less in all age groups after the introduction of screening. After a clinical mammogram, further assessment procedures (cytology/needle biopsies 8%, biopsies 10%) were considered necessary about 10 times more often than after a screening mammogram. CONCLUSIONS: Although the screening programme has almost no impact on the frequency of mammography in women who underwent a clinical mammogram, there has been a shift in reasons for these mammograms more towards reasons of prevention. Screening mammograms lead to a much smaller percentage of additional examinations than do clinical mammograms.

Adolescent↗