Implementation of service screening with mammography in Sweden: from pilot study to nationwide programme
|
|
- Philippa Floyd
- 7 years ago
- Views:
Transcription
1 14 J Med Screen 2000;7:14 18 Implementation of service screening with mammography in Sweden: from pilot study to nationwide programme Silas Olsson, Ingvar Andersson, Ingvar Karlberg, Nils Bjurstam, Ewa Frodis, Stefan Håkansson Swedish Institute for Health Services Development, Stockholm, Sweden S Olsson S Håkansson Malmö University Hospital, MAS, Malmö, Sweden I Andersson National Board of Health and Welfare, Stockholm, Sweden I Karlberg Institute of Selected Clinical Sciences, Department of Radiology, Gothenburg University, Sweden N Bjurstam Västerås Central Hospital, Västerås, Sweden E Frodis Correspondence to: Mr Silas Olsson, Telia Research, SE Farsta, Sweden silas.a.olsson@telia.se Accepted for publication 23 February 2000 Abstract Establishment of mammography screening in Sweden has progressed logically from pilot study through clinical trials to service screening. Screening with mammography for early detection of breast cancer has been provided by all Sweden s 26 county councils since It took 23 years from the initial pilot study through clinical trials to the establishment of mammography service screening throughout Sweden. In the screening rounds completed by , and provided by all but one county council, women participated, corresponding to 81% of those invited. The national average recall rate was 2.2%, and consequently women were recalled for additional investigations. Eleven county councils invited women aged 40 74, six invited women aged 50 69, the remaining eight invited women between both these age intervals. Mammography outside screening programmes clinical mammography is available throughout Sweden. About women a year were referred for clinical mammography and about 50% of these were either younger or older than those invited for screening. A negative relation between the use of clinical mammography and participation in the screening programmes was noticed. (J Med Screen 2000;7:14 18) Keywords: mammography; breast cancer; cost analysis Screening with mammography is one of the largest public health evorts to promote women s health in Sweden. The national service screening programme is an example of evidence based medicine, starting with a pilot study in Gävleborg county council in and continuing with several randomised clinical trials later in the 1970s. 2 4 Based on the results of the two counties (WE) study the National Board of Health and Welfare in Sweden published General guidelines on mammographic screening in These basic recommendations for mammography screening included women aged between 40 and 74. As a result of the amendments of the national recommendations in 1987 and 1988, screening of women only from 50 to 69 years of age was allowed if county councils were short of trained stav. 6 7 The recommendations resulted in a rapid divusion of service screening among the county councils. In the following years, data from the WE study and from other clinical trials accumulated. 3 4 An overview (pooled data from five individual studies from Sweden) in 1993 showed a 24% reduction in breast cancer mortality after years among those invited for screening compared with those not invited. 8 Additional data on women below age 50 at entry were published in 1997 and 1998 showing a statistically significant reduction in breast cancer mortality in this age group also On the basis of the new evidence, the National Board of Health and Welfare issued a revised version of the national recommendations towards the end of The main difference from the previous version was a clearer recommendation to include women aged The public part of Swedish health care was, at the time of this study, provided by 23 county councils (geographically defined areas governed by regional governments regarding for example, health care) and three municipalities, Gothenburg, Malmö, and Gotland that is, 26 healthcare areas. In 1999 some county councils merged to form larger regions. In this report, for practical purposes, we describe the healthcare system as having 26 county councils. The county councils operate independently within the legal frame of legislation set by the national government and are financed mainly by regional taxation, patient fees, and national governmental support. The decision to implement screening programmes or not is the responsibility of the county councils. The success of the screening programme depends on many factors, including participation rate and the total exposure to mammography that is, mammography screening and clinical mammography. Methods of survey Radiologists responsible for mammography screening, departmental heads and medical directors in radiology, and private providers of mammography in all county councils in Sweden were surveyed by postal questionnaires in 1989 and After reminder letters, the response rate from the two surveys was 100% During specific data of the surveys were updated by questionnaires, letters, and phone calls. 12
2 Mammography screening in Sweden WE study published National recommendations County councils Year Figure 1 Establishment of mammography screening by all the 26 county councils in Sweden. Pilot and trials during 1974 to The diagram indicates the publication dates of the WE report 2 and the General Guidelines on Mammographic Screening by the National Board of Health and Welfare in Sweden. 5 Results DIFFUSION OF MAMMOGRAPHY SCREENING PROGRAMMES In 1988, 15 county councils provided service screening programmes. By 1992, 22 of Sweden s 26 county councils provided screening programmes. The introduction was delayed in the remaining four county councils owing to lack of stav and facilities under construction. Three of these started service screening programmes during The last, Gotland, started screening in Consequently, from the pilot study in 1974, it took 23 years to establish mammography screening among all the county councils in Sweden. Figure 1 illustrates the establishment of mammography screening in Sweden. Most service screening programmes were introduced after publication of the results from the WE study 2 and the subsequent national recommendations. 5 By 1997 all county councils in Sweden provided mammography screening based on active invitation. The problem of stayng the mammography screening programmes can be illustrated by the major shortage in personnel reported by all but two of the county councils in In 1993 the situation had improved substantially, but still seven county councils continued to be short of qualified stav. Between 1996 and 1999, a lack of radiologists again became apparent, at least in part due to the retirement of the first generation of mammography screening radiologists. AGE GROUPS, PARTICIPATION, RECALL RATE, AND PATIENT FEES In Sweden there are 1.8 million women aged between 40 and 74 and 0.96 million women aged between 50 and 69. In the screening round, performed mainly between 1989 and 1992 in 22 county councils, women participated, corresponding to a participation rate of 81% (63 89%). This can be compared with the screening round completed in in 25 county councils where women participated, corresponding to 81% (66 91%) of those invited. In this round of screening, 11 county councils invited women aged 40 74, six invited women aged 50 69, and the remaining eight invited women between these two age intervals. Screening programmes which include women below the age of 50 had a higher participation rate. The national average recall rate for further investigations was 3.5% in 1988, 2.9% in 1992, and 2.2% in 1995 ( %). Given an average recall rate of 2.2%, this means that about women were recalled for additional investigations, which in most cases implied a complete mammography examination only. Table 1 shows the basic data on mammography screening programmes in Sweden in Based on data from 23 county councils, nearly all screening programmes in 1993 used two x ray images for each breast in the first round of screening, and thereafter one or two images, depending mainly on the radiological density of the breast and the woman s age. Occasionally, programmes used the one or two image method throughout. Double reading of mammograms (two radiologists review each case), as recommended by the national guidelines, was used in 15 screening programmes, partially in five programmes, and in three programmes single reading was used. The fee paid by the woman (not reimbursed) for the screening in 1997 was about $13 (104 SEK, ranging between 0 and 170 SEK among the county councils). The remaining cost for the screening is paid by the county councils. There was no apparent relation between the fee and the rate of participation (R 2 (adj) = 0.06). WAITING TIMES One important factor determining the degree of anxiety produced by the screening programme is the waiting time for the results of the examination and recall for further examinations In % of Sweden s screening centres normally sent a letter to women within three days describing the results of the examination, 35% sent the results within four to 10 days, and 17% sent the results within 11 to 14 days. Waiting times at the remaining screening centres (one third) were
3 16 Olsson, Andersson, Karlberg, et al Table 1 Basic data on mammography screening programmes in Sweden in The Swedish county councils and municipalities with authority for health care Start of mammography screening Age groups invited Screening interval (months) Number of women invited in the screening round Participation in screening round (%) Screening fee that womenhavetopay, (1997) (SEK) Stockholm (5 sites) * Uppsala Sörmland (120) Östergötland (100) Jönköping, East Jönköping, West Kronoberg Kalmar Blekinge Kristianstad, Krist Kristianstad, Ängel Malmöhus Halland Bohus Älvsborg, North Älvsborg, South Skaraborg Värmland Örebro Västmanland (100) Dalarna Gävleborg Västernorrland (150) Jämtland ** Västerbotten Norrbotten Malmö, municipality Gothenburg, municipality Gotland, municipality Started 1997 (40 69) (18 20) (10 000) (89) (80) Total, year mean 81 mean 99 (104) (Total, year 1993) ( ) (mean 81) (mean 91) * South hospital started Changed to in 1997, to in Depending on age or tissue density. **Screening programme started during insuyciently reported. If further investigation was required, women were notified by letter or telephone by 10% of the screening centres within three days, by one third of the centres within four to 10 days, and by 23% within 11 to 14 days. The remaining one third of providers either did not answer this question or provided insuycient information. CLINICAL MAMMOGRAPHY Clinical mammography denotes a mammography examination following referral, usually owing to symptoms or anxiety. Clinical mammography was introduced in Sweden during the 1960s, in Gothenburg, Stockholm, and Gävleborg county councils, and became established in the remaining county councils during the 1970s. Modern mammography using molybdenum technology was introduced in Sweden in 1968 in Gothenburg. In 1992, 61 hospitals in Sweden (out of about 90 in total) provided clinical mammography. In 1993 privately operated clinical mammography services were available at 12 locations in the metropolitan areas of Gothenburg, Malmö, Stockholm, and Uppsala. Between 1988 and 1992 the total volume of clinical mammography provided by the county councils and the private facilities declined from to women examined a year, corresponding to a reduction of 8%. During this time the volume of private clinical mammography declined from to , a reduction of 15%, and public clinical Attendance rate in screening programmes (%) Sweden (mean) Gothenburg 70 Malmö Stockholm Clinical mammography per 1000 women (all ages) Figure 2 Possible relation between participation in screening programmes (the screening rounds until 1992) and the scope of clinical mammography (1992). Each symbol in the diagram corresponds to one screening programme. 15
4 Mammography screening in Sweden 17 mammography declined from to women examined, a reduction of 5%. The tendency for women of all ages to seek clinical mammography has been studied. The results, based on a sample of approximately 40% of the clinical mammography volume in 1992, show that 30% of the women receiving clinical mammography from public health services are younger than the minimum screening age of women invited for screening in their respective county councils. The corresponding fraction in the private sector is 47%. In both the public and private sectors, 14% of women were older than the maximum age of women invited to screening programmes. This means that half of the women undergoing clinical mammography were either younger or older than the age group invited for screening in the county councils respectively. Participation in screening programmes completed by 1992 varied from 63% to 89%. This participation was compared with the distribution of clinical mammography to show how clinical mammography possibly influenced participation in the screening programmes. Figure 2 shows that participation in the screening programmes was lowest in the three metropolitan areas of Stockholm, Gothenburg, and Malmö, where clinical mammography was most frequent. The average use of clinical mammography in the 10 county councils that have provided screening programmes since 1988 or earlier (excluding Stockholm, Gothenburg, and Malmö) was 15 women per 1000 female inhabitants and per year (1992). The corresponding average for all county councils with screening programmes, excluding and including respectively the metropolitan areas, was 18 (17 and 20 for counties using age intervals of years and 50 69/74 years respectively) and 28 women per 1000 female inhabitants and per year. The average clinical mammography volume in the three county councils with no screening programmes in 1994 was 39 women examined per 1000 female inhabitants and per year. Clinical mammography in Stockholm, Gothenburg, and Malmö averaged 50 women examined per 1000 female inhabitants and per year (1992). Discussion Service screening with mammography for early detection of breast cancer is an example of evidence based medicine. After a pilot study, clinical trials, and national recommendations it took only five years to implement service screening in most county councils (fig 1). The total time span from the pilot study to nationwide coverage of service screening was 23 years. However, the pros and cons of service screening with mammography have been debated by the professionals and politicians in Sweden, sometimes intensely. One such debate resulted in a complete stop of service screening in one county council for six months in Participation in Sweden s mammography service screening programmes was high, with an average of 81% and a range from 66% to 91% in the diverent programmes. The larger metropolitan areas were chiefly responsible for pulling the national average down. One of the reasons seems to be the relation found between the greater use of clinical mammography in the large metropolitan areas and lower participation in the screening programmes. Socioeconomic and other factors may also contribute to the lower participation in the metropolitan areas. In the city of Malmö, which is the third largest city in Sweden, a correlation has been found between attendance and registered unemployment, income support, and foreign backgrounds (Matson S, et al, unpublished data). The county councils have adopted diverent age intervals when inviting women for screening owing to lack of stav or other resources and probably also because they valued the benefits of mammography screening diverently. The fraction of women recalled from the screening programmes for supplementary examinations decreased from 3.5% to 2.2% as national averages, from 1988 to The recall rate was higher in the first round of screening. This may be explained partly by the fact that more cases of cancer appeared in the first round than in subsequent screening rounds, and partly by the fact that the later rounds had the advantage of comparison films and also increasing experience among the radiologists. Thus the round of screening completed in resulted in recall of about women. The anxiety experienced by some women in conjunction with additional investigations is receiving increasing attention Additional work up also represents a substantial cost Although this recall fraction is low by international levels, a reduction of the number of false positive cases is essential. Substantially improving the predictive value of initial screening will probably require new methods of investigation. Digital mammography and computer based image analysis systems as well as magnetic resonance tomography may contribute in this direction. Digital mammography together with telemammography, when appropriately developed, will open new possibilities for distant reading and review of the mammograms, quality assurance, and organisational development. Clinical mammography is available throughout Sweden. This activity declined somewhat when screening programmes were started. One reason why the decline has not been greater, despite the major expansion of mammography screening during the period, is probably that 50% of the women who demand and receive clinical mammograms are outside the ages invited for screening. This should be taken into consideration when discussing age groups to be invited to screening programmes. Another reason for the continued high use may be the easy access to clinical mammography in metropolitan areas. Conclusions The establishment of mammography screening in Sweden represents a logical series of events,
5 18 Olsson, Andersson, Karlberg, et al from pilot study through clinical trials to service screening. Although the entire process took 23 years, after the production of scientific evidence service screening was rapidly established in most of the county councils with a high degree of acceptance among invited women. We thank colleagues and others who responded to the survey and contributed information to this study, and also B Lundgren, Gävle, S Törnberg, Stockholm, and L Nyström, Umeå, for specific statistical data, and Erik Grönqvist, Stockholm, for statistical analysis. 1 Lundgren B, Jakobsson S. Single-view mammography. A simple and eycient approach to breast cancer screening. Cancer 1976;38: Tabár L, Gad A, Holmberg LH, et al. Reduction in mortality from breast cancer after mass screening with mammography. Lancet 1985;i: Andersson I, Aspegren K, Janzon L, et al. Mammographic screening and mortality from breast cancer. The Malmö mammographic screening trial. BMJ 1988;297: Frisell J, Eklund G, Hellström L, et al. Randomized study of mammography screening: preliminary report on mortality in the Stockholm trial. Breast Cancer Res Treat 1991;18: Mammografiscreening: hälsokontroll för tidig upptäckt av bröstcancer. [General guidelines on mammographic screening: health check-up of early discovery of breast cancer.] Socialstyrelsen, Stockholm, Sweden: National Board of Health and Welfare, (Allmänna råd från Socialstyrelsen, Liber 1986:3.) 6 Om ändring i förslag till riktlinjer för mammografi-screening. [About changes in the suggested guide-lines for mammographic screening.] Socialstyrelsen, Stockholm, Sweden: National Board of Health and Welfare, (Meddelandeblad 15/87.) 7 Till samtliga landsting beträvande mammografiscreening.[to all county-councils concerning mammographic screening.] Socialstyrelsen, Stockholm, Sweden: National Board of Health and Welfare, (Letters to all county-councils.) 8 Nyström L, Rutqvist LE, Wall S, et al. Breast cancer screening with mammography: overview of Swedish randomised trials. Lancet 1993;341: Andersson I, Jansson L. Reduced breast cancer mortality in women under age 50: updated results from the Malmö mammographic screening program. J Natl Cancer Inst 1997;22: Bjurstam N, Björneld L, DuVy SW,et al. The Gothenburg Breast Screening Trial. First results on mortality, incidence, and mode of detection for women aged years at randomization. Cancer 1997;80: Larsson LG, Andersson I, Bjurstam N, et al. Updated overview of the Swedish randomized trials on breast screening with mammography: age group at randomization. J Natl Cancer Inst 1997;22: Hälsoundersökning med mammografi. [Screening with mammography.] Socialstyrelsen, Stockholm, Sweden: National Board of Health and Welfare, Olsson S, Lithander E. Mammografiverksamhetens utbredning och omfattning i Sverige: sammanställning av en enkätstudie. [The establishment of the mammographic work in Sweden: a specification of a study of inquiries.] Stockholm: Spri, Lennholm B. Enkätstudie om mammografi i Sverige: regionalt ojämn utbyggnad - inga resurser för screening i åtta landsting. [A study of inquiries about mammography in Sweden: a regionally uneven extension - no resources for screening in eight county-councils.] Läkartidningen 1989; 86: , Olsson S, Andersson I, Bjurstam N, et al kvinnor per år undersöks med mammografi: var femte inbjuden avstår från screening. [ women are each year examined using mammography: every fifth who is invited gives up screening.] Läkartidningen 1995;92: Ellman R, Angeli N, Christians A, et al. Psychiatric morbidity associated with screening for breast cancer. Br J Cancer 1989;60: Olsson P, Armelius K, Lenner P, et al. Mammografiscreening: en pilotstudie på de psykologiska evekterna. [Mammographic screening: a pilotstudy of the psychological evects.] Läkartidningen 1993;90: , Lidbrink E, Elfving J, Frisell J, et al. Neglected aspects of false positive findings of mammography in breast cancer screening: analysis from the Stockholm trial. BMJ 1996;312: Hurley SF, Huggins RM, Jolley DJ, et al. Recruitment activities and sociodemographic factors that predict attendance at a mammographic screening program. Am J Public Health 1994;84: Kiefe CI, McKay S, Halevy A, et al. Is cost a barrier to screening mammography for low-income women receiving medicare benefits? Arch Intern Med 1994;154: Svensson H, Håkansson S. Hälsokontroll med mammografi: kostnader och nytta. [Health check-up with mammography: costs and benefits.] Stockholm: Spri, (Spri rapport 298.)
Quality Report: The Labour Cost Survey 2008 in Sweden
December 2010 Quality Report: The Labour Cost Survey 2008 in Sweden Statistics Sweden Department of economic statistics Unit for salary and labour cost statistics Mrs Veronica Andersson veronica.andersson@scb.se
More informationThe Constitution of the Swedish Social Democratic Party
The Constitution of the Swedish Social Democratic Party Adopted by the party congress of 1997 with amendments decided on by the party congress of 2001 and the standard constitution adopted by the National
More informationSeaside recreation in the Stockholm archipelago:
SUCOZOMA 20 January, 2000 Project 1.2.1, subproject on benefits Draft Beijer Discussionpaper No 129 Seaside recreation in the Stockholm archipelago: travel patterns and costs by Mikael Sandström a, Henrik
More informationSWEDEN. Rural Development. 5.1 Strategic orientation of the Rural Development Policy
SWEDEN Rural Development 5.1 Strategic orientation of the Rural Development Policy In the Government Communication on sustainable development, the Rural Development Policy is discussed primarily within
More informationHow To Decide If You Should Get A Mammogram
American Medical Women s Association Position Paper on Principals of Breast Cancer Screening Breast cancer affects one woman in eight in the United States and is the most common cancer diagnosed in women
More informationCurrent Status and Problems of Breast Cancer Screening
Research and Reviews Current Status and Problems of Breast Cancer Screening JMAJ 52(1): 45 49, 2009 Noriaki OHUCHI,* 1,2 Akihiko SUZUKI,* 1,3 Yuu SAKURAI,* 1,4 Masaaki KAWAI,* 1 Yoko NARIKAWA,* 1 Hiroto
More informationCase Study submitted to NGVA Europe by The Swedish Gas Centre
NGVA Europe Case Study: Methane Powered Urban Transport in Sweden Public Transport Buses Case Study submitted to NGVA Europe by The Swedish Gas Centre November 2010 Case Study. November 2010 Methane Transport
More information137 people drowned 2014
NUMBER OF FATALITIES CAUSED BY DROWNING DURING Many swimming accidents amongst elders 137 people drowned According to the Swedish Lifesaving Society s, SLS, summary 137 people have lost their lives in
More informationThe evolution and utility of a national stroke registry: the Swedish experience
The evolution and utility of a national stroke registry: the experience Thomas Linden MD, PhD National Stroke Research Institute, Melbourne Gothenburg University, Sweden More info riks-stroke@medicin.umu.se
More informationStrategies for cancer care in Sweden
Strategies for cancer care in Sweden Bo Lindblom National Board of Health and Welfare Stockholm, Sweden Commission of inquiry 2007-2009 Principal investigator: DG Kerstin Wigzell Committee members Long
More informationWorking in Sweden. Information for doctors from EU/EEA countries. Swedish Medical Association National Board of Health and Welfare 2003 1
Working in Sweden Information for doctors from EU/EEA countries Swedish Medical Association National Board of Health and Welfare 2003 1 Contents Legal aspects on the recognition of diplomas... 4 Administrative
More informationThe Economy Report. ON SWEDISH MUNICIPAL AND COUNTY COUNCIL FINANCES OCTOBER 2012
The Economy Report. ON SWEDISH MUNICIPAL AND COUNTY COUNCIL FINANCES OCTOBER 2012 Information concerning the content of the report: Jessica Bylund tel +46 8 452 7718 Annika Wallenskog tel +46 8 452 7746
More informationBreast Cancer Survey. GfK HealthCare. A study conducted for Siemens Communication Sector, Erlangen. January 2011
.. Breast Cancer Survey GfK HealthCare A study conducted for Siemens Communication Sector, Erlangen January Agenda Study design Study results in detail Realization of sample Management summary Study design
More informationLarge infrastructure projects in Sweden. Lotta Brändström Executive Director, Major Projects
Large infrastructure projects in Sweden Lotta Brändström Executive Director, Major Projects Why was the Swedish Transport Administration created? An overall approach to all modes of transport A clearer
More informationMiljömålen på ny grund
Miljömålen på ny grund Naturvårdsverkets utökade årliga redovisning av miljökvalitetsmålen 2011 Reviderad version av rapport 6420 rapport 6433 maj 2011 figure 1 Greenhouse gas emissions in Sweden, 1990
More informationA case-control study to estimate the impact on breast cancer death of the breast screening programme in Wales
07 Fielder cpp 5/11/04 12:04 PM Page 194 194 ORIGINAL PAPER A case-control study to estimate the impact on breast cancer death of the breast screening programme in Wales HM Fielder, J Warwick, D Brook,
More informationSetting up and registering as a self-employed person in Sweden
Setting up and registering as a self-employed person 1/7 Photo: www.imagebank.sweden.se Louise Billgert Setting up and registering as a self-employed person in Sweden This is an introduction for individuals
More informationCertification protocol for breast screening and breast diagnostic services
Certification protocol for breast screening and breast diagnostic services Authors N. Perry R. Holland M. Broeders H. Rijken M. Rosselli del Turco C. de Wolf This is a revised version of the original EUREF
More informationScreening Mammography for Breast Cancer: American College of Preventive Medicine Practice Policy Statement
Screening Mammography for Breast Cancer: American College of Preventive Medicine Practice Policy Statement Rebecca Ferrini, MD, Elizabeth Mannino, MD, Edith Ramsdell, MD and Linda Hill, MD, MPH Burden
More informationSWEDISH GENEALOGY BEGINNING SWEDISH GENEALOGY AND DISCUSSION OF RESOURCES. Kathy Meade
SWEDISH GENEALOGY BEGINNING SWEDISH GENEALOGY AND DISCUSSION OF RESOURCES Kathy Meade Presentation Overview Introduction Sweden Country and Emigration Begin Your Search Names and Spelling Geography Find
More informationIMMIGRANT DOCTORS. a Swedish healthcare resource
IMMIGRANT DOCTORS a Swedish healthcare resource A summary of the action programme of the Swedish Medical Association and the Swedish Society of Medicine Swedish Medical Association Swedish Society of Medicine
More informationallvarligt läge en rapport om svensk odontologisk forskning
allvarligt läge en rapport om svensk odontologisk forskning VETENSKAPSRÅDETS RAPPORTSERIE 3:2007 Allvarligt läge en rapport om svensk odontologisk forskning ALLVARLIGT LÄGE en rapport om svensk odontologisk
More informationEarly Life Interventions: Evidence from the Swedish Maternity and Infant Health Care Program
Early Life Interventions: Evidence from the Swedish Maternity and Infant Health Care Program Martin Karlsson (University of Duisburg-Essen) Therese Nilsson (Lund University) Sarah Okoampah* (University
More informationSweden Theme of Aphasia Day 2014 Nordic Action Local activities in Sweden Västerbotten and Umeå Southern Lapland / Wilhelmina Skelleftea
Sweden Theme of Aphasia Day 2014 Sweden is going to work with theme for Aphasia Day - discrimination in communicative rehabilitation depending of age. In Sweden it is even harder to get communicative rehabilitation
More informationn Economic Commentaries
n Economic Commentaries In recent years, the analysis of household indebtedness has been based on aggregate data or random samples of new borrowers. It is not possible to analyse the allocation of debt
More informationEarly detection through mammography. Early breast cancer detection improved chances of recovery
Early detection through mammography Early breast cancer detection improved chances of recovery Contents 03 Experts recommend breast screening (mammography) 04 What is mammogram? 05 What is screening? What
More informationPersonalized Breast Screening Service
Frequently Asked Questions WHAT IS BREAST DENSITY? Breasts are made up of a mixture of fibrous, glandular and fatty tissue. Your breasts are considered if you have predominantly fibrous or glandular tissue
More informationAdvantages when Changing to a Nationwide Reference System Experiences from Umeå, a Municipality in Northern Sweden
Advantages when Changing to a Nationwide Reference System Experiences from Umeå, a Municipality in Kerstin HEGNER and Lars E. ENGBERG, Sweden Keywords: Digital cadastre; Geoinformation/GI; GPS; Positioning;
More informationAn Action Guide for Supplemental Cancer Screening for Women with Dense Breasts: Next Steps for Patients, Clinicians, and Insurers
Supplemental Screening Tests Following Negative Mammography in Women with Dense Breast Tissue The California Technology Assessment Forum An Action Guide for Supplemental Cancer Screening for Women with
More informationCulture and experience Health
48 Culture and experience Health Health The health of a population reflects both the lives of citizens and the health system's ability to prevent and cure diseases. With regard to health and welfare, there
More informationHomelessness in Sweden 2005. scale and character
Homelessness in Sweden 2005 scale and character The Board classifies its publications into different types of document. This is a Situation description. This means that it contains reports on and analysis
More informationBlind dates: quasi-experimental evidence on discrimination
Blind dates: quasi-experimental evidence on discrimination Per-Anders Edin Jonas Lagerström WORKING PAPER 2006:4 The Institute for Labour Market Policy Evaluation (IFAU) is a research institute under the
More informationCosts of Radiotherapy
æoriginal ARTICLE æ Costs of Radiotherapy Anders Norlund for the SBU Survey Group* From the SBU, Stockholm, Sweden Correspondence to: Anders Norlund, SBU, Box 5650, SE-114 86 Stockholm, Sweden. Tel: /46
More informationBreastScreen and You. Information about mammographic screening
BreastScreen and You Information about mammographic screening This information is about screening for breast cancer. It aims to help you choose whether or not you take part in the BreastScreen Australia
More informationCecilia Skingsley: Household debt under the microscope
Cecilia Skingsley: Household debt under the microscope Speech by Ms Cecilia Skingsley, Deputy Governor of the Sveriges Riksbank, at SABOs (the Swedish Association of Public Housing Companies) Finance Day,
More informationadvance and after-sale information Group Insurance including Disability Insurance Illness
group insurance advance and after-sale information Group Insurance including Disability Insurance Illness Applicable as of January 1, 2010 Information on Group Insurance including Disability Insurance
More informationprovided a variety of health services to 13,067 people at 243 community sites, staffing 381
Saint Peter s University Hospital 1 Saint Peter s University Hospital, through its Community Mobile Health Services, provided a variety of health services to 13,067 people at 243 community sites, staffing
More information1. History In 2003, the Prosecutor-General created the National Anti-Corruption Unit (NACU).
Sweden The National Anti-Corruption Unit (NACU) 1. History In 2003, the Prosecutor-General created the National Anti-Corruption Unit (NACU). 2. Structure The unit initially consisted of three prosecutors
More informationMedicare Part B. Mammograms - Updated Billing Guide for Screening and Diagnostic Tests
Mammograms - Updated Billing Guide for Screening and Diagnostic Tests This article from Medicare B News Issue 223 dated October 21, 2005 is being updated and reprinted to ensure that the Noridian Administrative
More information2. Incidence, prevalence and duration of breastfeeding
2. Incidence, prevalence and duration of breastfeeding Key Findings Mothers in the UK are breastfeeding their babies for longer with one in three mothers still breastfeeding at six months in 2010 compared
More informationThe PLCO Trial Not a comparison of Screening vs no Screening
PSA Screening: Science, Politics and Uncertainty David F. Penson, MD, MPH Hamilton and Howd Chair of Urologic Oncology Professor and Chair, Department of Urologic Surgery Director, Center for Surgical
More informationPENSIONS AT A GLANCE 2011: RETIREMENT-INCOME SYSTEMS IN OECD COUNTRIES SWEDEN
PENSIONS AT A GLANCE 2011: RETIREMENT-INCOME SYSTEMS IN OECD COUNTRIES Online Country Profiles, including personal income tax and social security contributions SWEDEN Sweden: pension system in 2008 The
More informationBreast Imaging Made Brief and Simple. Jane Clayton MD Associate Professor Department of Radiology LSUHSC New Orleans, LA
Breast Imaging Made Brief and Simple Jane Clayton MD Associate Professor Department of Radiology LSUHSC New Orleans, LA What women are referred for breast imaging? Two groups of women are referred for
More informationAuthor: Sirje Padam, WSP Sweden and Tallinn University of Technology
Challenges of SEA in regional planning in Sweden Author: Sirje Padam, WSP Sweden and Tallinn University of Technology E-mail: sirje.padam@wspgroup.se 1. Introduction Swedish counties are obliged to have
More informationBreast Cancer Screening in Low- and Middle-Income Countries A Framework To Choose Screening Strategies
Breast Cancer Screening in Low- and Middle-Income Countries A Framework To Choose Screening Strategies Richard Wender, MD Session code: www.worldcancercongress.org A Five Step Framework to Guide Screening
More informationForeword. Table of content
1 Table of content 2 Foreword 3 A House of Literature is a Room for Arts in Reading 4 It could be virtual Squoosh, enjoy writing! in the County of Östergötland 4 It could be physical The House of Literature
More informationSustaining a High-Quality Breast MRI Practice
Sustaining a High-Quality Breast MRI Practice Christoph Lee, MD, MSHS Associate Professor of Radiology Adjunct Associate Professor, Health Services University of Washington September 11, 2015 Overview
More informationWisconsin Cancer Data Bulletin Wisconsin Department of Health Services Division of Public Health Office of Health Informatics
Wisconsin Cancer Data Bulletin Wisconsin Department of Health Services Division of Public Health Office of Health Informatics In Situ Breast Cancer in Wisconsin INTRODUCTION This bulletin provides information
More informationNOTTINGHAM UNIVERSITY HOSPITAL NHS TRUST NOTTINGHAM BREAST INSTITUTE BREAST AND OVARIAN FAMILY HISTORY GUIDELINES
NOTTINGHAM UNIVERSITY HOSPITAL NHS TRUST NOTTINGHAM BREAST INSTITUTE BREAST AND OVARIAN FAMILY HISTORY GUIDELINES GP Referrals All GP referrals for asymptomatic women with a family history of breast and/or
More informationAUDIT REPORT, SUMMARY. Summary. Government measures against overindebtedness SWEDISH NATIONAL AUDIT OFFICE
AUDIT REPORT, SUMMARY 1 Summary Government measures against overindebtedness (RiR 2015:14) SWEDISH NATIONAL AUDIT OFFICE 1 Government measures against overindebtedness The Debt Relief Act regulates three
More informationTerms and conditions and rules for registering domain names with.se
Terms and conditions and rules for registering domain names with.se Updated October 11, 2010.SE s operations, including the administration and management of top-level.se domain names, are governed by the
More informationFollow-up care plan after treatment for breast cancer. A guide for General Practitioners
Follow-up care plan after treatment for breast cancer A guide for General Practitioners This leaflet provides information for GPs on the follow-up care required by women who had breast cancer. It is for
More informationFalköping A Safe Community
Falköping A Safe Community Municipality Municipality of Falköping Country Sweden Population 2003 30 991 Start of program 1979 A Safe Community 1991 Contact person Public health planner Ingela Backman Höglander
More informationSweden. Qualifying conditions. Benefit calculation. Earnings-related. Key indicators. Sweden: Pension system in 2012
Sweden Sweden: Pension system in 212 The earnings-related part is based on notional accounts and there is a small mandatory contribution to individual, defined-contribution funded pensions. There is also
More informationBreast Density Legislation: Implications for primary care providers
Breast Density Legislation: Implications for primary care providers Deborah J. Rhodes MD Associate Professor of Medicine 2012 MFMER slide-1 Disclosure Relevant financial relationship(s) None Off-label
More informationBreast Screening Explained. We can supply this information in other languages, in large print, on audio or in Braille.
Breast Screening Explained We can supply this information in other languages, in large print, on audio or in Braille. Breast Screening Explained This leaflet tells you about free breast screening. Breast
More informationBottleneck Vacancies in Sweden
Bottleneck Vacancies in Sweden Unmet demand for workers in the health care and ICT sector Main bottlenecks appear within health care and the ICT sector. A revival of the mining sector after a steep decline
More informationLA Hardesty MD, D Glueck PhD, K Lind MPH, JR Lambert, DJ Knapp BS RT. Recommended Frequency of Screening Mammography Continues to be Debated
Improving Compliance with Screening Mammography Guidelines in an Insured Population by Initiating a Mobile Mammography Program to Increase Access in a Metropolitan Area LA Hardesty MD, D Glueck PhD, K
More informationOffice of Population Health Genomics
Office of Population Health Genomics Policy: Protocol for the management of female BRCA mutation carriers in Western Australia Purpose: Best Practice guidelines for the management of female BRCA mutation
More informationSWECARE FOUNDATION. Uniting the Swedish health care sector for increased international competitiveness
SWECARE FOUNDATION Uniting the Swedish health care sector for increased international competitiveness SWEDEN IN BRIEF Population: approx. 9 800 000 (2015) GDP/capita: approx. EUR 43 300 (2015) Unemployment
More informationPSA Screening and the USPSTF Understanding the Controversy
PSA Screening and the USPSTF Understanding the Controversy Peter C. Albertsen Division of Urology University of Connecticut Farmington, CT, USA USPSTF Final Report 1 Four Key Questions 1. Does PSA based
More informationUpdated March 7, 2012
Updated March 7, 2012 (If there is deviation in this document from the Terms and Conditions for the registration of the Top- Level.se suffix, the Terms and Conditions shall prevail)..se s operations, including
More informationPeab AB (publ) Brinova Fastigheter AB
Information for Peab s shareholders prior to the ordinary annual general meeting 15 May 2003 Information for shareholders of Peab AB (publ) regarding the distribution of Brinova Fastigheter AB Table of
More informationPECKIANA Volume 8 (2012) pp. 109 115
PECKIANA Volume 8 (2012) pp. 109 115 ISSN 1618-1735 The distribution of the hazel dormouse (Muscardinus avellanarius) in Sweden Abstract The geographic range of the hazel dormouse (Muscardinus avellanarius)
More informationBrief description of data collections so far within the longitudinal research program Individual Development and Adaptation (IDA) Updated 2011-12-01
1 Brief description of data collections so far within the longitudinal research program Individual Development and Adaptation (IDA) Updated 2011-12-01 2 IDA data collections for the main group born 1955
More informationThe price elasticity for alcohol in Sweden 1984 2003
THOR NORSTRÖM Research report The price elasticity for alcohol in Sweden 1984 2003 Introduction The price of alcohol is considered to be one of the most important instruments for regulating overall consumption.
More informationColorado Cancer Coalition Priorities: 2016 2018
Option 3 of 10: Screening & Early Detection: Screening Rates Presenter: Toni Panetta, MA, Director of Mission Programs, Susan G. Komen Colorado Goal 5: Objective 5.1: Objective 5.2 Focus Area: Focus Area:
More informationCancer in Primary Care: Prostate Cancer Screening. How and How often? Should we and in which patients?
Cancer in Primary Care: Prostate Cancer Screening How and How often? Should we and in which patients? PLCO trial (Prostate, Lung, Colorectal and Ovarian) Results In the screening group, rates of compliance
More informationAn Action Guide for Supplemental Cancer Screening for Women with Dense Breasts: Next Steps for Patients, Clinicians, and Insurers
Supplemental Screening Tests Following Negative Mammography in Women with Dense Breast Tissue The New England Comparative Effectiveness Public Advisory Council An Action Guide for Supplemental Cancer Screening
More informationCancer Screening. Robert L. Robinson, MD, MS. Ambulatory Conference SIU School of Medicine Department of Internal Medicine.
Cancer Screening Robert L. Robinson, MD, MS Ambulatory Conference SIU School of Medicine Department of Internal Medicine March 13, 2003 Why screen for cancer? Early diagnosis often has a favorable prognosis
More informationIncreasing Cancer Screening: Client Reminders Breast Cancer
Increasing Cancer : Client Reminders Breast Cancer Summary Evidence Table Studies From the Updated Search Period population Crawford (2005) 2002-2003 : Other design with concurrent comparsion : US, Eastern
More informationPre test Question 2. Emily D. Babcock, DHSc, PA C, DFAAPA CAPA Annual Conference Palm Springs, California October 4, 2013
Emily D. Babcock, DHSc, PA C, DFAAPA CAPA Annual Conference Palm Springs, California October 4, 2013 Objectives After completion of this presentation, the participant will be able to: Explain the current
More information12. Regional differences in sick leave. Long lasting stress and exhaustion. Mental disorders on the increase. Can work make you sick?
25 2 15 1 5 Long lasting stress and exhaustion Senior professor Marie Åsberg, Karolinska institutet 12. stressforskningskonference den København 22 okt. 215 Sjukpenningtalet Sick leave in Sweden Days on
More informationShould I Continue Having Mammograms to Screen for Breast Cancer? A decision aid for women aged 70 and older at their next screening mammogram.
Should I Continue Having Mammograms to Screen for Breast Cancer? A decision aid for women aged 70 and older at their next screening mammogram. AUSTRALIAN SCREENING MAMMOGRAPHY DECISION AID TRIAL Why is
More informationChapter 5.10: Major public health problems dental health
Scandinavian Journal of Public Health, 2006; 34(Suppl 67): 139 146 Chapter 5.10: Major public health problems dental health AGNETA EKMAN National Board of Health and Welfare, Stockholm, Sweden N Children
More informationThe EFGCP Report on The Procedure for the Ethical Review of Protocols for Clinical Research Projects in Europe (Update: April 2012) Sweden
The Procedure for the Ethical Review of Protocols for Clinical Research Projects in Europe Sweden Question 1: What laws or regulations apply to an application for conducting a clinical trial in Sweden?
More informationAGREEMENT REGARDING RULES OF COOPERATION
AGREEMENT REGARDING RULES OF COOPERATION CONCERNING HEALTHCARE FINANCED BY PUBLIC FUNDING, THE PHARMACEUTICAL INDUSTRY, THE MEDICAL TECHNOLOGY INDUSTRY AND THE LABORATORY TECHNOLOGY INDUSTRY The Swedish
More informationWorking as a government employee in Sweden benefits and terms
Working as a government employee in Sweden benefits and terms ÄÄÅÅ of employment In the service of citizens Pay Working hours Holiday Work leave Pay and other benefits during sick leave Work environment
More informationSMS 112 in Sweden. Table of contents
SMS 112 in Sweden SMS 112 in Sweden Table of contents Background... 4 Results... 4 General description of the service... 5 SMS function... 5 Telephone... 5 Cooperation with other relay services... 6 Operator
More informationCompetence Development for Success and Security. Unionen s political platform for competence development
Competence Development for Success and Security Unionen s political platform for competence development Competence Development - for success and security When we learn new things and have the courage to
More informationSpecialist training of Saudi Arabian doctors in Sweden
Specialist training of Saudi Arabian doctors in Sweden 2015 Sweden- GENERAL FACTS Sweden is the third-largest country in the European Union by area, total population of about 9.7 million. Sweden is a unitary
More informationAVIATIONTRENDS Statistics, analysis and information from the swedish transport agency 2009
AVIATIONTRENDS Statistics, analysis and information from the swedish transport agency 2009 facts 28.1 million passengers in scheduled and charter traffic at Swedish airports, an increase of 3.4 per cent.
More informationThe Shortage of Specialist Nurses in Sweden
Stockholm School of Economics Department of Economics Bachelor s Thesis The Shortage of Specialist Nurses in Sweden Abstract The Swedish National Board of Health and Welfare reported in 2010 that there
More informationCONSOLIDATED GUIDANCE ON STANDARDS FOR THE NHS BREAST SCREENING PROGRAMME
CONSOLIDATED GUIDANCE ON STANDARDS FOR THE NHS BREAST SCREENING PROGRAMME NHSBSP Publication No 60 (Version 2) April 2005 Published by: NHS Cancer Screening Programmes The Manor House 260 Ecclesall Road
More informationDeveloping a model of total cost of ownership for evaluation of purchases at Saab Microwave Systems
Developing a model of total cost of ownership for evaluation of purchases at Saab Microwave Systems Erika Bodehed May 2008 Lund University, Faculty of Engineering, Department of Industrial Management and
More informationStricter Sickness and Disability Insurance Systems and Early Retirement
ISF Report 2014:7 Stricter Sickness and Disability Insurance Systems and Early Retirement Swedish Social Insurance Inspectorate www.inspsf.se Stockholm 2014 Inspektionen för socialförsäkringen Authors:
More informationExpansion of the Ontario Breast Screening Program (OBSP) to Include Women Aged 30 to 69 at High Risk for Breast Cancer
To: Physicians, Nurse Practitioners, Genetics Clinics, Hospitals and LHINs Published By: Implementation Branch Date Issued: June 27, 2011 Bulletin #: 10016 Re: Expansion of the Ontario Breast Screening
More informationInfrared Thermography Not a Useful Breast Cancer Screening Tool
Contact: Jeanne-Marie Phillips Sharon Grutman HealthFlash Marketing The American Society of Breast Surgeons 203-977-3333 877-992-5470 Infrared Thermography Not a Useful Breast Cancer Screening Tool Mammography
More informationBMJ 2014;348:g366 doi: 10.1136/bmj.g366 Page 1 of 10
BMJ 2014;348:g366 doi: 10.1136/bmj.g366 Page 1 of 10 Research Twenty five year follow-up for breast cancer incidence and mortality of the Canadian National Breast Screening Study: randomised screening
More informationNOTE THAT THIS IS NOT A PROCUREMENT NOTE THAT THIS IS A TRANSLATION AND NOT THE VALID DOCUMENT
NOTE THAT THIS IS NOT A PROCUREMENT NOTE THAT THIS IS A TRANSLATION AND NOT THE VALID DOCUMENT MÄLAB Regional Rail Service 2017 Consultation prior to procurement (CPP) NOTE THAT THIS IS NOT A PROCUREMENT
More informationEvaluation and Management of the Breast Mass. Gary Dunnington,, M.D. Department of Surgery Internal Medicine Ambulatory Conference December 4, 2003
Evaluation and Management of the Breast Mass Gary Dunnington,, M.D. Department of Surgery Internal Medicine Ambulatory Conference December 4, 2003 Common Presentations of Breast Disease Breast Mass Abnormal
More informationKarolinska Institutet is one of the world's leading medical universities. Its mission is to contribute to the improvement of human health through
In brief 2012-2013 Karolinska Institutet Karolinska Institutet is one of the world's leading medical universities. Its mission is to contribute to the improvement of human health through research and education.
More informationFrance Chapter. Salary by Employment Level, Education Level, Sex, Age, and Years Experience...2
Society for Technical Communication France Chapter 2006 France Salary Survey The France Chapter of the STC recently surveyed people working as technical communicators in France about their salaries. The
More informationCHAMP The Center for Health and Medical Psychology
CHAMP The Center for Health and Medical Psychology Report of External Review Date of review: 28 and 29 April 2009 Reviewers Professor Stephen Morley, University of Leeds Professor Örjan Sundin, Mid Sweden
More informationMeasuring and Improving Radiologists Interpretative Performance on Screening Mammography
Measuring and Improving Radiologists Interpretative Performance on Screening Mammography Karla Kerlikowske, MD Diana Buist,, PhD Patricia Carney, PhD Berta Geller, EdD Diana Miglioretti,, PhD Robert Rosenberg,
More informationBreast Cancer Screening
Breast Cancer Screening The American Cancer Society and Congregational Health Ministry Team October Module To access this module via the Web, visit www.cancer.org and type in congregational health ministry
More informationChart Audits: The how s and why s By: Victoria Kaprielian, MD Barbara Gregory, MPH Dev Sangvai, MD
Chart Audits: The how s and why s By: Victoria Kaprielian, MD Barbara Gregory, MPH Dev Sangvai, MD By Victoria Kaprielian, MD Associate Clinical Professor Barbara Gregory, MPH Quality Analyst Dev Sangvai,
More informationRetirement Income Adequacy With Immediate and Longevity Annuities
May 2011 No. 357 Retirement Income Adequacy With Immediate and Longevity Annuities By Youngkyun Park, Employee Benefit Research Institute UPDATING EARLIER EBRI ANALYSIS: This Issue Brief updates with recent
More informationTerms and conditions for warrants 2016/2019
The English text is an unofficial translation of the Swedish original. In case of any discrepancies between the Swedish text and the English translation, the Swedish text shall prevail. Terms and conditions
More informationFigure 1.1 Percentage of persons without health insurance coverage: all ages, United States, 1997-2001
Figure 1.1 Percentage of persons without health insurance coverage: all ages, United States, 1997-2001 DATA SOURCE: Family Core component of the 1997-2001 National Health Interview Surveys. The estimate
More information