M Hakama

Finnish Cancer Registry, Helsinki, Helsinki, Southern Finland Province, Finland

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Publications (396)1981.59 Total impact

  • 06/2015; DOI:10.1136/bmjgast-2015-000034
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    ABSTRACT: Prostate cancer (PC) screening with prostate-specific antigen (PSA) has been shown to decrease PC mortality in the European Randomized Study of Screening for Prostate Cancer (ERSPC). However, in the Finnish trial, which is the largest component of the ERSPC, no statistically significant mortality reduction was observed. We investigated which had the largest impact on PC deaths in the screening arm: nonparticipation, interval cancers or PSA threshold.The screening (SA) and control (CA) arms comprised altogether 80,144 men. Men in the SA were screened at four-year intervals and referred to biopsy if the PSA concentration was ≥4.0 ng/ml, or 3.0-3.99 ng/ml with a free/total PSA ratio ≤16%. The median follow-up was 15.0 years. A counterfactual exclusion method was applied to estimate the effect of three subgroups in the SA: the nonparticipants, the screen-negative men with PSA ≥3.0ng/ml and a subsequent PC diagnosis, and the men with interval PCs.The absolute risk of PC death was 0.76% in the SA and 0.85% in the CA; the observed hazard ratio (HR) was 0.89 (95% confidence interval (CI) 0.76-1.04). After correcting for nonattendance, the HR was 0.78 (0.64-0.96); predicted effect for a hypothetical PSA threshold of 3.0 ng/ml the HR was 0.88 (0.74-1.04) and after eliminating the effect of interval cancers the HR was 0.88 (0.74-1.04).Nonparticipating men in the SA had a high risk of PC death and a large impact on PC mortality. A hypothetical lower PSA threshold and elimination of interval cancers would have had a less pronounced effect on the screening impact. © 2014 Wiley Periodicals, Inc.
    International Journal of Cancer 05/2015; 136(10). DOI:10.1002/ijc.29300 · 5.01 Impact Factor
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    ABSTRACT: Studies on cancer screening often evaluate the performance by indirect indicators. In case the screening detects pre-invasive lesions, they may be a mixture of benefit of sensitivity and effect as well as of harm of over-diagnosis. Here, we develop the formulae for the sensitivity, the effect, and over-diagnosis in screening for pre-invasive lesions of cancer. Sensitivity is the ability of screening to identify a progressive lesion at the level of test (relevant for the laboratory), episode (relevant in the clinic) and program (relevant at the population level). Effect is reduction of cancer incidence in those screened (efficacy) and in the target population (effectiveness).The sensitivity is estimated by interval cancers between two consecutive screens (incidence method) and the effect by interval cancers and cancers detected at the subsequent screen. Over-diagnosis is estimated as the detection rate of pre-invasive lesions minus the rate of invasive cancer prevented by screening in one screening round. All the indicators are corrected for nonattendance and selective attendance by disease risk. The population to be followed and the period of follow-up are defined for each indicator separately. Data on cervix cancer screening with Papnet® automation device are given as an example.Estimation of sensitivity and effect are consistent with the purpose of the screening to prevent invasive disease. We further define the purpose at the level of laboratory, clinical medicine and public health and derive six estimators corresponding to the specific purposes considered in this paper. © 2014 Wiley Periodicals, Inc.
    International Journal of Cancer 02/2015; 136(4). DOI:10.1002/ijc.29053 · 5.01 Impact Factor
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    ABSTRACT: To estimate the long-term risk of cervical cancer among women screened by visual inspection with acetic acid (VIA) and to evaluate the benefit of additional colposcopy triage in rural south India. A retrospective analysis was conducted among 31 343 women who had undergone VIA at Dindigul district, India between January 1, 2000, and August 5, 2003, as part of a randomized screening trial. Women with positive VIA test results were offered colposcopy triage by trained nurses. Cervical cancer incidence data during follow-up (January 1, 2000, to December 31, 2012) were obtained from a regional cancer registry. Among 3021 screen-positive women free of cancer at baseline, 2974 women underwent colposcopy; colposcopic abnormalities suggestive of precancerous lesions were detected among 2792 of these women (93.9%). Compared with the women with negative VIA screening results, the hazard ratio (HR) of cervical cancer during follow-up among the VIA-positive women without colposcopic abnormalities was 6.5 (95% confidence interval [CI], 1.6-27.1). The risk was similar among VIA-positive women with colposcopic abnormalities but without histological confirmation (HR5.2; 95% CI, 1.9-14.6). The high risk of cancer among women without colposcopic abnormalities who tested positive by VIA suggested that screening without triage is potentially effective. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
    International Journal of Gynecology & Obstetrics 01/2015; 129(2). DOI:10.1016/j.ijgo.2014.11.019 · 1.56 Impact Factor
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    ABSTRACT: Background: Ductal carcinoma in situ (DCIS) incidence has grown with the implementation of screening and its detection varies across International Cancer Screening Network (ICSN) countries. The aim of this survey is to describe the management of screen-detected DCIS in ICSN countries and to evaluate the potential for treatment related morbidity. Methods: We sought screen-detected DCIS data from the ICSN countries identified during 2004-2008. We adopted standardised data collection forms and analysis and explored DCIS diagnosis and treatment processes ranging from pre-operative diagnosis to type of surgery and radiotherapy. Results: Twelve countries contributed data from a total of 15 screening programmes, all from Europe except the United States of America and Japan. Among women aged 50-69 years, 7,176,050 screening tests and 5324 screen-detected DCIS were reported. From 21% to 93% of DCIS had a pre-operative diagnosis (PO); 67-90% of DCIS received breast conservation surgery (BCS), and in 41-100% of the cases this was followed by radiotherapy; 6.4-59% received sentinel lymph node biopsy (SLNB) only and 0.8-49% axillary dissection (ALND) with 0.6% (range by programmes 0-8.1%) being node positive. Among BCS patients 35% received SLNB only and 4.8% received ALND. Starting in 2006, PO and SLNB use increased while ALND remained stable. SLNB and ALND were associated with larger size and higher grade DCIS lesions. Conclusions: Variation in DCIS management among screened women is wide and includes lymph node surgery beyond what is currently recommended. This indicates the presence of varying levels of overtreatment and the potential for its reduction.
    European Journal of Cancer 08/2014; 50:2695-704. DOI:10.1016/j.ejca.2014.07.019 · 4.82 Impact Factor
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    ABSTRACT: Background The European Randomised study of Screening for Prostate Cancer (ERSPC) has shown significant reductions in prostate cancer mortality after 9 years and 11 years of follow-up, but screening is controversial because of adverse events such as overdiagnosis. We provide updated results of mortality from prostate cancer with follow-up to 2010, with analyses truncated at 9, 11, and 13 years. Methods ERSPC is a multicentre, randomised trial with a predefined centralised database, analysis plan, and core age group (55–69 years), which assesses prostate-specific antigen (PSA) testing in eight European countries. Eligible men aged 50–74 years were identified from population registries and randomly assigned by computer generated random numbers to screening or no intervention (control). Investigators were masked to group allocation. The primary outcome was prostate cancer mortality in the core age group. Analysis was by intention to treat. We did a secondary analysis that corrected for selection bias due to non-participation. Only incidence and no mortality data at 9 years’ follow-up are reported for the French centres. This study is registered with Current Controlled Trials, number ISRCTN49127736. Findings With data truncated at 13 years of follow-up, 7408 prostate cancer cases were diagnosed in the intervention group and 6107 cases in the control group. The rate ratio of prostate cancer incidence between the intervention and control groups was 1·91 (95% CI 1·83–1·99) after 9 years (1·64 [1·58–1·69] including France), 1·66 (1·60–1·73) after 11 years, and 1·57 (1·51–1·62) after 13 years. The rate ratio of prostate cancer mortality was 0·85 (0·70–1·03) after 9 years, 0·78 (0·66–0·91) after 11 years, and 0·79 (0·69–0·91) at 13 years. The absolute risk reduction of death from prostate cancer at 13 years was 0·11 per 1000 person-years or 1·28 per 1000 men randomised, which is equivalent to one prostate cancer death averted per 781 (95% CI 490–1929) men invited for screening or one per 27 (17–66) additional prostate cancer detected. After adjustment for non-participation, the rate ratio of prostate cancer mortality in men screened was 0·73 (95% CI 0·61–0·88). Interpretation In this update the ERSPC confirms a substantial reduction in prostate cancer mortality attributable to testing of PSA, with a substantially increased absolute effect at 13 years compared with findings after 9 and 11 years. Despite our findings, further quantification of harms and their reduction are still considered a prerequisite for the introduction of populated-based screening. Funding Each centre had its own funding responsibility.
    The Lancet 08/2014; 384(9959). DOI:10.1016/S0140-6736(14)60525-0 · 45.22 Impact Factor
  • Sanni Helander, Matti Hakama, Nea Malila
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    ABSTRACT: To explore effects of a pre-screening life style survey on the subsequent attendance proportion in colorectal cancer screening. Finnish colorectal cancer screening programme in 2011. Double randomized and controlled follow-up design. The study population comprised of 31,951 individuals born in 1951. In 2010 to a random sample of every sixth (n = 5,312) person we sent a 7-paged life style questionnaire, and to another random sample of every sixth person (n = 5,336) a 10-paged life style and quality of life questionnaire. One year later, in 2011, 31,484 individuals of the original cohort were independently randomized (1:1) for colorectal cancer screening (n = 15,748) or control group (n = 15,736). Of those who were invited for screening, 5185 had received a questionnaire during the previous year. 5870 individuals (55.1 %) responded to the questionnaire in 2010. The overall attendance at screening in 2011 was 59.0 % in those born in 1951 (i.e. the 60-year-olds). In those who had been sent the survey the attendance in screening was 56.6% (57.3% for the short and 56.0% for the long questionnaire) and in those who had not received the questionnaire it was 60.2% (P < 0.001). We believe that the observed reduction in attendance in those who had been sent a questionnaire earlier is generally true. Thus, if any survey is enclosed in the screening invitation, this finding should be taken into account when planning the programme. Any extra effort requested may reduce the attendance proportion for screening, reducing the population level impact of screening.
    Journal of Medical Screening 05/2014; 21(2). DOI:10.1177/0969141314534229 · 2.72 Impact Factor
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    ABSTRACT: Background There is concern about detection of ductal carcinoma in situ (DCIS) in screening mammography. DCIS accounts for a substantial proportion of screen-detected lesions but its effect on breast cancer mortality is debated. The International Cancer Screening Network conducted a comparative analysis to determine variation in DCIS detection. Patients and Methods Data were collected during 2004–2008 on number of screening examinations, detected breast cancers, DCIS cases and Globocan 2008 breast cancer incidence rates derived from national or regional cancer registers. We calculated screen-detection rates for breast cancers and DCIS. Results Data were obtained from 15 screening settings in 12 countries; 7,176,050 screening examinations; 29,605 breast cancers and 5324 DCIS cases. The ratio between highest and lowest breast cancer incidence was 2.88 (95% confidence interval (CI) 2.76–3.00); 2.97 (95% CI 2.51–3.51) for detection of breast cancer; and 3.49 (95% CI 2.70–4.51) for detection of DCIS. Conclusions Considerable international variation was found in DCIS detection. This variation could not be fully explained by variation in incidence nor in breast cancer detection rates. It suggests the potential for wide discrepancies in management of DCIS resulting in overtreatment of indolent DCIS or undertreatment of potentially curable disease. Comprehensive cancer registration is needed to monitor DCIS detection. Efforts to understand discrepancies and standardise management may improve care.
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    ABSTRACT: Background There is concern about detection of ductal carcinoma in situ (DCIS) in screening mammography. DCIS accounts for a substantial proportion of screen-detected lesions but its effect on breast cancer mortality is debated. The International Cancer Screening Network conducted a comparative analysis to determine variation in DCIS detection. Patients and Methods Data were collected during 2004–2008 on number of screening examinations, detected breast cancers, DCIS cases and Globocan 2008 breast cancer incidence rates derived from national or regional cancer registers. We calculated screen-detection rates for breast cancers and DCIS. Results Data were obtained from 15 screening settings in 12 countries; 7,176,050 screening examinations; 29,605 breast cancers and 5324 DCIS cases. The ratio between highest and lowest breast cancer incidence was 2.88 (95% confidence interval (CI) 2.76–3.00); 2.97 (95% CI 2.51–3.51) for detection of breast cancer; and 3.49 (95% CI 2.70–4.51) for detection of DCIS. Conclusions Considerable international variation was found in DCIS detection. This variation could not be fully explained by variation in incidence nor in breast cancer detection rates. It suggests the potential for wide discrepancies in management of DCIS resulting in overtreatment of indolent DCIS or undertreatment of potentially curable disease. Comprehensive cancer registration is needed to monitor DCIS detection. Efforts to understand discrepancies and standardise management may improve care.
    European Journal of Cancer 01/2014; 50(1):185–192. DOI:10.1016/j.ejca.2013.08.013 · 4.82 Impact Factor
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    ABSTRACT: To compare outcome of lower urinary tract symptoms (LUTS) between men with medical and surgical treatment. A questionnaire was mailed to men aged 55, 65 and 75 years living in Tampere region, Finland in 1999 and the survey was repeated in 2004. LUTS were evaluated using DAN-PSS-1 questionnaire. A total of 1679 men (68% of the eligible) responded to both questionnaires. Of them, 114 men reported LUTS at baseline and medical treatment in the repeat survey and 47 men with LUTS had received surgical treatment. Seventy-two men with prostate cancer were excluded. Men with no medical treatment or surgery for LUTS in either questionnaire were included to no-treatment group. The men after surgical treatment showed a reduction in all LUTS symptom groups. However, among the medically treated and untreated men, all the symptoms worsened during the follow up. The proportion of symptomatic men after surgery was lower than among the medically treated men. In men with medical treatment, the prevalence of all 12 LUTS increased. Dysuria and postmicturition dribble were the only symptoms that had slightly better results in medical than in surgical treatment group. In this population-based study, operative treatment seemed to relieve LUTS, whereas medical treatment only slowed down their progression. These findings suggest that men with surgical treatment experience a more favourable outcome in LUTS than those receiving medical treatment.
    International Journal of Clinical Practice 12/2013; 68(3). DOI:10.1111/ijcp.12318 · 2.54 Impact Factor
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    Matti Hakama
    Acta oncologica (Stockholm, Sweden) 06/2013; 52(5):883-5. DOI:10.3109/0284186X.2013.791028 · 3.71 Impact Factor
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    ABSTRACT: We compared test sensitivity (in terms of prevented cancers) and overdiagnosis (in terms of non-progressive pre-invasive lesions) between the human papillomavirus test (HPV test, Hybrid Capture 2) and the traditional Pap test in routine screening for cervical cancer. The design was a randomised (1:1) health services study in Finland with intake between 2003 and 2007. We estimated sensitivity by the incidence method within one screening round. Overdiagnosis was based on the rate of cervical intraepithelial Grade 3 (CIN3) lesions diagnosed at screen and during the following interval. Out of 203,788 randomised women 132,298 attended (65% in both study arms) and 600,753 person-years accumulated among attenders up to the end of 2010. In all attenders, 34 invasive cervical cancers and 288 CIN3 lesions were diagnosed at screen or during the following interval. The interval cancer incidence was 2.5/10(5) person-years (sensitivity 0.87) and 1.4 (sensitivity 0.93) in the HPV arm and Pap test arm, respectively. The rate of CIN3 lesions was 57.1 and 38.8, respectively. In conclusion, sensitivity of HPV testing was similar to that of Pap testing but caused more overdiagnosis. Therefore, implementation of HPV testing needs to be reconsidered especially in countries with well organised programmes.
    International Journal of Cancer 05/2013; 132(9). DOI:10.1002/ijc.27850 · 5.01 Impact Factor
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    ABSTRACT: Background Prostate cancer (PC) screening with prostate-specific antigen (PSA) has been shown to decrease PC mortality by the European Randomized Study of Screening for Prostate Cancer (ERSPC). We evaluated mortality results in the Finnish Prostate Cancer Screening Trial, the largest component of ERSPC. The primary endpoint was PC-specific mortality.MethodsA total of 80 144 men were identified from the population registry and randomized to either a screening arm (SA) or a control arm (CA). Men in the SA were invited to serum PSA determination up to three times with a 4-year interval between each scan and referred to biopsy if the PSA concentration was greater than or equal to 4.0ng/mL or 3.0 to 3.99ng/mL with a free/total PSA ratio less than or equal to 16%. Men in the CA received usual care. The analysis covers follow-up to 12 years from randomization for all men. Hazard ratios (HRs) were estimated for incidence and mortality using Cox proportional hazard model. All statistical tests were two-sided.ResultsPC incidence was 8.8 per 1000 person-years in the SA and 6.6 in the CA (HR = 1.34, 95% confidence interval [CI] = 1.27 to 1.40). The incidence of advanced PC was lower in the SA vs CA arm (1.2 vs 1.6, respectively; HR = 0.73, 95% CI = 0.64 to 0.82; P < .001). No statistically significant difference was observed between the SA and CA (HR = 0.85, 95% CI = 0.69 to 1.04) (with intention-to-screen analysis). To avoid one PC death, we needed to invite 1199 men to screening and to detect 25 PCs. We observed no difference in all-cause mortality between trial arms.Conclusions At 12 years, a relatively conservative screening protocol produced a small, non-statistically significant PC-specific mortality reduction in the Finnish trial, at the cost of moderate overdiagnosis.
    CancerSpectrum Knowledge Environment 03/2013; 105(10). DOI:10.1093/jnci/djt038 · 15.16 Impact Factor
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    ABSTRACT: Background: Prospective cohort studies to determine cofactors with oncogenic HPV- infections for cervical cancer are very rare from developing countries and such data are limited to the few screening trials. Large screening trials provide such data as a by product. Some of the cases are prevented by screening and do not surface as invasive cancers at all. Also, pre-invasive lesions are detected almost entirely by screening. Screening causes selection bias if attendance in or effectiveness of screening is correlated with the risk factors. The aim of this study was to quantify the influence of screening on risk factors for cervical cancer. Materials and Methods: Our material stems from a rural cohort of 80,000 women subjected to a randomised screening trial. The effect of screening on the incidence of cervix cancer was estimated with reference to socio-demographic and reproductive risk factors of cervical cancer. We compared these risks with the incidence of cancer in the randomised control population by the same determinants of risk. Results: The results in the screening arm compared to the control arm showed that the women of low SES and young age were benefitting more than those of high SES and old age. The relative risk by age (30-39 vs 50-59) was 0.33 in the control arm and 0.24 in the screening arm. The relative risk by education (not educated vs educated) was 2.8 in the control arm and 1.8 in the screening arm. The previously married women did not benefit (incidence 113 and 115 per 100,000 women years in control vs screening arms) whereas the effect was substantial in those married (86 vs 54). Conclusions: The results in controls were consistent with the general evidence, but results in attenders and nonattenders of the screening arm showed that screening itself and self-selection in attendance and effectiveness can influence the effect estimates of risk factors. The effect of cervical cancer screening programmes on the estimates of incidence of cervical cancer causes bias in the studies on etiology and, therefore, they should be interpreted with caution.
    Asian Pacific journal of cancer prevention: APJCP 01/2013; 14(1):589-594. DOI:10.7314/APJCP.2013.14.1.589 · 2.51 Impact Factor
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    Matti Hakama, Nea Malila, Joakim Dillner
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    ABSTRACT: The randomised controlled (or clinical) trial (RCT) is recognized as the most valid among the study designs. The use of RCT in research is widespread and well formalised. In contrast, implementations of new methods and policies in routine health care are commonly lacking a formalised design, impairing the ability to evaluate and improve health care. Use of experimental designs in health care is possible at the implementation phase of clinical or preventive action or more broad process-of-care. We propose the terminology randomised health services studies (RHS) to denote the use of a randomised design with observations in routine health care, regardless of whether randomisation is done at individual, population or process level. In contrast to RCT, the RHS should be based on the same regulative actions, funding mechanisms and ethical framework as routine health care itself. This commentary discusses the different basis, practicalities, and formalities that distinguish the RHS from the RCT. Development of a formalised framework for RHS, including distinct registration, could contribute to an increased use of valid methods in effectiveness research, thus gaining better and more direct evidence on routine medical practice.
    International Journal of Cancer 12/2012; 131(12):2898-902. DOI:10.1002/ijc.27561 · 5.01 Impact Factor
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    ABSTRACT: To compare the detection rates of precancerous and cancerous cervical lesions by human papillomavirus (HPV) DNA testing and by conventional cytology screening. Prospective randomised trial. Two cohorts were followed over one screening round of five years, screened initially by primary HPV DNA testing or by primary Pap test. Population based programme for cervical cancer screening in Finland. Women aged 25-65 years invited for screening in 2003-07 (101 678 in HPV arm; 101 747 in conventional cytology arm). INTERVENTION : Women were randomly allocated (1:1) to primary HPV DNA screening followed by cytology triage if they had positive results, or to primary cytology screening. Screening method was disclosed at the screening visit. Trial personnel involved were aware of all test results. Cumulative detection rates of cervical intraepithelial neoplasia (CIN), adenocarcinoma in situ (AIS), and invasive cervical cancer before the second screening (after five years) or before 31 December 2008. Lesions detected at screening and during the five year interval were included. 1010 and 701 precancerous or cancerous lesions were detected during an average follow-up of 3.6 years in the HPV and cytology arms, respectively. Among invited women, the hazard ratio was 1.53 (95% confidence interval l.28 to 1.84) for CIN grade 1, 1.54 (1.33 to 1.78) for CIN 2, 1.32 (1.09 to 1.59) for CIN 3 or AIS, and 0.81 (0.48 to 1.37) for cervical cancer. In 25-34 year old participants, the cumulative hazard (or cumulative detection rate) was 0.0057 (0.0045 to 0.0072) for HPV screening versus 0.0046 (0.0035 to 0.0059) for conventional screening; corresponding data for women aged 35 years and older were 0.0022 (0.0019 to 0.0026) and 0.0017 (0.0014 to 0.0021), respectively. Primary HPV DNA screening detects more cervical lesions than primary cytology within one screening round of five years. Even if the detection rate of CIN 3 or AIS increased in the HPV arm in both age groups, the absolute difference in cumulative rates in women aged 35 years or older was small. By carefully selecting age groups and screening intervals, HPV screening could increase the overall detection rate of cervical precancerous lesions only slightly. However, these findings should be interpreted in the context of the high level of opportunistic screening that occurs in Finland. International Standard Randomised Controlled Trial ISRCTN23885553.
    BMJ (online) 11/2012; 345:e7789. DOI:10.1136/bmj.e7789 · 16.38 Impact Factor
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    ABSTRACT: What's known on the subject? and What does the study add? The ICS has divided LUTS into three groups: storage, voiding and post-micturition symptoms. The classification is based on anatomical, physiological and urodynamic considerations of a theoretical nature. We used principal component analysis (PCA) to determine the inter-correlations of various LUTS, which is a novel approach to research and can strengthen existing knowledge of the phenomenology of LUTS. After we had completed our analyses, another study was published that used a similar approach and results were very similar to those of the present study. We evaluated the constellation of LUTS using PCA of the data from a population-based study that included >4000 men. In our analysis, three components emerged from the 12 LUTS: voiding, storage and incontinence components. Our results indicated that incontinence may be separate from the other storage symptoms and post-micturition symptoms should perhaps be regarded as voiding symptoms. OBJECTIVE: To determine how lower urinary tract symptoms (LUTS) relate to each other and assess if the classification proposed by the International Continence Society (ICS) is consistent with empirical findings. MATERIALS AND METHODS: The information on urinary symptoms for this population-based study was collected using a self-administered postal questionnaire in 2004. The questionnaire was sent to 7470 men, aged 30-80 years, from Pirkanmaa County (Finland), of whom 4384 (58.7%) returned the questionnaire. The Danish Prostatic Symptom Score-1 questionnaire was used to evaluate urinary symptoms. Principal component analysis (PCA) was used to evaluate the inter-correlations among various urinary symptoms. RESULTS: The PCA produced a grouping of 12 LUTS into three categories consisting of voiding, storage and incontinence symptoms. Post-micturition symptoms were related to voiding symptoms, but incontinence symptoms were separate from storage symptoms. In the analyses by age group, similar categorization was found at ages 40, 50, 60 and 80 years, but only two groups of symptoms emerged among men aged 70 years. The prevalence among men aged 30 was too low for meaningful analysis. CONCLUSIONS: This population-based study suggests that LUTS can be divided into three subgroups consisting of voiding, storage and incontinence symptoms based on their inter-correlations. Our empirical findings suggest an alternative grouping of LUTS. The potential utility of such an approach requires careful consideration.
    BJU International 10/2012; DOI:10.1111/j.1464-410X.2012.11593.x · 3.13 Impact Factor
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    ABSTRACT: As with wide-spread use of prostate cancer (Pca) screening with prostate-specific antigen testing, overdetection has increasingly gained attention. The authors aimed to estimate absolute risk of overdetection (RO) in Pca screening with various interscreening intervals and ages at start of screening. We estimated age-specific preclinical incidence rates (per 100,000 person-years) for progressive cancer (from 128 for age group 55-58 years to 774 for age group 67-71 years) and nonprogressive cancer (from 40 for age group 55-58 years to 66 for age group 67-71 years), the mean sojourn time (7.72 years) and the sensitivity (42.8% at first screen and 59.8% at the second screen) by using a multistep epidemiological model with data from the Finnish randomized controlled trial. The overall number of screens for overdetection (NSO) was 29 (95% confidence interval (CI): 18, 48) for screenees aged 55-67 years, equivalent to 3.4 (95% CI: 2.1, 5.7) overdetected Pcas per 100 screenees. The NSO decreased from 63 (95% CI: 37, 109) at the first screen to 29 (95% CI: 18, 48) at the third screen and from 43 (95% CI: 36, 52) for age 55 years to 25 (95% CI: 8, 75) at age 67 years at the first screen. In conclusion, around 3.4 cases for every 100 screened men would be overdetected during three screen rounds (~ 13 years of follow-up) in the Finnish randomized controlled trial. Elucidating the absolute RO under various scenarios makes contribution for evaluating the benefit and harm of Pca screening.
    International Journal of Cancer 09/2012; 131(6):1367-75. DOI:10.1002/ijc.27340 · 5.01 Impact Factor
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    ABSTRACT: Abstract Objective. The aim of this study was to determine the prevalence and bother of postmicturition dribble in relation to age in the male population. Material and methods. Information for a population-based study was collected by means of a mailed self-administered questionnaire, which was returned by 4384 men out of 7470 (58.7%). The participants were men aged 30-80 years from the Pirkanmaa Region in Finland. The Danish Prostatic Symptom Score (DAN-PSS-1) questionnaire was used to evaluate their urinary symptoms. SPSS was used in the data analysis. Two-sided chi-squared test and Kendall tau-b test were used for analysis. Results. The overall prevalence of postmicturition dribble was 58.1% (95% confidence interval 56.6-59.6). Prevalence of postmicturition dribble increased with age (p < 0.001). In men aged 60-80 years, two-thirds reported postmicturition dribble and approximately one out of four had dribbling into their trousers after voiding. In the 30-year-old group, over 40% reported postmicturition dribble and almost one out of five had also dribbling into their trousers. One out of five men in the 30-year-old group reported minor bother; the proportion of men reporting bother increased with age to one-third of the men in the oldest cohort (p < 0.001). Conclusions. The prevalence of the postmicturition dribble was found to be high in this survey. Half of the 30-year-old men and two-thirds of the men aged 60-80 years had postmicturition dribble. Dribbling into trousers increased with age but as a severe symptom, it was rare (0.5%). Minor problems from postmicturition dribble were common, but major bother occurred seldom (1.1%).
    Scandinavian Journal of Urology and Nephrology 07/2012; DOI:10.3109/00365599.2012.702786 · 1.06 Impact Factor
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    ABSTRACT: BACKGROUND: Patient preference for the choice of treatment modality for prostate cancer has increasingly gained attention. OBJECTIVE: To assess the impact of client-oriented decision on long-term mortality, disease progression and biochemical failure compared with standard treatment protocol (TP). METHODS: With data from a Finnish multicentre, randomized controlled trial with two arms [104 in the enhanced patient participation (EPP) arm and 106 in the TP arm], disease-specific and disease-free survival, biochemical failure with elevated prostate-specific antigen (PSA) level and disease progression were compared between the two arms using Wilcoxon test and also Cox proportional hazards regression model. RESULTS: Patients in the EPP arm had a higher risk of death by 37% [HR, 1.37 (0.87-2.17)] compared with those in the TP arm. Patients in the EPP arm were at increased risk of having biochemical failure by 14% [HR, 1.14 (0.72-1.79)] and for having disease progression by 2% [HR, 1.02 (0.61-1.70)] compared with those in the TP arm. All the differences were non-significant. CONCLUSIONS: Patients actively involved in the choice of treatment had higher risk of prostate cancer death but only slightly increased risk of biochemical failure and clinical disease progression. These findings would provide a good reference when patient autonomy for the choice of treatment modality is addressed.
    Health expectations: an international journal of public participation in health care and health policy 07/2012; 17(6). DOI:10.1111/j.1369-7625.2012.00802.x · 2.85 Impact Factor

Publication Stats

11k Citations
1,981.59 Total Impact Points

Institutions

  • 1976–2015
    • Finnish Cancer Registry, Helsinki
      Helsinki, Southern Finland Province, Finland
  • 1978–2013
    • University of Tampere
      • • School of Health Sciences
      • • Department of Public Health
      • • Department of Biomedical Sciences
      Tammerfors, Province of Western Finland, Finland
  • 1996–2012
    • Erasmus Universiteit Rotterdam
      • Department of Urology
      Rotterdam, South Holland, Netherlands
  • 2011
    • Tata Memorial Centre
      • Pathology
      Mumbai, Mahārāshtra, India
  • 2007
    • ORTON Foundation, Helsinki, Finland
      Helsinki, Uusimaa, Finland
  • 2004–2007
    • International Agency for Research on Cancer
      • Section of Cancer Information
      Lyons, Rhône-Alpes, France
  • 2006
    • Lund University
      Lund, Skåne, Sweden
    • University of Tartu
      • Department of Public Health (ARTH)
      Dorpat, Tartu, Estonia
  • 1997–2005
    • National Public Health Institute
      Helsinki, Southern Finland Province, Finland
    • Umeå University
      • Department of Public Health and Clinical Medicine
      Umeå, Västerbotten, Sweden
  • 1999–2004
    • University of Helsinki
      • • Department of Dental Public Health
      • • Department of Chemistry
      Helsinki, Uusimaa, Finland
    • German Cancer Research Center
      Heidelburg, Baden-Württemberg, Germany
  • 2003
    • Seinäjoki Central Hospital
      Seinäjoki, Province of Western Finland, Finland
  • 1998
    • Tampere University Hospital (TAUH)
      Tammerfors, Province of Western Finland, Finland
  • 1994–1996
    • Säteilyturvakeskukseen
      Helsinki, Southern Finland Province, Finland
    • University of Turku
      • Department of Pathology
      Turku, Western Finland, Finland
  • 1995
    • Helsinki University Central Hospital
      • Department of Obstetrics and Gynaecology
      Helsinki, Southern Finland Province, Finland
  • 1988–1992
    • Kela - The Social Insurance Institution of Finland
      • Research Department
      Helsinki, Southern Finland Province, Finland
  • 1990
    • Jesus College, Cambridge
      Cambridge, England, United Kingdom