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Cancer survival is a key measure of the effectiveness of health-care systems. Persistent regional and international differences in survival represent many avoidable deaths. Differences in survival have prompted or guided cancer control strategies. This is the first study in a programme to investigate international survival disparities, with the aim of informing health policy to raise standards and reduce inequalities in survival. Data from population-based cancer registries in 12 jurisdictions in six countries were provided for 2·4 million adults diagnosed with primary colorectal, lung, breast (women), or ovarian cancer during 1995–2007, with follow-up to Dec 31, 2007. Data quality control and analyses were done centrally with a common protocol, overseen by external experts. We estimated 1-year and 5-year relative survival, constructing 252 complete life tables to control for background mortality by age, sex, and calendar year. We report age-specific and age-standardised relative survival at 1 and 5 years, and 5-year survival conditional on survival to the first anniversary of diagnosis. We also examined incidence and mortality trends during 1985–2005. Relative survival improved during 1995–2007 for all four cancers in all jurisdictions. Survival was persistently higher in Australia, Canada, and Sweden, intermediate in Norway, and lower in Denmark, England, Northern Ireland, and Wales, particularly in the first year after diagnosis and for patients aged 65 years and older. International differences narrowed at all ages for breast cancer, from about 9% to 5% at 1 year and from about 14% to 8% at 5 years, but less or not at all for the other cancers. For colorectal cancer, the international range narrowed only for patients aged 65 years and older, by 2–6% at 1 year and by 2–3% at 5 years. Up-to-date survival trends show increases but persistent differences between countries. Trends in cancer incidence and mortality are broadly consistent with these trends in survival. Data quality and changes in classification are not likely explanations. The patterns are consistent with later diagnosis or differences in treatment, particularly in Denmark and the UK, and in patients aged 65 years and older. Department of Health, England; and Cancer Research UK.

The prostate-specific antigen (PSA) test is used to screen for prostate cancer but has a high false-positive rate that translates into unnecessary prostate biopsies and overdiagnosis of low-risk prostate cancers. We aimed to develop and validate a model to identify high-risk prostate cancer (with a Gleason score of at least 7) with better test characteristics than that provided by PSA screening alone. The Stockholm 3 (STHLM3) study is a prospective, population-based, paired, screen-positive, diagnostic study of men without prostate cancer aged 50–69 years randomly invited by date of birth from the Swedish Population Register kept by the Swedish Tax Agency. Men with prostate cancer at enrolment were excluded from the study. The predefined STHLM3 model (a combination of plasma protein biomarkers [PSA, free PSA, intact PSA, hK2, MSMB, MIC1], genetic polymorphisms [232 SNPs], and clinical variables [age, family, history, previous prostate biopsy, prostate exam]), and PSA concentration were both tested in all participants enrolled. The primary aim was to increase the specificity compared with PSA without decreasing the sensitivity to diagnose high-risk prostate cancer. The primary outcomes were number of detected high-risk cancers (sensitivity) and the number of performed prostate biopsies (specificity). The STHLM3 training cohort was used to train the STHLM3 model, which was prospectively tested in the STHLM3 validation cohort. Logistic regression was used to test for associations between biomarkers and clinical variables and prostate cancer with a Gleason score of at least 7. This study is registered with ISCRTN.com, number ISRCTN84445406. The STHLM3 model performed significantly better than PSA alone for detection of cancers with a Gleason score of at least 7 (p<0·0001), the area under the curve was 0·56 (95% CI 0·55–0·60) with PSA alone and 0·74 (95% CI 0·72–0·75) with the STHLM3 model. All variables used in the STHLM3 model were significantly associated with prostate cancers with a Gleason score of at least 7 (p<0·05) in a multiple logistic regression model. At the same level of sensitivity as the PSA test using a cutoff of ≥3 ng/mL to diagnose high risk prostate cancer, use of the STHLM3 model could reduce the number of biopsies by 32% (95% CI 24–39) and could avoid 44% (35–54) of benign biopsies. The STHLM3 model could reduce unnecessary biopsies without compromising the ability to diagnose prostate cancer with a Gleason score of at least 7, and could be a step towards personalised risk-based prostate cancer diagnostic programmes. Stockholm County Council (Stockholms Läns Landsting).

Introduction Radiographs of the hand and teeth are frequently used for medical age assessment, as skeletal and dental maturation correlates with chronological age. These methods have been criticized for their lack of precision, and magnetic resonance imaging (MRI) of the knee has been proposed as a more accurate method. The aim of this systematic review is to explore the scientific and statistical evidence for medical age estimation based on skeletal maturation as assessed by MRI of the knee. Materials and methods A systematic review was conducted that included studies published before April 2021 on living individuals between 8 and 30 years old, with presumptively healthy knees for whom the ossification stages had been evaluated using MRI. The correlation between “mature knee” and chronological age and the risk of misclassifying a child as an adult and vice versa was calculated. Results We found a considerable heterogeneity in the published studies —in terms of study population, MRI protocols, and grading systems used. There is a wide variation in the correlation between maturation stage and chronological age. Conclusion Data from published literature is deemed too heterogenous to support the use of MRI of the knee for chronological age determination. Further, it is not possible to assess the sensitivity, specificity, negative predictive value, or positive predictive value for the ability of MRI to determine whether a person is over or under 18 years old. Key Points • There is an insufficient scientific basis for the use of magnetic resonance imaging of the knee in age determination by skeleton. • It is not possible to assess the predictive value of MRI of the knee to determine whether a person is over or under 18 years of age.

Background Improving participation rates in epidemiologic studies using questionnaires and biological sampling is important for the generalizability of the outcome. The aim of this study was to examine the effects of pre-notification, invitation length, questionnaire length, and reminder on participation rate and to investigate whether some factors contributed to participants doing both the questionnaire and blood sampling as oppose to only one part. Methods Our study was embedded within the pilot testing of a large population-based study about prostate cancer screening. Our study sample consisted of 28.134 men between 50 and 69 years of age and living in the region of Stockholm (Sweden) invited to respond to a web-based questionnaire and to provide blood for prostate cancer testing. The men were randomly allocated according to birth of date to receive either: (a) a pre-notification postcard or not; (b) a shorter or a longer invitation letter; (c) a shorter or a longer web-based questionnaire, and (d) a reminder or not. The effects of the survey design factors were tested using chi-square. Results The use of a pre-notification ( p  < 0.0001), a longer questionnaire ( p  = 0.004) and the use of a reminder ( p  = 0.02) were associated with an increase in overall participation, i.e. responding to the questionnaire or providing blood for PCT or performing both components. Conclusions The results of this pilot study justified the use of a pre-notification and a reminder in the following large population based study since the benefits of increased participation traded off against the greater costs incurred. Furthermore, we were able to use the longer version of the questionnaire, which allowed us to collect more information without risking a lower response rate.

This article reports on the inclusive production cross section of several quarkonium states, [Formula omitted], [Formula omitted], [Formula omitted], [Formula omitted], and [Formula omitted], measured with the ALICE detector at the LHC, in pp collisions at [Formula omitted] TeV. The analysis is performed in the dimuon decay channel at forward rapidity ( [Formula omitted]). The integrated cross sections and transverse-momentum ( [Formula omitted]) and rapidity ( [Formula omitted]) differential cross sections for [Formula omitted], [Formula omitted], [Formula omitted], and the [Formula omitted]-to- [Formula omitted] cross section ratios are presented. The integrated cross sections, assuming unpolarized quarkonia, are: [Formula omitted] ( [Formula omitted] GeV/c) = 5.88 ± 0.03 ± 0.34 [Formula omitted]b, [Formula omitted] ( [Formula omitted] GeV/c) = 0.87 ± 0.06 ± 0.10 [Formula omitted]b, [Formula omitted] ( [Formula omitted] GeV/c) = 45.5 ± 3.9 ± 3.5 nb, [Formula omitted] ( [Formula omitted] GeV/c) = 22.4 ± 3.2 ± 2.7 nb, and [Formula omitted] ( [Formula omitted] GeV/c) = 4.9 ± 2.2 ± 1.0 nb, where the first (second) uncertainty is the statistical (systematic) one. For the first time, the cross sections of the three [Formula omitted] states, as well as the [Formula omitted] one as a function of [Formula omitted] and [Formula omitted], are measured at [Formula omitted] TeV at forward rapidity. These measurements also significantly extend the [Formula omitted] [Formula omitted] reach and supersede previously published results. A comparison with ALICE measurements in pp collisions at [Formula omitted], 7, 8, and 13 TeV is presented and the energy dependence of quarkonium production cross sections is discussed. Finally, the results are compared with the predictions from several production models.

Implementation of risk-based prostate cancer screening has been proposed as a means to reduce the harms of PSA screening. Little is known, however, about the factors influencing men's decision to attend a prostate cancer screening based on a risk assessment. We sent postal invitations with a login to a survey to 10.000 men, three months before invitation to a risk-based prostate cancer screening. Prostate cancer specific worry, prostate cancer-related knowledge, health behaviour, and health related quality of life were used as predictors of subsequent participation. Participation to risk-based prostate cancer screening was defined as providing a blood sample for the STHLM3 trial, a study evaluating a risk-based model that predicts the risk for aggressive prostate cancer. With a response rate of 20%, 1.347 men (70%) participated in ensuing risk-based prostate cancer screening three months later whereas 568 men (30%) declined participation in the STHLM3-study. These decliners reported less worry and feeling less vulnerable to prostate cancer and responded \"Do not know\" more often than participants when asked questions about prostate cancer knowledge. Participants reported greater benefits of prostate testing (p = 0.0005), less barriers to prostate testing (p<0.0001), and higher intention to attend prostate cancer testing (p<0.0001) than decliners. Finally, participants reported better overall health than decliners (p<0.0001). Prostate cancer worry, PC knowledge, health behaviour and quality of life were identified as predictors of participation in risk-based prostate cancer screening. Targeting these predictors may improve the participation rates. These results can inform policymaking for future population-based prostate cancer screening programs that should address potential worry in men and lack of knowledge about prostate cancer.

Background: Metastatic breast cancer is a severe condition without curative treatment. How relative and absolute risk of distant metastasis varies over time since diagnosis, as a function of treatment, age and tumour characteristics, has not been studied in detail. Methods: A total of 9514 women under the age of 75 when diagnosed with breast cancer in Stockholm and Gotland regions during 1990–2006 were followed up for metastasis (mean follow-up=5.7 years). Time-dependent development of distant metastasis was analysed using flexible parametric survival models and presented as hazard ratio (HR) and cumulative risk. Results: A total of 995 (10.4%) patients developed distant metastasis; the most common sites were skeleton (32.5%) and multiple sites (28.3%). Women younger than 50 years at diagnosis, with lymph node-positive, oestrogen receptor (ER)-negative, >20 mm tumours and treated only locally, had the highest risk of distant metastasis (0–5 years’ cumulative risk =0.55; 95% confidence interval (CI): 0.47–0.64). Women older than 50 years at diagnosis, with ER-positive, lymph node-negative and ⩽20-mm tumours, had the same and lowest cumulative risk of developing metastasis 0–5 and 5–10 years (cumulative risk=0.03; 95% CI: 0.02–0.04). In the period of 5–10 years after diagnosis, women with ER-positive, lymph node-positive and >20-mm tumours were at highest risk of distant recurrence. Women with ER-negative tumours showed a decline in risk during this period. Conclusion: Our data show no support for discontinuation at 5 years of clinical follow-up in breast cancer patients and suggest further investigation on differential clinical follow-up for different subgroups of patients.

This paper presents the measurements of [Formula omitted], [Formula omitted], [Formula omitted] and [Formula omitted] transverse momentum ( [Formula omitted]) spectra as a function of charged-particle multiplicity density in proton-proton (pp) collisions at [Formula omitted] with the ALICE detector at the LHC. Such study allows us to isolate the center-of-mass energy dependence of light-flavour particle production. The measurements reported here cover a [Formula omitted] range from 0.1 to 20 [Formula omitted] and are done in the rapidity interval [Formula omitted]. The [Formula omitted]-differential particle ratios exhibit an evolution with multiplicity, similar to that observed in pp collisions at [Formula omitted], which is qualitatively described by some of the hydrodynamical and pQCD-inspired models discussed in this paper. Furthermore, the [Formula omitted]-integrated hadron-to-pion yield ratios measured in pp collisions at two different center-of-mass energies are consistent when compared at similar multiplicities. This also extends to strange and multi-strange hadrons, suggesting that, at LHC energies, particle hadrochemistry scales with particle multiplicity the same way under different collision energies and colliding systems.

In this companion to the report by Holmberg et al. on survival in a randomized comparison of radical prostatectomy with watchful waiting among men with localized prostate cancer, sexual dysfunction and urinary leakage were more common in the radical-prostatectomy group, but the subjective quality of life in the two groups was similar. In a comparison of prostatectomy with watchful waiting, the quality of life in the two groups was similar. A man with newly diagnosed localized prostate cancer faces a frustrating choice of therapy. 1 He can defer treatment until symptoms appear (watchful waiting), undergo major surgery (radical prostatectomy), or receive radiotherapy (interstitial or external) with the intention of eliminating the tumor. 2 , 3 He may also receive hormonal therapy with antiandrogens or undergo castration. His choice may influence survival as well as the risk of therapy-induced acute or chronic symptoms. 4 Between 1989 and 1999, a group of Swedish urologists enrolled men with localized high-grade or moderate-grade prostate cancer in a randomized trial to compare radical prostatectomy with watchful waiting. 5 We examined . . .