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In this randomized trial involving 84,585 participants in Poland, Norway, and Sweden, the risk of colorectal cancer at 10 years was lower among those invited to undergo screening colonoscopy than among those assigned to no screening.

This analysis of Norwegian registry data suggests that colonoscopic surveillance during the 8 years after removal of low-risk adenomas is not required for a reduction in colorectal-cancer mortality. Screening programs for colorectal cancer are currently implemented in many Western populations 1 , 2 because randomized trials have documented an association between screening and a sustained reduction in colorectal-cancer mortality. 3 The benefit is most likely due to early detection of cancer, endoscopic removal of adenomas, and surveillance of patients who are considered to be at high risk for the development of new neoplastic lesions. 4 , 5 However, precise quantification of the risk of death from cancer after adenoma removal has been hampered by the scarceness of large, population-based studies with long follow-up periods. Previous studies were performed in populations undergoing intensive surveillance, . . .

Evaluating diagnostic tests in learning screening programs could improve public health National cancer screening programs, such as mammography for breast cancer, are widely implemented to reduce cancer incidence and mortality in high-income countries. Their introduction is also being considered in low- and middle-income countries. For many cancer types, the benefits and harms of different screening tests and the intervals at which they should be implemented are unknown. Thus, randomized comparison testing is warranted. However, this is not possible because most people in high-income countries have already undergone screening or have refused screening and are not comparable ( 1 ). There is an ethical, medical, economic, and societal imperative for continuous evaluation of cancer screening programs to ensure that their benefits outweigh any harms. This may be achievable if the screening programs can become the arena for clinical testing through the implementation of learning screening programs.

Mammography screening for breast cancer is widely available in many countries. Initially praised as a universal achievement to improve women's health and to reduce the burden of breast cancer, the benefits and harms of mammography screening have been debated heatedly in the past years. This review discusses the benefits and harms of mammography screening in light of findings from randomized trials and from more recent observational studies performed in the era of modern diagnostics and treatment. The main benefit of mammography screening is reduction of breast-cancer related death. Relative reductions vary from about 15 to 25% in randomized trials to more recent estimates of 13 to 17% in meta-analyses of observational studies. Using UK population data of 2007, for 1,000 women invited to biennial mammography screening for 20 years from age 50, 2 to 3 women are prevented from dying of breast cancer. All-cause mortality is unchanged. Overdiagnosis of breast cancer is the main harm of mammography screening. Based on recent estimates from the United States, the relative amount of overdiagnosis (including ductal carcinoma in situ and invasive cancer) is 31%. This results in 15 women overdiagnosed for every 1,000 women invited to biennial mammography screening for 20 years from age 50. Women should be unpassionately informed about the benefits and harms of mammography screening using absolute effect sizes in a comprehensible fashion. In an era of limited health care resources, screening services need to be scrutinized and compared with each other with regard to effectiveness, cost-effectiveness and harms.

Assessment of the effect of breast-cancer screening has been hampered by difficulty in measuring secular trends. In this study, data from a cancer registry were used to determine secular trends and to evaluate the effect of screening on breast-cancer mortality. On the basis of several randomized clinical trials, 1 – 3 the World Health Organization concluded in 2002 that screening mammography for women between the ages of 50 and 69 years reduced the rate of death from breast cancer by 25%. 4 Nevertheless, the use of screening mammography is still debated, chiefly because of concern regarding methodologic limitations in some of the randomized trials. 5 In addition, the benefit of mammography when implemented in a population-based service program remains poorly quantified. Therefore, continued evaluation of breast-cancer screening programs is warranted. 6 The main challenge in quantifying the reduction in mortality from nonrandomized screening programs is . . .

Background Norway and Sweden have similar populations and health care systems, but different reactions to the COVID-19 pandemic. Norway closed educational institutions, and banned sports and cultural activities; Sweden kept most institutions and training facilities open. We aimed to compare peoples’ attitudes towards authorities and control measures, and perceived impact of the pandemic and implemented control measures on life in Norway and Sweden. Methods Anonymous web-based surveys for individuals age 15 or older distributed through Facebook using the snowball method, in Norway and Sweden from mid-March to mid-April, 2020. The survey contained questions about perceived threat of the pandemic, views on infection control measures, and impact on daily life. We performed descriptive analyses of the responses and compared the two countries. Results 3508 individuals participated in the survey (Norway 3000; Sweden 508). 79% were women, the majority were 30–49 years (Norway 60%; Sweden 47%), and about 45% of the participants in both countries had more than 4 years of higher education. Participants had high trust in the health services, but differed in the degree of trust in their government (High trust in Norway 17%; Sweden 37%). More Norwegians than Swedes agreed that school closure was a good measure (Norway 66%; Sweden 18%), that countries with open schools were irresponsible (Norway 65%; Sweden 23%), and that the threat from repercussions of the mitigation measures were large or very large (Norway 71%; Sweden 56%). Both countries had a high compliance with infection preventive measures (> 98%). Many lived a more sedentary life (Norway 69%; Sweden 50%) and ate more (Norway 44%; Sweden 33%) during the pandemic. Conclusion Sweden had more trust in the authorities, while Norwegians reported a more negative lifestyle during the pandemic. The level of trust in the health care system and self-reported compliance with preventive measures was high in both countries despite the differences in infection control measures.

Colorectal cancer is the third most common cancer worldwide. The lifetime risk of colorectal cancer in the United States is approximately 5%. Clinical symptoms develop late in the course of the disease, and precursor lesions (adenomas) can be easily detected and removed. The disease is a candidate for early detection and prevention by screening. This issue of the Journal features two important studies that shed light on a number of interesting features in screening for colorectal cancer. 1 , 2 Zauber and colleagues present long-term follow-up data on mortality from colorectal cancer from the National Polyp Study. 1 After a mean period of . . .

To the Editor: The International Committee of Medical Journal Editors (ICMJE) recently announced data-sharing requirements for member journals. 1 Among the issues that were raised is giving adequate academic credit to the people who design clinical trials, enroll and treat patients, and curate the resulting data. Two main parties are involved in data sharing: those who have performed a clinical trial and possess the data (data generators) and those who want to use those data for other purposes (data reanalysts). Data-sharing requirements need to ensure that the interests of both parties are protected. Data-sharing requirements may discourage researchers from initiating and . . .

In this correspondence we respond to critique of our randomized trial of Covid-19 transmission in fitness centers. The trial was performed in Norway during May and June 2020. Keywords: Covid-19, Randomized trial, Public health

In a mission that aims to improve cancer control throughout Europe, the European Academy of Cancer Sciences has defined two key indicators of progress: within one to two decades, overall cancer‐specific 10‐year survival should reach 75%, and in each country, overall cancer mortality rates should be convincingly declining. To lay the ground for assessment of progress and to promote cancer outcomes research in general, we have reviewed the most common population‐based measures of the cancer burden. We emphasize the complexities and complementary approaches to measure cancer survival and the novel opportunities for improved assessment of quality of life. We propose that: incidence and mortality rates are standardized to the European population; net survival is used as the measure of prognosis but with proper adjustments for confounding when temporal trends in overall cancer survival are assessed; and cancer‐specific quality of life is measured by a combination of existing questionnaires and utilizes emerging communication technologies. We conclude that all measures are important and that a meaningful interpretation also requires a deep understanding of the larger clinical and public health context. This review defines the many measures used to quantify the burden of cancer, their pros, cons, and utility for different purposes. Recommendations are provided for the most informative measures and the methodologic challenges that need accommodation in assessing the Academy's goals. The needs and opportunities for development of and standardization of cancer‐specific quality of life assessments is also emphasized.