Mammography screening can result in early detection and possibly earlier treatment and better prognosis of breast cancer. In the Netherlands, women aged 50-74 are invited biennially to digital mammography screening. The aim of this thesis was to quantify the effects of current screening in the Netherlands and to determine the effects and cost-effectiveness of alternative screening strategies, using micro-simulation modelling.
With respect to current screening, we found that digital mammography leads to the detection of more breast cancers than film-screen mammography, but also to more referrals and false-positives. The number of cancers detected during the screening interval is unaffected, compared to film-screen mammography. Further, we found that the breast cancer mortality rate in the Netherlands decreased by 30% since the introduction of screening until 2010, in women aged 55-74 years. Mammography screening and (improvements in) adjuvant therapy contributed to this decrease.
Using microsimulation, we showed that earlier screening, starting between 40-50 years, is cost-effective and increases the screening benefit, especially in women with a high relative risk of breast cancer, but at the same time results in more false-positives. In addition, we found that triennial screening in women with a low relative risk results in a better balance of benefits and harms than biennial screening. Finally, we found that the rather new technique digital breast tomosynthesis, which creates a pseudo 3D breast image, has a lower chance of being cost-effective than digital mammography. However, at a slightly higher cost-effectiveness threshold than currently used, tomosynthesis becomes more cost-effective than digital mammography.
The main aim of this thesis was to study social inequalities in children’s lifestyle behaviors and child overweight, asthma, and health-related quality of life (HRQoL). The studies conducted in this thesis were embedded in the Generation R Study. The following conclusions can be drawn from the studies presented in this thesis. Social inequalities in the clustering of children’s lifestyle behaviors (screen time, physical activity, calorie-rich snack, and sugar-sweetened beverages) are present among school-aged children. From preschool to school-age the trajectories of children’s television time may vary according to indicators of social status. Findings also indicate that social inequalities in childhood asthma and indicators of lung function are present among school-aged children. Experiencing family poverty, either as an intermittent episode or as a chronic situation, is associated with childhood overweight, asthma, and HRQoL. When parents obtain a higher level of education after their child is born, this might be beneficial to attenuate the risk of the child developing overweight at school age. A joint effort between parents, schools, community, public health professionals, and policymakers is needed to reduce these inequalities.
Colorectal cancer is one of the leading causes of cancer death, and is an increasing public health concern for many countries worldwide. Screening can prevent colorectal cancer death through removal of premalignant lesions or through early detection of colorectal cancer. The aim of this thesis was to estimate population-level effects of colorectal cancer screening policy changes or interventions. Our analyses focused on three different policy domains. First, we attempted to optimize colorectal cancer screening guidelines in light of contemporary trends in colorectal cancer screening incidence in the United States. We demonstrated that screening initiation at age 45 years rather than age 50 years has a favorable balance between screening benefits, burden and costs. Second, we evaluated the cost-effectiveness of interventions that potentially increase screening participation. Waiving all out-of-pocket costs for colorectal cancer screening, mailing a stool-based test to individuals eligible for screening, and offering an alternative blood-based test for individuals that otherwise do not want to participate in screening are cost-effective interventions. Third, we focused on improving the detection and clinical management of Lynch syndrome patients. Our analyses suggest that testing colorectal cancer cases for Lynch syndrome, and subsequently testing first-degree relatives of those found to have Lynch syndrome, provides a good balance between costs and long-term benefits.
Op vrijdag 23 oktober om 16.00 uur zal Professor Mackenbach zijn afscheidscollege houden in de Aula van de Erasmus Universiteit in Rotterdam.
Vanwege de COVID-19 epidemie is in de grote Aula van de EUR slechts een beperkt aantal plaatsen beschikbaar. Het afscheidscollege zal daarom ook via een livestream worden uitgezonden. Voor beide is aanmelding noodzakelijk. Na aanmelding hoort u in de week van 12 oktober of u in de Aula aanwezig kunt zijn, resp. hoe u het afscheidscollege op afstand kunt volgen.
n.b. Inschrijving is gesloten. Neem bij vragen contact op met: secretariaat.mgz@erasmusmc.nl
On Friday, October 23, 4:00 PM, Professor Mackenbach will give his farewell lecture in the Aula of Erasmus University Rotterdam. The lecture will be in Dutch, but English subtitles will be provided. You can attend the lecture either in person or via the livestream. Registration is required.
n.b. Registration is closed. For questions, please contact: secretariaat.mgz@erasmusmc.nl
Trauma, defined as a physical injury, is a global public health problem and is a leading cause of death among young adults. In countries with advanced health care mortality rates after trauma decreased the past decades. The focus on trauma outcome has been, next to fatal outcome, complemented with non-fatal consequences, such as physical, psychological and social functioning after trauma. The main aim of this thesis was to evaluate, develop and validate fatal and non-fatal outcome prediction models in the trauma population. A new survival prediction model was developed and validated, which enables the inclusion of elderly patients with an isolated hip fracture in the evaluation of quality of trauma care. This project developed a model to predict health status after trauma for the evaluation of quality of trauma care. Baseline conditions (before injury) are essential to consider in predicting non-fatal outcome.
In this thesis, we studied health promotion with regard to people with frailty and chronic conditions in order to provide insights and directions in developing health promotion to support healthy ageing of older people. We suggest future research on the development and effects of interventions to target people at an earlier age to prevent frailty in later life and to promote healthy ageing. On-going support may be important for the prevention and better management of frailty and chronic conditions. We recommend to develop strategies to enable the sustainability of newly developed (effective) approaches.
https://www.publicatie-online.nl/publicaties/xuxi-zhang
Both PDF and E-pub are available on this link; the password is 20200924
You can watch the defence online: https://media.eur.nl/Mediasite/Play/404de4964b3d4eae8c6394894bc75c421d
Cardiovascular diseases are still common worldwide. Considering that there are risk assessment tools and preventive measures available, it has been suggested that population-based screening might be a promising strategy for identifying potential high-risk persons and consequently start preventive treatment. The ROBINSCA trial investigates whether screening for a high risk of cardiovascular diseases followed by preventive measures in asymptomatic individuals reduces cardiovascular morbidity and mortality. This thesis describes the secondary outcomes of the ROBINSCA screening trial, including contamination of screening arms, the impact of screening on participants, the risk distribution among the asymptomatic population and the potential reduction in overtreatment.
Esophageal adenocarcinoma is the most common type of esophageal cancer in Western countries. Various risk factors are associated with EAC, of which Barrett’s esophagus (BE) is the most important one. Targeted screening of well-defined high-risk populations and surveillance of BE patients using an upper gastrointestinal endoscopy is recommended by several clinical practice guidelines in the world. However, there are discrepancies in guidelines’ recommendations.
In this thesis, we conducted cost-effectiveness analyses on BE screening and surveillance strategies. First, we focused on screening for BE and evaluated the cost-effectiveness of using a minimally invasive method to screen high-risk people for BE, and we assessed the impact of including unrelated health effects and costs on our cost-effectiveness estimates. Then, we evaluated several ways to further improve the cost-effectiveness of BE surveillance by optimizing different aspects of BE management. Subsequently, we evaluated how the lack of adherence to surveillance guidelines for BE patients can impact cost-effectiveness estimates.
In the United States, annual lung cancer screening has been recommended since 2013, for persons aged 55-80 with a smoking history of at least 30 pack-years, that currently smoke or quit less than 15 years ago. Despite this recommendation, the uptake of lung cancer screening in the United States remains low. In Europe and the United Kingdom, many countries have been debating a possible implementation of lung cancer screening. In the meantime, many topics of debate remain. This thesis deals with two of these topics. The first part of this thesis (Chapters 1-3) investigates which treatments lung cancer patients in the United States received before the implementation of lung cancer screening, and how these treatment patterns change as a result of the implementation of lung cancer screening. In the second part of this thesis (Chapters 4-6), the benefits and harms of population-based lung cancer screening in the United States are investigated from different perspectives.
Traumatic brain injury (TBI) is defined as “an alteration in brain function, or other evidence of brain pathology, caused by an external force”. TBI is considered “the most complex disease in the most complex organ” and it is known that no two TBIs are rendered exactly the same, thus recovery after TBI leads to variability and uncertainty. On top of this, TBI is a leading cause of death and disability worldwide and has tremendous economic repercussions.
The overall aim of this thesis was to expand our knowledge on assessing outcome following TBI, and measuring outcome preferences for TBI and stroke among patients and the general population. The first part of this thesis (Chapter 2-8) describes the association between post-concussion symptoms and health-related quality of life in mild TBI and assesses the outcome following mild TBI, the prevalence and risk factors of post-concussion symptoms in patients with mild TBI and the general population and lastly, classifies post-concussion symptoms. In part two of this thesis (Chapter 9-12) we examine the preferences and utility weights for TBI and stroke health states and their application.