Estimation of age- and stage-specific Catalan breast cancer survival functions using US and Catalan survival data

Background: During the last part of the 1990s the chance of surviving breast cancer increased. Changes in survival functions reflect a mixture of effects. Both, the introduction of adjuvant treatments and early screening with mammography played a role in the decline in mortality. Evaluating the contribution of these interventions using mathematical models requires survival functions before and after their introduction. Furthermore, required survival functions may be different by age groups and are related to disease stage at diagnosis. Sometimes detailed information is not available, as was the case for the region of Catalonia (Spain). Then one may derive the functions using information from other geographical areas. This work presents the methodology used to estimate age- and stage-specific Catalan breast cancer survival functions from scarce Catalan survival data by adapting the age- and stage-specific US functions. Methods: Cubic splines were used to smooth data and obtain continuous hazard rate functions. After, we fitted a Poisson model to derive hazard ratios. The model included time as a covariate. Then the hazard ratios were applied to US survival functions detailed by age and stage to obtain Catalan estimations. Results: We started estimating the hazard ratios for Catalonia versus the USA before and after the introduction of screening. The hazard ratios were then multiplied by the age- and stage-specific breast cancer hazard rates from the USA to obtain the Catalan hazard rates. We also compared breast cancer survival in Catalonia and the USA in two time periods, before cancer control interventions (USA 1975–79, Catalonia 1980–89) and after (USA and Catalonia 1990–2001). Survival in Catalonia in the 1980–89 period was worse than in the USA during 1975–79, but the differences disappeared in 1990–2001. Conclusion: Our results suggest that access to better treatments and quality of care contributed to large improvements in survival in Catalonia. On the other hand, we obtained detailed breast cancer survival functions that will be used for modeling the effect of screening and adjuvant treatments in Catalonia.

Effectiveness of early detection on breast cancer mortality reduction in Catalonia (Spain)

Background: At present, it is complicated to use screening trials to determine the optimal age intervals and periodicities of breast cancer early detection. Mathematical models are an alternative that has been widely used. The aim of this study was to estimate the effect of different breast cancer early detection strategies in Catalonia (Spain), in terms of breast cancer mortality reduction (MR) and years of life gained (YLG), using the stochastic models developed by Lee and Zelen (LZ). Methods: We used the LZ model to estimate the cumulative probability of death for a cohort exposed to different screening strategies after T years of follow-up. We also obtained the cumulative probability of death for a cohort with no screening. These probabilities were used to estimate the possible breast cancer MR and YLG by age, period and cohort of birth. The inputs of the model were: incidence of, mortality from and survival after breast cancer, mortality from other causes, distribution of breast cancer stages at diagnosis and sensitivity of mammography. The outputs were relative breast cancer MR and YLG. Results: Relative breast cancer MR varied from 20% for biennial exams in the 50 to 69 age interval to 30% for annual exams in the 40 to 74 age interval. When strategies differ in periodicity but not in the age interval of exams, biennial screening achieved almost 80% of the annual screening MR. In contrast to MR, the effect on YLG of extending screening from 69 to 74 years of age was smaller than the effect of extending the screening from 50 to 45 or 40 years. Conclusion: In this study we have obtained a measure of the effect of breast cancer screening in terms of mortality and years of life gained. The Lee and Zelen mathematical models have been very useful for assessing the impact of different modalities of early detection on MR and YLG in Catalonia (Spain).

Distribuição volumétrica e espectro de gotas de pontas de pulverização de baixa deriva

Objetivou-se neste trabalho avaliar a distribuição volumétrica e o espectro de gotas das pontas de pulverização de baixa deriva TTI110015, AI110015 e AVI11001 sob diferentes condições operacionais. A distribuição volumétrica foi determinada em bancada de ensaios padronizada analisando o coeficiente de variação (CV%) de uma barra simulada em computador, utilizando pressões de 200, 300 e 400 kPa, altura de 30, 40 e 50 cm em relação à bancada e espaçamento entre pontas de 40 a 100 cm. O espectro de gotas foi produzido utilizando-se apenas água como calda em um analisador de partículas em meio aquoso, nas pressões de 200, 300 e 400 kPa. Foram avaliados o DMV, a porcentagem de gotas com diâmetro inferior a 100 µm (%100 µm) e a amplitude relativa (AR). As pontas proporcionaram perfil descontínuo nas pressões de 300 e 400 kPa e uniforme a 200 kPa. Na pressão de 200 kPa, as pontas foram adequadas apenas para aplicação em faixa, e a 300 e 400 kPa, apenas para área total. Ocorreu menor CV (abaixo de 7%) com a maior pressão de trabalho e menor espaçamento entre pontas. À medida que se aumentou a pressão de trabalho, reduziu-se o DMV. As pontas TTI110015 e AI110015 em todas as pressões e a ponta AVI11001 na pressão de 200 kPa produziram gotas extremamente grossas e gotas grossas nas pressões de 300 e 400 kPa apenas para a ponta AVI11001. As pontas proporcionaram baixos valores de amplitude relativa (AR) e gotas de tamanho uniforme, bem como produziram baixa porcentagem de gotas menores que 100 µm, principalmente TTI110015 e AI110015, com menor risco de deriva.

Cost-effectiveness of early detection of breast cancer in Catalonia (Spain)

Background: Breast cancer (BC) causes more deaths than any other cancer among women in Catalonia. Early detection has contributed to the observed decline in BC mortality. However, there is debate on the optimal screening strategy. We performed an economic evaluation of 20 screening strategies taking into account the cost over time of screening and subsequent medical costs, including diagnostic confirmation, initial treatment, follow-up and advanced care. Methods: We used a probabilistic model to estimate the effect and costs over time of each scenario. The effect was measured as years of life (YL), quality-adjusted life years (QALY), and lives extended (LE). Costs of screening and treatment were obtained from the Early Detection Program and hospital databases of the IMAS-Hospital del Mar in Barcelona. The incremental cost-effectiveness ratio (ICER) was used to compare the relative costs and outcomes of different scenarios. Results: Strategies that start at ages 40 or 45 and end at 69 predominate when the effect is measured as YL or QALYs. Biennial strategies 50-69, 45-69 or annual 45-69, 40-69 and 40-74 were selected as cost-effective for both effect measures (YL or QALYs). The ICER increases considerably when moving from biennial to annual scenarios. Moving from no screening to biennial 50-69 years represented an ICER of 4,469€ per QALY. Conclusions: A reduced number of screening strategies have been selected for consideration by researchers, decision makers and policy planners. Mathematical models are useful to assess the impact and costs of BC screening in a specific geographical area.

Caracterización del comportamiento agroforestal de doce genotipos de nogal (Juglans sp.) en dos localidades de Cataluña

El comportamiento agroforestal de 10 genotipos de J. regia y dos híbridos comerciales de Juglans, Ng23xRa y Mj209xRa, se ha evaluado desde 1995 a 2000 en dos localidades: Massanes (Girona) y Prades (Tarragona). Se establecen tres grupos de genotipos diferenciados de acuerdo a su tasa de crecimiento en altura: 1) crecimiento medio superior a 60 cm/año, que corresponde a los dos híbridos; 2) crecimiento medio de unos 50 cm/año, que corresponde a las progenies de J. regia con brotaciones anteriores al 20 de abril; y 3) crecimiento medio inferior a los 40 cm/año, que corresponde a los genotipos de J. regia con brotación posterior al 20 de abril. La evolución de las progenies en altura y diámetro está significativamente ligada a la localidad. El orden en la clasificación de las progenies por su crecimiento, en altura y en grosor, es prácticamente idéntico en ambas localidades. El diámetro a 2,50 m, al sexto período vegetativo, presenta una dependencia significativa de localidad y genotipo: en Massanes se alcanza un mayor crecimiento que en Prades y el diámetro a 2,50 m de los híbridos es el doble que el del mejor J. regia. La dominancia y la rectitud dependen de los genotipos. Sólo dos J. regia tienen una aptitud forestal aceptable, concretamente dos genotipos italianos, «Bleggiana» y «Boschi Maria Grazia». Los híbridos Ng23xRa y Mj209xRa presentan un mejor comportamiento agroforestal que los genotipos de J. regia estudiados: menor mortalidad en plantación, superiores crecimientos primario y secundario y buena dominancia apical y rectitud.

Contribution of early detection and adjuvant treatments to breast cancer mortality reduction in Catalonia, Spain

Background: Reductions in breast cancer (BC) mortality in Western countries have been attributed to the use of screening mammography and adjuvant treatments. The goal of this work was to analyze the contributions of both interventions to the decrease in BC mortality between 1975 and 2008 in Catalonia. Methodology/Principal Findings: A stochastic model was used to quantify the contribution of each intervention. Age standardized BC mortality rates for calendar years 1975-2008 were estimated in four hypothetical scenarios: 1) Only screening, 2) Only adjuvant treatment, 3) Both interventions, and 4) No intervention. For the 30-69 age group, observed Catalan BC mortality rates per 100,000 women-year rose from 29.4 in 1975 to 38.3 in 1993, and afterwards continuously decreased to 23.2 in 2008. If neither of the two interventions had been used, in 2008 the estimated BC mortality would have been 43.5, which, compared to the observed BC mortality rate, indicates a 46.7% reduction. In 2008 the reduction attributable to screening was 20.4%, to adjuvant treatments was 15.8% and to both interventions 34.1%. Conclusions/Significance: Screening and adjuvant treatments similarly contributed to reducing BC mortality in Catalonia. Mathematical models have been useful to assess the impact of interventions addressed to reduce BC mortality that occurred over nearly the same periods.