Suchergebnisse

Background: Breast cancer screening in the Basque Country has shown 20 % reduction of the number of BC deaths and an acceptable overdiagnosis level (4 % of screen detected BC). The aim of this study was to evaluate the breast cancer early detection programme in the Basque Country in terms of retrospective cost-effectiveness and budget impact from 1996 to 2011. Methods: A discrete event simulation model was built to reproduce the natural history of breast cancer (BC). We estimated for lifetime follow-up the total cost of BC (screening, diagnosis and treatment), as well as quality-adjusted life years (QALY), for women invited to participate in the evaluated programme during the 15-year period in the actual screening scenario and in a hypothetical unscreened scenario. An incremental cost-effectiveness ratio was calculated with the use of aggregated costs. Besides, annual costs were considered for budget impact analysis. Both population level and single-cohort analysis were performed. A probabilistic sensitivity analysis was applied to assess the impact of parameters uncertainty. Results: The actual screening programme involved a cost of 1,127 million euros and provided 6.7 million QALYs over the lifetime of the target population, resulting in a gain of 8,666 QALYs for an additional cost of 36.4 million euros, compared with the unscreened scenario. Thus, the incremental cost-effectiveness ratio was 4,214€/QALY. All the model runs in the probabilistic sensitivity analysis resulted in an incremental cost-effectiveness ratio lower than 10,000€/QALY. The screening programme involved an increase of the annual budget of the Basque Health Service by 5.2 million euros from year 2000 onwards. Conclusions: The BC screening programme in the Basque Country proved to be cost-effective during the evaluated period and determined an affordable budget impact. These results confirm the epidemiological benefits related to the centralised screening system and support the continuation of the programme. ; This study was funded by the grant 2010111007 from the Health Department of the Basque Government.

Abstract:This study explored the barriers and facilitators to the implementation of a risk-basedbreast cancer screening program from the point of view of Spanish health professionals. A cross-sectional study with 220 Spanish health professionals was designed. Data were collected in 2020 viaa web-based survey and included the advantages and disadvantages of risk-based screening andbarriers and facilitators for the implementation of the program. Descriptive statistics and Likert scaleresponses analyzed as category-ordered data were obtained. The risk-based screening was consideredimportant or very important to reduce breast cancer mortality and promote a more proactive role forwomen in breast cancer prevention, to increase coverage for women under 50 years, to promote abreast cancer prevention strategy for women at high risk, and to increase efficiency and effectiveness.Switching to a risk-based program from an age-based program was rated as important or veryimportant by 85% of participants. As barriers for implementation, risk communication, the workloadof health professionals, and limited human and financial resources were mentioned. Despite thebarriers, there is good acceptance, and it seems feasible, from the perspective of health professionals,to implement a risk-based breast cancer screening program in Spain. However, this poses a numberof organizational and resource challenges. ; This research was funded by Instituto de Salud Carlos III and co-funded by Fondo Europeode Desarrollo Regional (FEDER) 'Una manera de hacer Europa', grant numbers PI17/00834 andPI18/00773. C.L.-V. received a grant from Santander Program scholarship 2020 as a predoctoral fellowat the University of Lleida and M.J.H.-L. was supported by the European Regional Development Fund,European Union's Horizon 2020 research and innovation program under the Marie Skłodowska-Curiegrant agreement No. 713679 from the Rovira i Virgili University. The funders did not participate inthe study design; collection, management, analysis, and interpretation of data; writing of the report;and the decision to submit the report for publication

Background: With the aim of increasing benefits and decreasing harms, risk-based breast cancer screening has been proposed as an alternative to age-based screening. This study explores barriers and facilitators to implementing a risk-based breast cancer screening program from the perspective of health professionals, in the context of a National Health Service. Methods: Socio-constructivist qualitative research carried out in Catalonia (Spain), in the year 2019. Four discussion groups were conducted, with a total of 29 health professionals from primary care, breast cancer screening programs, hospital breast units, epidemiology units, and clinical specialties. A descriptive-interpretive thematic analysis was performed. Results: Identified barriers included resistance to reducing the number of screening exams for low-risk women; resistance to change for health professionals; difficulties in risk communication; lack of conclusive evidence of the benefits of risk-based screening; limited economic resources; and organizational transformation. Facilitators include benefits of risk-based strategies for high and low-risk women; women's active role in their health care; proximity of women and primary care professionals; experience of health professionals in other screening programs; and greater efficiency of a risk-based screening program. Organizational and administrative changes in the health system, commitment by policy makers, training of health professionals, and educational interventions addressed to the general population will be required. Conclusions: Despite the expressed difficulties, participants supported the implementation of risk-based screening. They highlighted its benefits, especially for women at high risk of breast cancer and those under 50 years of age, and assumed a greater efficiency of the risk-based program compared to the aged-based one. Future studies should assess the efficiency and feasibility of risk-based breast cancer screening for its transfer to clinical practice. ; MR PI17/00834: Personalized breast cancer screening: assessment of its feasibility and acceptability in the National Health System. Instituto de Salud Carlos III and cofunded by Fondo Europeo de Desarrollo Regional (FEDER) 'Una manera de hacer Europa' https://www.isciii.es MCL PI18/00773: Collaboration of healthcare professionals to include shared decision-making in the breast cancer screening program. Instituto de Salud Carlos III and cofunded by Fondo Europeo de Desarrollo Regional (FEDER) 'Una manera de hacer Europa' https://www.isciii.es CLV Santander Program scholarship 2020: predoctoral fellow at the University of Lleida MJH-L: European Regional Development Fund (ERDF). European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No. 713679 from the Universitat Rovira i Virgili (URV). The funders did not participate in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Human brain aging is the physiological process which underlies as cause of cognitive decline in the elderly and the main risk factor for neurodegenerative diseases such as Alzheimer's disease. Human neurons are functional throughout a healthy adult lifespan, yet the mechanisms that maintain function and protect against neurodegenerative processes during aging are unknown. Here we show that protein oxidative and glycoxidative damage significantly increases during human brain aging, with a breakpoint at 60 years old. This trajectory is coincident with a decrease in the content of the mitochondrial respiratory chain complex I–IV. We suggest that the deterioration in oxidative stress homeostasis during aging induces an adaptive response of stress resistance mechanisms based on the sustained expression of REST, and increased or decreased expression of Akt and mTOR, respectively, over the adult lifespan in order to preserve cell neural survival and function. ; R.C. received predoctoral fellowships from the Autonomous Government of Catalonia. We thank T. Yohannan for editorial help. Research reported in this publication was supported by the Spanish Ministry of Economy and Competitiveness, Institute of Health Carlos III (FIS Grants PI14/00757 and PI14/00328), and the Autonomous Government of Catalonia (2014SGR69 and 2014SGR168) to I.F. and R.P. This study was co-financed by FEDER funds from the European Union ('a way to build Europe').