Publications by authors named "Anni Virtanen"

12 Publications

  • Page 1 of 1

Cervical Cancer Screening Participation among Women of Russian, Somali, and Kurdish Origin Compared with the General Finnish Population: A Register-Based Study.

Int J Environ Res Public Health 2020 10 28;17(21). Epub 2020 Oct 28.

Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), P.O. Box 30, FI-00271 Helsinki, Finland.

Migrant-origin women are less prone to cervical screening uptake compared with host populations. This study examined cervical cancer screening participation and factors associated with it in the Finnish mass screening program during 2008-2012 in women of Russian, Somali and Kurdish origin compared with the general Finnish population (Finns) in Finland. The study population consists of samples from the Finnish Migrant Health and Well-being Study 2010-2012 and Health 2011 Survey; aged 30-64 ( = 2579). Data from the Finnish screening register linked with other population-based registry data were utilized. For statistical analysis we employed logistic regression. Age-adjusted screening participation rates were Russians 63% (95% CI: 59.9-66.6), Somalis 19% (16.4-21.6), Kurds 69% (66.6-71.1), and Finns 67% (63.3-69.8). In the multiple-adjusted model with Finns as the reference; odds ratios for screening were among Russians 0.92 (0.74-1.16), Somalis 0.16 (0.11-0.22), and Kurds 1.37 (1.02-1.83). Among all women, the substantial factor for increased screening likelihood was hospital care related to pregnancy/birth 1.73 (1.27-2.35), gynecological 2.47 (1.65-3.68), or other reasons 1.53 (1.12-2.08). Screening participation was lower among students and retirees. In conclusion, screening among the migrant-origin women varies, being significantly lowest among Somalis compared with Finns. Efforts using culturally tailored/population-specific approaches may be beneficial in increasing screening participation among women of migrant-origin.
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October 2020

Cancer Incidence and Mortality in the Oldest Old: A Nationwide Study in Finland.

Am J Epidemiol 2021 05;190(5):836-842

The world's population is aging rapidly. This study reports the burden of cancer in the "oldest old" (aged ≥85 years) in Finland, 1953-2017, and estimates age-specific cancer rates in the older population (65-99 years) for 1988-2017. The Finnish Cancer Registry provided data on all cancer diagnoses, cancer deaths, and other deaths in cancer patients in Finland for 1953-2017. Between 1953-1957 and 2013-2017, the proportion of incident cancers in those aged ≥85 years increased from 1.5% to 9.6% (597 to 15,360 new cases), and in 2013-2017, more new cancers were diagnosed at ages ≥85 years than ages <50 years. Cancer incidence and excess mortality attributable to cancer peaked at ages 85-94 years and declined subsequently, whereas cancer-specific mortality continued to increase or plateaued. Due to demographic changes, the number of new cancers in the oldest old has increased substantially in Finland, and currently nearly 1 in 10 cancers are diagnosed in this age group. The increasing cancer burden in the oldest old poses a major challenge for health care and needs to be addressed in designing clinical research and reporting of cancer registries. In older populations with competing risks of death, we propose excess cancer mortality as a measure of cancer-related mortality.
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May 2021

Trends in cancer survival in the Nordic countries 1990-2016: the NORDCAN survival studies.

Acta Oncol 2020 Nov 19;59(11):1266-1274. Epub 2020 Oct 19.

Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.

Background: Differences in cancer survival between the Nordic countries have previously been reported. The aim of this study was to examine whether these differences in outcome remain, based on updated information from five national cancer registers.

Materials And Methods: The data used for the analysis was from the NORDCAN database focusing on nine common cancers diagnosed 1990-2016 in Denmark, Finland, Iceland, Norway and Sweden with maximum follow-up through 2017. Relative survival (RS) was estimated at 1 and 5 years using flexible parametric RS models, and percentage point differences between the earliest and latest years available were calculated.

Results: A consistent improvement in both 1- and 5-year RS was found for most studied sites across all countries. Previously observed differences between the countries have been attenuated. The improvements were particularly pronounced in Denmark that now has cancer survival similar to the other Nordic countries.

Conclusion: The reasons for the observed improvements in cancer survival are likely multifactorial, including earlier diagnosis, improved treatment options, implementation of national cancer plans, uniform national cancer care guidelines and standardized patient pathways. The previous survival disadvantage in Denmark is no longer present for most sites. Continuous monitoring of cancer survival is of importance to assess the impact of changes in policies and the effectiveness of health care systems.
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November 2020

Vaginal Microbiota Composition Correlates Between Pap Smear Microscopy and Next Generation Sequencing and Associates to Socioeconomic Status.

Sci Rep 2019 05 23;9(1):7750. Epub 2019 May 23.

Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland.

Recent research on vaginal microbiota relies on high throughput sequencing while microscopic methods have a long history in clinical use. We investigated the correspondence between microscopic findings of Pap smears and the vaginal microbiota composition determined by next generation sequencing among 50 asymptomatic women. Both methods produced coherent results regarding the distinction between Lactobacillus-dominant versus mixed microbiota, reassuring gynaecologists for the use of Pap smear or wet mount microscopy for rapid evaluation of vaginal bacteria as part of diagnosis. Cytologic findings identified women with bacterial vaginosis and revealed that cytolysis of vaginal epithelial cells is associated to Lactobacillus crispatus-dominated microbiota. Education and socio-economic status were associated to the vaginal microbiota variation. Our results highlight the importance of including socio-economic status as a co-factor in future vaginal microbiota studies.
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May 2019

Nordic Cancer Registries - an overview of their procedures and data comparability.

Acta Oncol 2018 Apr 11;57(4):440-455. Epub 2017 Dec 11.

k Cancer Registry of Norway , Oslo , Norway.

Background: The Nordic Cancer Registries are among the oldest population-based registries in the world, with more than 60 years of complete coverage of what is now a combined population of 26 million. However, despite being the source of a substantial number of studies, there is no published paper comparing the different registries. Therefore, we did a systematic review to identify similarities and dissimilarities of the Nordic Cancer Registries, which could possibly explain some of the differences in cancer incidence rates across these countries.

Methods: We describe and compare here the core characteristics of each of the Nordic Cancer Registries: (i) data sources; (ii) registered disease entities and deviations from IARC multiple cancer coding rules; (iii) variables and related coding systems. Major changes over time are described and discussed.

Results: All Nordic Cancer Registries represent a high quality standard in terms of completeness and accuracy of the registered data.

Conclusions: Even though the information in the Nordic Cancer Registries in general can be considered more similar than any other collection of data from five different countries, there are numerous differences in registration routines, classification systems and inclusion of some tumors. These differences are important to be aware of when comparing time trends in the Nordic countries.
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April 2018

Self-sampling in cervical cancer screening: comparison of a brush-based and a lavage-based cervicovaginal self-sampling device.

BMC Cancer 2016 Mar 15;16:221. Epub 2016 Mar 15.

Mass Screening Registry, Finnish Cancer Registry, Unioninkatu 22, FI-00130, Helsinki, Finland.

Background: High coverage and attendance is essential for cervical cancer screening success. We investigated whether the previous positive experiences on increasing screening attendance by self-sampling in Finland are sampler device dependent.

Methods: All women identified to cervical cancer screening in 2013 in 28 Finnish municipalities were randomised to receive a lavage- (n = 6030) or a brush type of self-sampling device (n = 6045) in case of non-attendance after two invitation letters. Seven hundred seventy non-attending women in the lavage device group and 734 in the brush group received the self-sampling offer. Women's experiences were enquired with an enclosed questionnaire.

Results: Total attendance in the lavage group increased from 71.0 to 77.7% by reminder letters and further to 80.5% by self-sampling. Respective increase in the brush group was from 72.2 to 78.6% and then to 81.5%. The participation by self-sampling was 21.7% (95% CI 18.8-24.6) in the lavage group and 23.8% (95% CI 20.8-26.9) in the brush group. Women's self-sampling experiences were mainly positive and the sampler devices were equally well accepted by the women.

Conclusion: Our study shows that the lavage device and brush device perform similarly in terms of uptake by non-attending women and user comfort. If self-sampling is integrated to the routine screening program in Finland, either of the devices can be chosen without the fear of losing participants due to a less acceptable device.
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March 2016

The costs of offering HPV-testing on self-taken samples to non-attendees of cervical screening in Finland.

BMC Womens Health 2015 Nov 5;15:99. Epub 2015 Nov 5.

Department of Obstetrics and Gynecology, Kätilöopisto Hospital, Helsinki University Central Hospital, Helsinki, Finland.

Background: Offering self-sampling to non-attendees of cervical screening increases screening attendance.

Methods: We used observations from two Finnish studies on the use of self-sampling among the non-attendees to estimate in a hypothetical screening population of 100,000 women the possible costs per extra screened woman and costs per extra detected and treated CIN2+ with three intervention strategies; 1) a primary invitation and a reminder letter, 2) a primary invitation and a mailed self-sampling kit and 3) two invitation letters and a self-sampling kit. The program costs were derived from actual performance and costs in the original studies and a national estimate on management costs of HPV related diseases.

Results: The price per extra participant and price per detected and treated CIN2+ lesion was lower with a reminder letter than by self-sampling as a first reminder. When self-sampling was used as a second reminder with a low sampler price and a triage Pap-smear as a follow-up test for HPV-positive women instead of direct colposcopy referral, the eradication of a CIN2+ lesion by self-sampling was not more expensive than in routine screening, and the addition of two reminders to the invitation protocol did not increase the price of an treated CIN2+ lesion in the entire screened population.

Conclusions: As a first reminder, a reminder letter is most likely a better choice. As second reminder, the higher costs of self-sampling might be compensated by the higher prevalence of CIN2+ in the originally non-attending population.
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November 2015

Self-sampling experiences among non-attendees to cervical screening.

Gynecol Oncol 2014 Dec 2;135(3):487-94. Epub 2014 Oct 2.

Mass Screening Registry, Finnish Cancer Registry, Unioninkatu 22, FI-00130 Helsinki, Finland.

Objective: High coverage and attendance is essential to positive cervical cancer screening results. Offering self-sampling for HPV-testing to the non-attendees of the program may improve attendance rates. Information on women's perceptions and experiences with self-sampling (acceptability) is needed to further optimize attendance by this method.

Methods: A questionnaire study focusing on women's experiences on the screening method was embedded in a trial investigating the effects and feasibility of self-sampling among non-attendees of cervical screening in 31 Finnish municipalities in 2011-2012 (n=4688). Reasons for non-attendance in routine screening were also surveyed.

Results: Response rate to the questionnaire was 98.8% (909/920) among women who performed self-sampling. Self-sampling participants reported mainly good experiences. Negative experiences (difficulties in sample taking, pain, fear, anxiety, insecurity) were reported rarely, but more commonly among women with a mother tongue other than Finnish or Swedish (immigrants). Most common reason for non-attendance in routine screening was a recent Pap-smear elsewhere (opportunistic screening). Practical reasons (pregnancy, scheduling difficulties) were reported by 42%, emotional or attitudinal reasons by 17%, and 16% forgot to take part. Response yield to questionnaire was unsatisfactory among those women who declined the self-sampling option.

Conclusions: Optimizing the practical aspects of screening and offering a self-sampling option to non-attendees can help to overcome a large variety of both practical and emotional barriers to traditional screening. More research is needed among the non-attendees to routine screening who decline also the self-sampling option.
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December 2014

Improving cervical cancer screening attendance in Finland.

Int J Cancer 2015 Mar 15;136(6):E677-84. Epub 2014 Sep 15.

Mass Screening Registry, Finnish Cancer Registry, Unioninkatu 22, Helsinki, Finland.

High attendance is essential to cervical cancer screening results. Attendance in the Finnish program is currently at 70%, but extensive opportunistic screening occurs beside the organized. A shift from opportunistic to organized screening is imperative to optimize the costs and impact of screening and minimize potential harms. We evaluated the effect of reminder letters (1st reminder) and self-sampling test (2nd reminder) on program attendance. The study population consisted of 31,053 screening invitees in 31 Finnish municipalities. 8,284 non-attendees after one invitation received a reminder letter and 4,536 further non-attendees were offered a self-sampling option. Socioeconomic factors related to participation were clarified by combining screening data to data from Statistics Finland. Reminder letters increased participation from 72.6% (95% CI 72.1, 73.1) to 79.2% (95% CI 78.8, 79.7) and self-sampling further to 82.2% (95% CI 81.8, 82.7). Reminder letters with scheduled appointments resulted in higher increase than open invitations (10 vs. 6%). Screening of original non-attendees increased the yield of CIN3+ lesions by 24%. Non-attendance was associated with young age, immigrant background, lower education level and having never been married. We showed that a total attendance of well over 80% can be achieved within an organized program when the invitational protocol is carefully arranged.
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March 2015

[Self-sampling and reminder letters increase participation in the Finnish cervical cancer screening programme].

Duodecim 2013 ;129(16):1709-17

HYKS, naistentautien klinikka.

Background: Participation rate in the national cervical cancer screening programme is currently less than 70% in Finland. A new potential method of increasing the attendance are self-taken samples for hrHPV-testing.

Methods: All cervical cancer screening non-attendees in 22 municipalities received first a reminder letter. Non-attendees after the reminder letter were offered a self-sampling device.

Results: Reminder letters increased total participation from 72.6% to 79.9%, and self-sampling tests further to 83.4%. If reminder letters were sent with fixed appointments, participation was significantly higher (30 vs. 14%).

Conclusions: If self-sampling is used after the recommended two invitations, overall screening attendance could reach the desired 80% to 85%.
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December 2013

Self-sample HPV tests as an intervention for nonattendees of cervical cancer screening in Finland: a randomized trial.

Cancer Epidemiol Biomarkers Prev 2011 Sep 13;20(9):1960-9. Epub 2011 Jul 13.

Mass Screening Registry, Finnish Cancer Registry, Pieni Roobertinkatu 9, FI-00130 Helsinki, Finland.

Background: Attendance in screening is an important determinant of cervical cancer. Previous experience on high-risk human papillomavirus (hrHPV) DNA testing on patient-obtained samples suggests a good effect among nonattendees of screening. We assessed the effects of self-sampling on attendance in the Finnish screening program.

Methods: Nonattendees after the primary invitation in one municipality (Espoo) were randomized to receive either a self-sampling kit (2,397 women) or an extra invitation (6,302 women). One fourth (1,315 women) of reminder letter arm nonattendees also received a self-sampling kit as a third intervention. Main outcomes were increases in screening attendance and coverage.

Results: The adjusted relative risk for participation by self-sampling as a second intervention in comparison to a reminder letter arm was 1.21 (95% CI: 1.13-1.30). Total attendance increased from 65% to 76% by self-sampling and from 65% to 74% with a reminder letter. Combining the interventions (reminder letter and then self-sampling) increased total attendance from 63% to 78%. One fifth of the participants in all three groups increased screening coverage (previous Pap smear ≥5 years ago or never). Self-obtained samples were more often HPV positive than provider-obtained ones (participants after primary invitation and reminder letter), 12% to 13% versus 7%.

Conclusions: Self-sampling is a feasible option in enhancing the attendance at organized screening, particularly as an addition to a reminder letter.

Impact: If self-sampling is used as a third intervention after two written invitations, the overall attendance in Finland could most likely reach the desired 80% to 85%.
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September 2011

Self-sampling versus reminder letter: effects on cervical cancer screening attendance and coverage in Finland.

Int J Cancer 2011 Jun 28;128(11):2681-7. Epub 2010 Jul 28.

Mass Screening Registry, Finnish Cancer Registry, Helsinki, Finland.

Optimizing attendance and coverage of organized screening is needed to reduce cervical cancer incidence to previous lower levels. In our study, all nonparticipants in organized cervical cancer screening in 2008 in Espoo, Finland were randomized to receive a self-sampling kit (1,130 women) or a reminder letter (3,030 women). Effects on screening coverage were assessed according to the self-reported previous Pap smear history of the participants. Participation rate in the self-sampling arm, 29.8%, was significantly higher than in the reminder letter arm, 26.2% (adjusted relative risk for participation 1.13). Total participation in Espoo in 2008 rose significantly after the two interventions from 64.0 to 75.4%. In both arms, ∼ 20% of the participants after second intervention could be considered under screened (previous Pap smear ≥ 5 years ago) and thus increased screening coverage. Respectively, for 70-75%, the second intervention only provided overscreening. Participation was lowest among young age groups and immigrants, after primary invitation and after interventions. Our study shows that a second intervention for nonattendees after the first invitation is needed to optimize the attendance rates. Self-sampling might be slightly more successful in this, but the effects on screening coverage were similar in both groups.
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June 2011