Dr. Kristjan Sigurdsson, MD, PhD, DrPh - University of Iceland - Clinical Professor Emeritus

Dr. Kristjan Sigurdsson

MD, PhD, DrPh

University of Iceland

Clinical Professor Emeritus

Reykjavik | Iceland

Main Specialties: Obstetrics & Gynecology, Oncology, Public Health

Additional Specialties: gyn obs, gyn onc, public health, health care administration


Top Author

Dr. Kristjan Sigurdsson, MD, PhD, DrPh - University of Iceland - Clinical Professor Emeritus

Dr. Kristjan Sigurdsson

MD, PhD, DrPh

Introduction

My basic training was carried out in Iceland and the specialist training in Sweden. After returning to Iceland in 1982 my work was divided between the Department of Obs/Gyn at the University Hospital Landspitalinn, and the Cancer Screening Centre at the Icelandic Cancer Society, Reykjavik. The working time was divided between clinical work, administration, teaching and research.

At Landspítalinn, University Hospital (01.08.1982-01.02.2001) I started out as a consultant, then as Chief Physician at the Gyn Onc Section and later as Medical Director at the Department of Obs/Gyn.

At the Icelandic Cancer Society (01.09.1982-31.03.2013) I started out as a Chief Physician at the Cancer Screening Station and later as Medical Director at the Cancer Screening Centre including all sections of the Breast and Cervical Screening in Iceland.

Administrative work:
As Medical Director of the Icelandic Cancer Centre I was responsible for the operation of the combined national screening for cervical and breast cancer in accordance with a contract between the Icelandic Cancer Society and the Department of Health. The Centre thus decided the timing and interval of screening, registers attendance and controls the follow-up of abnormal cases diagnosed both at organized and spontaneous screening. The screening is performed in co-operation with 45 health care stations throughout the country and also in co-operation with consultant specialists, departments of cytology and pathology and different hospitals. This activity is secured by a centralized data handling system, meetings, written communications and published guidelines for the medical profession. The reorganization of the screening activity after 1982 resulted in improved attendance and better screening results. The screening organization was reorganized with electronic digital workflow systems including an electronic system for the cervical screening and Radiological Information System (RIS) / Picture Archival and Communication System (PACS) for the mammography screening. The final aim in 2013 was to create a paperless national screening system.
As head of the Gynecologic Oncologic Section (one of five sections at the Department of Obstetrics and Gynecology) I was responsible for the treatment planning of preinvasive / invasive gynecologic tumors and other gynecologic tumors of unspecified nature. A part of this work was the evaluation of the quality of the treatment given. This was partly done by prospective treatment protocols and partly by retrospective studies of the treatment given and evaluation of prognostic factors and by participation in multicentre studies and consensus meetings. As Medical Director of the Department of Obstetrics and Gynecology I was later temporarily responsible for the administrative management of the Department.

Research and teaching:
In Sweden the research and publications were mostly concentrated on ovarian, corpus and cervical cancer but thereafter mainly on cancer screening, HPV-vaccination, guidelines for the medical profession, articles/booklets for the public, and issues in health care administration/public health /national affairs.

The teaching was first concentrated on Gynecologic Oncology and screening but after 2000 on public health issues such as cancer epidemiology, prevention and screening related to GDP and total expenditure on health. The teaching was based on lectures, teaching compendium and published papers.

Primary Affiliation: University of Iceland - Reykjavik , Iceland

Specialties:

Additional Specialties:


View Dr. Kristjan Sigurdsson’s Resume / CV

Education

Aug 2018
For further information see CV
Nov 2007
University of Iceland
Professor
Faculty of Medicine; Emeritus 2013
Mar 2000
Specialist Degree
Health Care Administration
Iceland
Dec 1999
Nordic School of Public Health, Gothenburg, Sweden
Dr.PH.
Public Health
Sep 1982
University of Lund, Sweden
Ph.D.
Faculty of Medicine
Aug 1981
Specialist Degree, Sweden
Gyn Onc
Iceland Mar 1982
Oct 1978
Specialist Degree, Sweden
Gyn Obs
Iceland Dec 1978
Mar 1974
University of Iceland
Licentia practicandi
Sweden Sep 1976

Experience

Aug 2018
For further information see CV
Aug 2000
The Future II HPV Multicentre Study
PI for Iceland
2000-2007
Aug 1994
The EORTC Ovarian Multicentre Study
PI for Iceland
1994-1997
Aug 1983
The Collaaborative Programme on Evaluation of Screening Programmes of the Uterine Cervix
PI for Iceland
IARC/WHO project 1983-1991
Aug 1983
The International Radiation Study of Cervical Cancer
PI for Iceland
IARC/WHO project 1983-
Aug 1979
Swedish Co-operative Ovarian Cancer Study Group projects
Part of my Thesis in Lund
1979-1982

Publications

70Publications

830Reads

1137Profile Views

1405PubMed Central Citations

Human papillomavirus types in cervical high-grade lesions or cancer among Nordic women – potential for prevention

DOI:10.1002/cam4.1961

Cancer Medicine

Abstract

It is valuable to establish a population‐based prevaccination baseline distribution of human papillomavirus (HPV) types among women with high‐grade cervical intraepithelial neoplasia (CIN) grade 2 or 3 and cervical cancer in order to assess the potential impact of HPV vaccination. In four countries (Denmark, Norway, Sweden, and Iceland), we collected consecutive series of cervical cancers (n = 639) and high‐grade precancerous cervical lesions (n = 1240) during 2004‐2006 before implementation of HPV vaccination and subjected the specimens to standardized HPV genotyping. The HPV prevalence was 82.7% (95% confidence interval [CI] 79.0‐86.4) in CIN2, 91.6% (95% CI 89.7‐93.5) in CIN3, and 86.4% (95% CI 83.7‐89.1) in cervical cancer. The most common HPV types in CIN2/3 were HPV16 (CIN2: 35.9%, 95% CI 31.2‐40.6; CIN3: 50.2%, 95% CI 46.8‐53.6) and HPV31 (CIN2: 10.9%, 95% CI 7.8‐13.9; CIN3: 12.1%, 95% CI 9.9‐14.3), while HPV16 and HPV18 were the most frequent types in cervical cancer (48.8%, 95% CI 44.9‐52.7 and 15.3%, 95% CI 12.5‐18.1, respectively). The prevalence of HPV16/18 decreased with increasing age at diagnosis in both CIN2/3 and cervical cancer (P < 0.0001). Elimination of HPV16/18 by vaccination is predicted to prevent 42% (95% CI 37.0‐46.7) of CIN2, 57% (95% CI 53.8‐60.5) of CIN3 and 64% (95% CI 60.3‐67.7) of cervical cancer. Prevention of the five additional HPV types HPV31/33/45/52/58 would increase the protection to 68% (95% CI 63.0‐72.2) in CIN2, 85% (95% CI 82.4‐87.2) in CIN3 and 80% (95% CI 77.0‐83.2) in cervical cancer. This study provides large‐scale and representative baselines for assessing and evaluating the population‐based preventive impact of HPV vaccination.

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January 2019
1 Read

Population-based service mammography screening: the Icelandic experience.

Breast Cancer (Dove Med Press) 2013 9;5:17-25. Epub 2013 May 9.

The Icelandic Cancer Registry, Icelandic Cancer Society, Reykjavik, Iceland.

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http://dx.doi.org/10.2147/BCTT.S44671DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3929328PMC
March 2014
77 Reads
3 Citations

Is a liquid-based cytology more sensitive than a conventional Pap smear?

Authors:
K Sigurdsson

Cytopathology 2013 Aug 20;24(4):254-63. Epub 2013 Jan 20.

Cancer Detection Clinic, Icelandic Cancer Society, 105 Reykjavik, Iceland.

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http://dx.doi.org/10.1111/cyt.12037DOI Listing
August 2013
11 Reads
4 Citations
1.481 Impact Factor

The accuracy of colposcopic biopsy: analyses from the placebo arm of the Gardasil clinical trials.

Int J Cancer 2011 Mar;128(6):1354-62

Robert E Fechner Laboratory of Surgical Pathology, University of Virginia Health System, Charlottesville, VA, USA.

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http://dx.doi.org/10.1002/ijc.25470DOI Listing
March 2011
19 Reads
24 Citations
5.085 Impact Factor

Breast and cervical cancer screening programme implementation in 16 countries.

J Med Screen 2010 ;17(3):139-46

Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA.

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http://dx.doi.org/10.1258/jms.2010.010033DOI Listing
February 2011
9 Reads
18 Citations
2.722 Impact Factor

Cervical cancer: cytological cervical screening in Iceland and implications of HPV vaccines.

Authors:
K Sigurdsson

Cytopathology 2010 Aug;21(4):213-22

Cancer Detection Clinic, The Icelandic Cancer Society, Reykjavik, Iceland.

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http://dx.doi.org/10.1111/j.1365-2303.2010.00783.xDOI Listing
August 2010
7 Reads
3 Citations
1.481 Impact Factor

The impact of a quadrivalent human papillomavirus (types 6, 11, 16, 18) virus-like particle vaccine in European women aged 16 to 24.

J Eur Acad Dermatol Venereol 2009 Oct 23;23(10):1147-55. Epub 2009 Apr 23.

Department of Dermatology and Venereology, Center of Diagnostics and Treatment of Sexually Transmitted Diseases, Medical University of Warsaw, Warsaw, Poland.

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http://dx.doi.org/10.1111/j.1468-3083.2009.03266.xDOI Listing
October 2009
8 Reads
10 Citations
2.830 Impact Factor

The efficacy of HPV 16/18 vaccines on sexually active 18-23 year old women and the impact of HPV vaccination on organized cervical cancer screening.

Acta Obstet Gynecol Scand 2009 ;88(1):27-35

The Cancer Detection Clinic, Icelandic Cancer Society, Reykjavik, Iceland.

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http://dx.doi.org/10.1080/00016340802566770DOI Listing
February 2009
15 Reads
6 Citations
1.990 Impact Factor

Baseline demographic characteristics of subjects enrolled in international quadrivalent HPV (types 6/11/16/18) vaccine clinical trials.

Authors:
Jorma Paavonen

Curr Med Res Opin 2008 Jun 23;24(6):1623-34. Epub 2008 Apr 23.

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

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http://dx.doi.org/10.1185/03007990802068151DOI Listing
June 2008
11 Reads
6 Citations
2.653 Impact Factor

[HPV vaccination and cervical cancer screening].

Laeknabladid 2007 Dec;93(12):819, 821

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December 2007
7 Reads
1 Citation
0.210 Impact Factor

HPV genotypes in CIN 2-3 lesions and cervical cancer: a population-based study.

Int J Cancer 2007 Dec;121(12):2682-7

The Icelandic Cancer Detection Clinic, Icelandic Cancer Society, Reykjavik, Iceland.

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http://dx.doi.org/10.1002/ijc.23034DOI Listing
December 2007
10 Reads
8 Citations
5.085 Impact Factor

Prophylactic efficacy of a quadrivalent human papillomavirus (HPV) vaccine in women with virological evidence of HPV infection.

Authors:

J Infect Dis 2007 Nov 31;196(10):1438-46. Epub 2007 Oct 31.

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http://dx.doi.org/10.1086/522864DOI Listing
November 2007
11 Reads
36 Citations
6.000 Impact Factor

A case-control study to estimate the impact of the Icelandic population-based mammography screening program on breast cancer death.

Acta Radiol 2007 Nov;48(9):948-55

Cancer Research UK, Centre for Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive Medicine, London, UK and Icelandic Cancer Society (Krabbameinsfélag Islands), Reykjavik, Iceland.

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November 2007
8 Reads
15 Citations
1.350 Impact Factor

Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions.

Authors:

N Engl J Med 2007 May;356(19):1915-27

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http://dx.doi.org/10.1056/NEJMoa061741DOI Listing
May 2007
10 Reads
412 Citations
55.873 Impact Factor

Is it rational to start population-based cervical cancer screening at or soon after age 20? Analysis of time trends in preinvasive and invasive diseases.

Eur J Cancer 2007 Mar 22;43(4):769-74. Epub 2007 Jan 22.

Cancer Detection Clinic, Icelandic Cancer Society, 105 Reykjavik, Iceland.

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http://dx.doi.org/10.1016/j.ejca.2006.11.017DOI Listing
March 2007
13 Reads
4 Citations
5.420 Impact Factor

Effectiveness of cervical cancer screening in Iceland, 1964-2002: a study on trends in incidence and mortality and the effect of risk factors.

Acta Obstet Gynecol Scand 2006 ;85(3):343-9

Cancer Detection Clinic, Icelandic Cancer Society, Reykjavik, Iceland.

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April 2006
12 Reads
7 Citations
1.990 Impact Factor

Longitudinal trends in cervical cytological lesions and the effect of risk factors. A 30-year overview.

Acta Obstet Gynecol Scand 2006 ;85(3):350-8

Cancer Detection Clinic, Icelandic Cancer Society, Reykjavik, Iceland.

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April 2006
18 Reads
1.990 Impact Factor

HPV subtypes and immunological parameters of cervical cancer in Iceland during two time periods, 1958-1960 and 1995-1996.

Gynecol Oncol 2003 Apr;89(1):22-30

Laboratory of Molecular and Cell Biology, The Icelandic Cancer Society, Skogarhlid 8, 105 Reykjavik, Iceland.

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April 2003
11 Reads
3.774 Impact Factor

Eligibility and willingness of young Icelandic women to participate in a HPV vaccination trial.

Acta Obstet Gynecol Scand 2003 Apr;82(4):345-50

The Icelandic Directorate of Health, Division of Infectious Disease Control, Reykjavik, Iceland.

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April 2003
24 Reads
4 Citations
1.990 Impact Factor

Risk variables affecting high-grade Pap smears at second visit: effects of screening interval, year, age and low-grade smears.

Int J Cancer 2001 Dec;94(6):884-8

Cancer Detection Clinic, Icelandic Cancer Society, Reykjavik, Iceland.

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December 2001
8 Reads
2 Citations
5.085 Impact Factor

Cervical cancer screening. The Nordic experience through 1995

Authors:
Sigurdsson K

NLM ID 100961423 (Book), ed. Monsonego J, editor. Bologna, Italy: Monduzzi Editore, Bologna, Italy;

Eurogin 2000: 4th International Multidisciplenary Congress: Paris, France, April 5-9, 2000

Cervical Cancer Screening: The Nordic Experience through 1995 K. Sigurdsson The Cancer Detection Clinic, The Icelandic Cancer Society, Iceland Summary Except for Norway, scrceening in the Nordic countries has been organised since the sixties. The reduction in both the incidence and the mortality rates was greatest in Iceland and Finland and lowest in Norway. In Iceland screening has greatly affected the rate of squamous cell carcinomas, but not the rate of adeno- and adenosquamous carcinomas. The frequency of preinvasive disease has increased significantly since 1980. The rate of cytologic and histologic CIN 2-3 begins increasing at the age of 20 and decreases with the number of negative smears. Histologic CIN 2-3 and early invasive disease starts to accumulate 24 months after a normal smear. It is concluded that organised screening is more effective than spontaneous screening and should start soon after age 20 with an interval of 2-3 years but could stop around the age of 60 among regularly screened women.

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April 2000
16 Reads

The value of screening as an approach to cervical cancer control: A study based on the Icelandic and Nordic experience through 1995

Authors:
Sigurdsson K

NHV Report 1999:4/ ISSN 0283-1961 / ISBN 91-88710-91-2 / NLM Unique ID: 101089379

Doctoral Dissertation in Public Health 16. December 1999; ed. Nordic School of Public Health, Box 12133, 402 42 Göteborg, Sweden

DISSERTATION IN PUBLIC HEALTH, 16 December 1999. NHV REPORTS 1999:4 / ISSN 0283-1961/ ISBN 91-88710-91-2 / NLM ID 101089379. The Nordic School of Public Health,Box 12133, 402 42 Göteborg, Sweden Title and subtitle: THE VALUE OF SCREENING AS AN APPROACH TO CERVICAL CANCER CONTROL: A study based on the Icelandic and Nordic experience through 1995. KRISTJAN SIGURDSSON M.D., Ph.D. ABSTRACT: Background and aims of the study. This study evaluates the hypothesis that Pap smear screening is an effective public health approach to cervical cancer control and the role of HPV testing in cervical cancer screening. Material and methods. Data on screening organisation, attendance rates, and trends in incidence and mortality rates were collected for all the Nordic countries. Data on trends in preinvasive disease, stage and histologic distribution of invasive disease, and HPV testing were collected for Iceland. Statistical analyses were carried out on time-trends in invasive and preinvasive disease and the outcome correlated with ongoing screening activity in different age groups and countries. The data allowed analyses on screening effectiveness, optimal targeted age groups and screening intervals, screening quality assurance and the role of HPV testing. Results. Organised Pap smear screening started in all the Nordic countries except in Norway soon after 1960. By about 1973 organised screening was carried out nation-wide in Finland, Iceland and Sweden but in Denmark only 45% screening coverage was accomplished in 1991. Up to 1985 the screening was most comprehensive in Iceland followed by Finland, Sweden and Denmark. All these countries except Finland lowered the lower age limit and intensified the screening intervals after 1985. In Norway screening was spontaneous up to late 1994. Spontaneous smears have always far exceeded organised smears in all the Nordic countries except Iceland. Through the period 1986-1995 the reduction in both the mortality and the incidence rates was greatest in Iceland and Finland, intermediate in Sweden and Denmark, and lowest in Norway. The age specific incidence in the 20- 29 year age group has been increasing since 1971 in all the Nordic countries, except in Finland, where the yearly registered age-specific incidence has been increasing in the 30-54 targeted age group since 1991. In Iceland screening has greatly affected the rate of all stages of squamous cell carcinoma but not the rate of adeno- and adenosquamous carcinomas, and the rate of adenocarcinomas has, in fact, been increasing. Invasive cancer is practically non-existent over the age of 60 among women correctly screened before that age. Among the younger women microinvasive cases start to appear 2 to 5 years after a normal smear. A strong positive correlation was found between increased attendance rates to screening and the occurrence of early asymptomatic cases diagnosed with an abnormal Pap smear. The rates of moderate and severe preinvasive lesions have increased significantly since 1980 in all age groups between 20-34 and the mean age of invasive disease has decreased significantly. In Iceland during the year 1994 about 95% of cases referred for colposcopy with abnormal smears had HPV positive testing. The sensitivity of commercially available Hybrid Capture test and Pap smears for high grade histology was 70% and 8l%, respectively, and the positive predictive value (PPV) 67% and 64%, respectively. Conclusions. Pap smear screening is an effective public health approach to lower both the incidence and mortality rates of cervical cancer. In developed countries screening should preferably start at or soon after age 20 with a screening interval of 2-3 years. The interval can probably be extended at higher age and could stop around the age of 60, depending on the number of negative smears by that age. At present routine HPV testing with Hybrid Capture is of limited value in a population with well-orgarlised and established Pap smear screening.

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December 1999
18 Reads

[The Nordic cervical screening programmes through 1995. Evaluation of incidence and mortality rates, targeted age groups and screening intervals.].

Authors:
K Sigurdsson

Laeknabladid 1999 Nov;85(11):862-72

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November 1999
8 Reads
1 Citation
0.210 Impact Factor

The Nordic cervical cancer screening experience

Authors:
Sigurdsson K

NLM ID 100929443 (Book), ed. Testa R, Jakob CA, Huguet JO, editors. Bologna, Italy: Monduzzi Editore

10th World Congress of Cervical Pathology and Colposcopy, Buenos Aires, Argentina, 7-11 November, 1999

The Nordic cervical cancer screening experience K. SIGURDSSON The Cancer Detection Clinic of The Icelandic Cancer Society SUMMARY The features and effectiveness of cervical Pap screening in the Nordic countries and the role of HPV testing in Iceland are evaluated. Except for Norway, screening has been organised with varying targeted age groups and screening intervals. The reduction in both the incidence and the motality rates was greatest in Iceland and Finland and lowest in Norway. In lceland screening has greatly affected the rate of squamous cell carcinomas, but not the rate of adeno- andadenosquamous carcinomas. The prevalence of preinvasive disease has increased significantly since 1980. The rate of high risk cytologic changes (CIN 2-3) begins increasing at the age of 20 and decreases with the number of negative smears taken. High risk histologic changes (CIN 2-3) and early invasive disease starts to accumulate 24 months after a normal smear. It is concluded that organised scrceening is more effective than spontaneous screening. Screening should start soon after age 20 with an interval of 2-3 years but could stop around the age of 60 among regularily screened women. Routine HPV testing is of limited value.

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November 1999
16 Reads

The Icelandic and Nordic cervical screening programs: trends in incidence and mortality rates through 1995.

Authors:
K Sigurdsson

Acta Obstet Gynecol Scand 1999 Jul;78(6):478-85

Cancer Detection Clinic of the Icelandic Cancer Society, Reykjavik.

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July 1999
7 Reads
12 Citations
1.990 Impact Factor

Cervical cancer, Pap smear and HPV testing: an update of the role of organized Pap smear screening and HPV testing.

Authors:
K Sigurdsson

Acta Obstet Gynecol Scand 1999 Jul;78(6):467-77

Cancer Detection Clinic of the Icelandic Cancer Society, Reykjavik.

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July 1999
8 Reads
1 Citation
1.990 Impact Factor

Trends in cervical intra-epithelial neoplasia in Iceland through 1995: evaluation of targeted age groups and screening intervals.

Authors:
K Sigurdsson

Acta Obstet Gynecol Scand 1999 Jul;78(6):486-92

Cancer Detection Clinic of the Icelandic Cancer Society, Reykjavik.

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July 1999
9 Reads
1.990 Impact Factor

Human papillomavirus (HPV) in an Icelandic population: the role of HPV DNA testing based on hybrid capture and PCR assays among women with screen-detected abnormal Pap smears.

Int J Cancer 1997 Jul;72(3):446-52

The Icelandic Cancer Society, The Cancer Detection Clinic, Reykjavik.

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July 1997
7 Reads
1 Citation
5.085 Impact Factor

What attendance rate can be achieved for Pap smear screening? A case-control study of the characteristics of non-attenders and results of reminder efforts.

Scand J Prim Health Care 1996 Sep;14(3):152-8

Department of Family Medicine, Solvangur Health Centre, University of Iceland, Iceland.

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September 1996
7 Reads
3 Citations
1.610 Impact Factor

Human papillomavirus (HPV) in an Icelandic population: correlation of HPV DNA to cyto- and histopathologic lesions and evaluation of treatment strategies

Int J Gynecol Cancer 1996; 6:175-82

Int J Gynecol Cancer

Int J Gynecol Cancer,1996,6, 175-182 Human papillomavirus (HPV) in an Icelandic population: correlation of HPV DNA to cyto- and histopathologic lesions and evaluation of treatment strategies K. SIGURDSSON*$, T. ARNADOTTIR**, M. SNORRAOOTTIR*, K. BENEDIKTSDOTTIR*** & H. SAMUNDSSON$ *The Icelandic Cancer Society, **Department of Virology , ***Department of Pathology , $ Section of Gynecologic Oncology , The University Hospital, Landspitalinn, Reykj avik, Iceland Abstract. Sigurdsson K, Arnadottir T, Snorradottir M, Benediktsd6ttir K, Semundsson H. Human papillomavirus (HPV) in an Icelandic population: correlation of HPV DNA to cyto- and histopathologic lesions and evaluation of treatment strategies. Int I Gynecol Cancer 7996; 6:775-782. This study is based on 100 cases with cervical intra-epithelial neoplasia (CIN) smears referred for colposcopy and 200 controls with normal smears. The study analyses (a) the frequency of different grades of CIN and koilocytotic lesions among the cases based on cyto- and histopathologic findings; (b) the frequency of human papillomavirus (HPV) among the cases with Virapap/Viratype (V/V) in biopsies vs swabs and among the controls with V/V and polymerase chain reaction (PCR) in swabs; (c) the frequency of the HPV types according to the grade of CIN. Among the cases koilocytotic lesions were found in 98% of the biopsies and, 27Vo of the smears. High-graded smears and high-risk viruses had at entry a positive predictive value (PPV) ol80% and 88% respectively and a sensitivity of 72% for histologically verified high-graded CIN lesions. Both tests combined increased the sensitivity to 88%. The false-negative rate of colposcopy was 3Vo and the undergraded rate of CIN I and unclassified CIN smears for histologically verified CIN II-III was 62%. Arnongthe cases the rate of HPV positive tests increased with a higher CIN grade. Cytology and colposcopy are complementary forthe diagnosis of CIN and the swabs and biopsies for the diagnosis of HPV. Among the cases the rate of HPV-positive tests with ViV was 62Vo (97% high-risk viruses) and among the controls 5.57a (78% high-risk viruses). Among the controls the frequency of HPV occurrence with PCR was 1'1,.2% and decreased with older age. The therapeutic conclusions are that the high-graded CIN lesions should receive ablative treatment irrespective of HPV typing, whereas low-graded lesions with high-risk viruses should be treated or observed closely. KEYWORDS: carcinoma in situ, cervix dysplasia, colposcopy, epidemiology, human papillomavirus (HPV), mass screening.

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June 1996
15 Reads

Quality assurance in cervical cancer screening: the Icelandic experience 1964-1993.

Authors:
K Sigurdsson

Eur J Cancer 1995 ;31A(5):728-34

Cancer Detection Clinic of the Icelandic Cancer Society, Reykjavik.

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September 1995
7 Reads
5.420 Impact Factor

Effect of organized screening on the risk of cervical cancer. Evaluation of screening activity in Iceland, 1964-1991.

Authors:
K Sigurdsson

Int J Cancer 1993 Jun;54(4):563-70

Cancer Detection Clinic, Icelandic Cancer Society, Reykjavík.

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June 1993
7 Reads
15 Citations
5.085 Impact Factor

Nordic symposium on gynecological oncology, Svalbard, Norway 1990. Consensus statements.

Acta Obstet Gynecol Scand 1991 ;70(4-5):401-3

Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tromsø, Norway.

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January 1992
8 Reads
1.990 Impact Factor

Screening as a prognostic factor in cervical cancer: analysis of survival and prognostic factors based on Icelandic population data, 1964-1988.

Gynecol Oncol 1991 Oct;43(1):64-70

Cancer Detection Clinic, Icelandic Cancer Society, Reykjavík.

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October 1991
7 Reads
3 Citations
3.774 Impact Factor

Trends in cervical and breast cancer in Iceland. A statistical evaluation of trends in incidence and mortality for the period 1955-1989, their relation to screening and prediction to the year 2000.

Int J Cancer 1991 Jun;48(4):523-8

Cancer Detection Clinic, Icelandic Cancer Society, Reykjavik.

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June 1991
7 Reads
3 Citations
5.085 Impact Factor

Cervical intra-epithelial neoplasia and koilocytotic lesions of the lower genitalia in an Icelandic population

Int J Gynecol Cancer 1991; 1:49-57

Int J Gynecol Cancer

Abstract. Sigurdsson K, Benediktsdottir K, Snorradottir M, Saemundsson H, Olafsson JH, Einarsson GV. Cervical intra-epithelial neoplasia and koilocytotic lesions of the lower genitalia in an Icelandic population. Int Gynecol Cancer 1991; 1: 49-57. This study is based on women who participated in cervical cancer screening and on 390 women referred from the screened group for colposcopy. The study analyzed the frequency of atypia, CIN and koilocytosis and evaluated the efficiency of cytologic vs. histologic diagnosis. The clinical expression of the koilocytotic lesions and the rate of infected partners were evaluated. In the screened population the prevalence of smears with atypia and CIN was 3.2% and that of koilocytosis 0.5%. In the colposcopic group the frequency of koilocytosis in the histologic sections was 98% compared to 18% of the smears. The koilocytotic lesions were mostly multicentric, subclinical and asymptomatic and often associated with normal cytology. The rate of infected partners of women with normal smears and non-symptomatic vulvar lesions was low (15%), increased if smears were abnormal (30%), and was highest when the partner had gross condylomata (89%). As to atypia and CIN, the rate of undegraded smears was l8%, false-negative smears 8%, undergraded colposcopic biopsies 33%, false-negative colposcopic biopsies 3%, and the false-negative rate of combined cytology and colposcopy was less that 1%. Colposcopy is recommended for unclassified CIN and CIN 2-3 repeat smear for atypia and CIN 1 and combined cytology and colposcopy for condylomata. KEYWORDS: carcinoma in situ, cervix dysplasia, condylomata accuminata, colposcopy, mass screening, epidemiology. Address for correspondence: Dr Kristjan Sigurdsson, the Icelandic Cancer Society, P.O. Box5420, IS-l25 Reykjavik, Iceland.

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January 1991
16 Reads

Reproductive factors and breast cancer risk in Iceland. A second cohort study.

Int J Cancer 1990 Dec;46(6):972-5

Icelandic Cancer Society, Reykjavik.

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December 1990
8 Reads
5 Citations
5.085 Impact Factor

The value of screening as an approach to cervical cancer control in Iceland, 1964-1986.

Int J Cancer 1989 Jan;43(1):1-5

Cancer Detection Clinic, Icelandic Cancer Society, Reykjavik.

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January 1989
7 Reads
2 Citations
5.085 Impact Factor

[Screening for Cervical Cancer in Iceland 1964-86: do we reap as we sow?]

Laeknabladid. 1988; 74:35-40

Laeknabladid

LÆKNABLAÐIÐ 1988; 74: 35-40 SUMMARY Screening for cervical cancer in Iceland 1964-862 Do we reap as we sow? K Sigurdsson, S Adalsteinsson Before screening for cervical cancer was started in Iceland in 1964, incidence and mortality rates was on the increase but fell significantly between 1966-70 and 1976-80. After commencement of the screening programme there was a shift from advanced to early stages and at the same time the five year survival rate doubled. The mortality rates among the unscreened population remained high compared with the screened population. After 1979 the incidence rose again and reached a local maximum in 1984 but has decreased since then. About one third of the female population has not attended the screening at the recommended maximum three year intervals and two thirds of the cervical cancer was found among these since 1980. During the latter years there has been a shift in the occurrence of invasive cervical cancer from the older to the younger age groups. At the same time, up to 1985, there was a significant rise in the rate of preinvasive stages among women under 45 years of age. After analyzing the screening history, stage and histology distribution, we find that screening appeared still to be an effective approach to control most of the squamous cell carcinomas of stage l B and higher, but not the adeno- and adenosquamous carcinomas. Technical details such as strict working rules, central steering and an effective data-handling system are a prerequisite foroptimal results in a cancer screening program.

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January 1988
15 Reads

Cervical cancer screening in Iceland: a case-control study.

IARC Sci Publ 1986 (76):37-41

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June 1987
7 Reads
2 Citations

Advanced stage III ovarian carcinoma. Prospective randomized trials comparing radiotherapy and chemotherapy.

Authors:
K Sigurdsson

Acta Obstet Gynecol Scand 1986 ;65(1):69-74

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July 1986
7 Reads
1.990 Impact Factor

[Staging and differentiated grading are the factors influencing mortality in ovarian cancer].

Lakartidningen 1984 Jun;81(23):2354-7

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June 1984
7 Reads

Screening for cervix cancer in Iceland

ISBN 0.12.481760.2 / NLM Unique ID: 8410241 (Book), ed. McBrien DC, Slater TF, editors. London: Acad

Cancer of the uterine cervix : biochemical and clinical aspects / edited by D.C.H. McBrien and T.F. Slater

SCREENING FOR CERVIX CANCER IN ICELAND Tulinius H, Geirsson G, Sigurdsson K, Day NE SUMMARY The experience from attempts at influencing the incidence of, and mortality from, cancer of the cervix uteri in Iceland has been reviewed. Previous publications and recent information allow certain conclusions to be drawn. The incidence, which had been rising prior to the conmencement of cytological screening, continued to rise for the next five years and then started to fall, and has continued to fall since. The mortality rate had also been on the increase prior to screening and reached a peak in the five-year period 1955-1969. The mean age specific mortality for the age-group 25-59 was then 26.5 per 100.000 p.a. For 1970-1974 it was 12.2, and for 1975-1979 it was 5.7, or less than 25% of what it was 15 years earlier. In spite of the falling mortality rates, for the whole population, the rates have remained relatively high, or between 20 and 30 per 100.000 p.a. for those never screened, and low, or between 2 and 5 for those who have ever had a negative screen. Comparing the clinical stage of the disease for the first ten years after screening started with what it was in the preceding ten years shows that the increase in incidence is due to a sharp rise in the incidence of stages IA and IB, whereas the rates for the more advanced stages have fallen. Possibly consequent on that, the five-year survival which was around 4O% before screening started, was 70% for the years 1971-1975. Using the W.H.O. histological classification of tumours for the cervical carcinomas it has been shown that there are no substantial differences in morphology type between those diagnosed by the screening and those diagnosed in other institutions except for the frequency of microcarcinomas which are practically confined to screening. The attendance at screening has been such that by the end of 1981 83% of the females between the ages 25 and 69 had been screened at least once, 64% had been screened within the last five years, and 44% within the last two years. In the light of the experience with screening for carcinoma of the cervix uteri in Iceland we have tried to define on what a successful operation of that kind depends. The population to be screened has to be defined at the outset and constantly kept up to date. The working rules for the operation should be clear and precise and the steering should be central. A well-functioning data handling system is required for aII the information which is generated and to control the invitations for attendance for the most efficient use of the clinic. All diagnostic methods, clinical, cytological and pathological should be as reliable as they can be made. Efficient follow-up is necessary for people under investigation as well as after treatment. Finally, efficient therapy, without which the screening would hardly be justifiable, and motivation, both of the participants and of the health professions, is extremely beneficial.

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January 1984
14 Reads

Tranexamic acid for the treatment of advanced ovarian carcinoma.

Acta Obstet Gynecol Scand 1983 ;62(3):265-6

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November 1983
10 Reads
1.990 Impact Factor

Prognostic factors in malignant epithelial ovarian tumors.

Gynecol Oncol 1983 Jun;15(3):370-80

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June 1983
7 Reads
3 Citations
3.774 Impact Factor

Bleomycin-mitomycin C in advanced carcinoma of the cervix. A third look.

Cancer 1983 Feb;51(4):591-3

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February 1983
7 Reads
4.890 Impact Factor

[Ovarian Cancer. Diagnosis, treatment and prognostic factors]

Authors:
Sigurdsson K

Laeknabladid. 1983; 69:226-34

Laeknabladid

LAEKNABLADID 1983; 69:226-34 Cancer Ovarii: Diagnosis, treatment and prognostic factors. K Sigurdsson SUMMARY The incidence of ovarian cancer has gradually increased and it has the highest mortality rate of themalignant tumours of the female genital tract. The sign and symptoms of the disease are non-specific and the diagnosis is most often made at surgery when most of the patients are at an advanced stage of the disease. Surgery together with chemotherapy or radiotherapy, or both in combination. is the main form of treatment. The following statements are based on the results of a study of Prognostic Factors and the Effects of Combined Treatments carried outat the University Hospital of Lund. Young patients with well or moderately differentiated stage la tumours can be treated with unilateral salpingo-oophorectomy, if wedge-resection of the unaffected ovary shows normal tissue. The value ofhysterectomy in stage I is doubtful and ought only to be performed in stages II and III if this operation leads to surgical radicality or minimal residual disease. Infracolic omentectomy should be perfor-med as a staging operation. Patients primarly judged inoperable should be biopsied and reoperated after preoperative treatment with radiotherapy or combination chemotherapy. Postoperative treatment does not seem to improve cases of well differentiated tumours in stages Ia with no extracystic excrescences and intact tumour capsule. Acceptable results are obtained irrespective of histologic type in weil or moderately differentiated tumours in stage I and IIa treared with five malphalan infusionsat four weeks intervals. Chemotherapy given prior to postoperative radiotherapy gives no advantages,but chemotherapy after given radiotherapy does. ln advanced poorly differentiated stage III ovariantumours the effect of combination chemotherapy are significantly higher than the effects of radiotherapy and singie drug chemotherapy. The effect of combination chemotherapy and radiotherapy on operability are much the same while the effect of single drug chemotherapy is low. In a multivariate statistical analysis, using survival as the dependent variable, the following three factors are found to be of significance: the histologic grade, the size of the residual tumour after surgery, and the stage of tumour progression. Stage lla had the same survival rate as Stage I of this disease. The state of the tumour capsules in Stage I had no prognostic effect.Ascites did not affect survival in stages I and lI. The histologic type only affects survival in patients with large residual tumours (>2 cm). A prognostic classification is proposed for ovarian cancer, based on the above results using the tumour grading, residual tumour and the FIGO stages.

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January 1983
16 Reads

Malignant Epithelial Ovarian Tumours: A study of prognostic factors and the effect of combined treatments

Authors:
Sigurdsson K

CODEN: LUMEDW/ (MEOK-1001)/1-42; http://lovisa.lub.lu.se

Doctoral Dissertation in Medicine (Oncology), ed. Department of Oncology,Gynecological Section, University Hospital, S-221 85 Lund, Sweden: Lunds University, Sweden; 1982.

DOCTORAL DISSERTATION IN MEDICINE (ONCOLOGY), 3 September, 1982; CODEN: LUMEDW/ (MEOK-1001 ) /1-42 (1982). LUND UNIVERSITY, Department of Oncology, Gynecologic Section, University Hospital S-221 85 Lund, Sweden Title and subtitle: MALIGNANT EPITHELIAL OVARIAN TUMOURS. A Study of Prognostic Factors and the Effects of Combined Treatments. Kristjan Sigurdsson M.D. Abstract: Six-hundred and twenty-two women with malignant epithelial tumour have been studied. Of these, 494 women were treated at the Department ol Oncology in Lund during 1974-1978 and 128 women treated at this and seven other Oncologic Departments in Sweden during 1978-1980. These women were included in studies analyzing the prognostic factors, and in prospective randomized trials comparing the elfects on survival and operability of: a) chemotherapy, radiotherapy or the combination of both in Stages I through III, and b) radiotherapy, single-drug and combination chemotherapy in advanced Stage III. Twenty patients were included in a trial, comparing the drug-sensitivity in vitro with the in vivo treatment results. The stage of tumour dissemination, the tumour grade and the size of the residual tumour after surgery had the greatest prognostic significance. Stages I through IIa can be divided into three prognostic groups according to the tumour grade. Well differentiated, early Stage Ia tumours do not seem to benefit from postoperative treatment. Single-drug chemotherapy seems to be sufficient as additional treatment in well differentiated, advanced Stage Ia and Stages Ib through IIa tumours and all moderately differentiated tumours in Stages I through IIa. All poorly differentiated tumours in Stages I and IIa need more aggressive treatment, Stages IIb through III can be divided into three prognostic groups, depending on the size of the residual tumour and the tumour grade. Patients with no or small residual tumours, well or moderately differentiated, had the best prognosis, while patients with poorly differentiated tumours, or large residual tumours, irrespective of grade, had the poorest prognosis. Radiotherapy gave acceptable results on well or moderately differentiated tumours with no or small residual tumours. In large residual tumours combination chemotherapy had significantly better effect on survival than single-drug chemotherapy or radiotherapy, irrespective of grade. Combination chemotherapy and radiotherapy had the same effect on (re)-operability and can be used as preoperative treatment in order to increase the operability. Unilateral salpingo-oophorectomy is indicated in young women with well or moderately differentiated Stage Ia tumours. Hysterectomy and omentectomy are only indicated if radical surgery or small residual tumour can thereby be accomplished. In 80% (16/20) of the patients there was a correlation between the drug sensitivity results in vitro and the treatment results in vivo. Key words: Malignant epithelial ovarian tumours, surgery, chemotherapy, radiotherapy, combined treatment, prognostic factors, drug-sensitivity testing.

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September 1982
15 Reads

High-dose medroxyprogesterone acetate for the treatment of advanced ovarian carcinoma.

Cancer Treat Rep 1982 Jun;66(6):1441-3

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June 1982
7 Reads
2 Citations

[Bleomycin combined with mitomycin C in recurrent cervix cancer].

Lakartidningen 1982 Apr;79(17):1689-91

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April 1982
7 Reads

Phase II study of spirogermanium in advanced ovarian malignancy.

Cancer Treat Rep 1981 Jan-Feb;65(1-2):119-20

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July 1981
7 Reads

[Abortions at Nacka Hospital, 1975--somatic complications and preventive technics].

Authors:
K Sigurdsson

Lakartidningen 1977 Feb;74(5):318-21

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February 1977
8 Reads

Top co-authors

Jorma Paavonen
Jorma Paavonen

University of Helsinki

9
Daron G Ferris
Daron G Ferris

Gynecologic Cancer Prevention Center

8
Kevin A Ault
Kevin A Ault

Emory University School of Medicine

8
Gonzalo Perez
Gonzalo Perez

Merck & Co.

8
Joakim Dillner
Joakim Dillner

Karolinska Institutet

8
Susanne K Kjaer
Susanne K Kjaer

Danish Cancer Society Research Center

8
Elmar A Joura
Elmar A Joura

Medical University of Vienna

8
Suzanne M Garland
Suzanne M Garland

The Royal Women's Hospital

7