Publications by authors named "S Hofvind"

174 Publications

The relation of number of childbirths with age at natural menopause: a population study of 310 147 women in Norway.

Hum Reprod 2021 Nov 13. Epub 2021 Nov 13.

Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway.

Study Question: Does age at natural menopause increase with increasing of number of childbirths?

Summary Answer: Age at menopause increased with increasing number of childbirths up to three childbirths; however, we found no further increase in age at menopause beyond three childbirths.

What Is Known Already: Pregnancies interrupt ovulation, and a high number of pregnancies have therefore been assumed to delay menopause. Previous studies have had insufficient statistical power to study women with a high number of childbirths. Thus, the shape of the association of number of childbirths with age at menopause remains unknown.

Study Design, Size, Duration: A retrospective population study of 310 147 women in Norway who were 50-69 years old at data collection.

Participants/materials, Setting, Methods: The data were obtained by two self-administered questionnaires completed by women attending BreastScreen Norway, a population-based screening program for breast cancer. The associations of number of childbirths with age at menopause were estimated as hazard ratios by applying Cox proportional hazard models, adjusting for the woman's year of birth, cigarette smoking, educational level, country of birth, oral contraceptive use and body mass index.

Main Results And The Role Of Chance: Women with three childbirths had the highest mean age at menopause (51.36 years; 95% CI: 51.33-51.40 years), and women with no childbirths had the lowest (50.55 years; 95% CI: 50.48-50.62 years). Thus, women with no childbirths had higher hazard ratio of reaching menopause compared to women with three childbirths (reference group) (adjusted hazard ratio, 1.24; 95% CI: 1.22-1.27). Beyond three childbirths, we estimated no further increase in age at menopause. These findings were confirmed in sub-analyses among (i) women who had never used hormonal intrauterine device and/or systemic menopausal hormonal therapy; (ii) women who were born before 1950 and (iii) women who were born in 1950 or after.

Limitations, Reasons For Caution: Information about age at menopause was based on self-reports.

Wider Implications Of The Findings: If pregnancies truly delay menopause, one would expect that women with the highest number of childbirths had the highest age at menopause. Our results question the assumption that interrupted ovulation during pregnancy delays menopause.

Study Funding/competing Interest(s): This work was supported by the South-Eastern Norway Regional Health Authority [2016112 to M.S.G.] and by the Norwegian Cancer Society [6863294-2015 to E.K.B.]. The authors declare no conflicts of interest.

Trial Registration Number: N/A.
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http://dx.doi.org/10.1093/humrep/deab246DOI Listing
November 2021

A Warning about Warning Signals for Interpreting Mammograms.

Radiology 2021 Nov 9:212092. Epub 2021 Nov 9.

From the Section for Mammographic Screening, Cancer Registry of Norway, PO Box 5313, Majorstuen, Oslo 0304, Norway (S.H.); Department of Health and Care Sciences, UiT-The Arctic University of Norway, Tromsø, Norway (S.H.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (C.I.L.); and Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Wash (C.I.L.).

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http://dx.doi.org/10.1148/radiol.2021212092DOI Listing
November 2021

Quality of life among women with symptomatic, screen-detected, and interval breast cancer, and for women without breast cancer: a retrospective cross-sectional study from Norway.

Qual Life Res 2021 Oct 26. Epub 2021 Oct 26.

Cancer Registry of Norway, Majorstuen, P.O. 5313, 0304, Oslo, Norway.

Purpose: Breast cancers detected at screening need less aggressive treatment compared to breast cancers detected due to symptoms. The evidence on the quality of life associated with screen-detected versus symptomatic breast cancer is sparse. This study aimed to compare quality of life among Norwegian women with symptomatic, screen-detected and interval breast cancer, and women without breast cancer and investigate quality adjusted life years (QALYs) for women with breast cancer from the third to 14th year since diagnosis.

Methods: This retrospective cross-sectional study was focused on women aged 50 and older. A self-reported questionnaire including EQ-5D-5L was sent to 11,500 women. Multivariable median regression was used to analyze the association between quality of life score (visual analogue scale 0-100) and detection mode. Health utility values representing women's health status were extracted from EQ-5D-5L. QALYs were estimated by summing up the health utility values for women stratified by detection mode for each year between the third and the 14th year since breast cancer diagnosis, assuming that all women would survive.

Results: Adjusted regression analyses showed that women with screen-detected (n = 1206), interval cancer (n = 1005) and those without breast cancer (n = 1255) reported a higher median quality of life score using women with symptomatic cancer (n = 1021) as reference; 3.7 (95%CI 2.2-5.2), 2.3 (95%CI 0.7-3.8) and 4.8 (95%CI 3.3-6.4), respectively. Women with symptomatic, screen-detected and interval cancer would experience 9.5, 9.6 and 9.5 QALYs, respectively, between the third and the 14th year since diagnosis.

Conclusion: Women with screen-detected or interval breast cancer reported better quality of life compared to women with symptomatic cancer. The findings add benefits of organized mammographic screening.
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http://dx.doi.org/10.1007/s11136-021-03017-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8547129PMC
October 2021

Long-term quality of life among breast cancer survivors eligible for screening at diagnosis: a systematic review and meta-analysis.

Public Health 2021 Oct 21;199:65-76. Epub 2021 Sep 21.

Cancer Registry of Norway, Section of Cancer Screening, P.O. 5313, Majorstuen, Oslo, 0304, Norway; Department of Health and Care Sciences, UiT The Artic University of Norway, P.O. 6050, Tromsø, 9037, Norway. Electronic address:

Objectives: This study aimed to explore the long-term quality of life (QoL) among breast cancer survivors eligible for mammographic screening at diagnosis and compare that to QoL among women with no history of breast cancer.

Study Design: Systematic review and meta-analysis.

Methods: A systematic review of randomised controlled trials and observational studies published between January 2000 and July 2019 was performed. Eight studies were included in the review. Six studies with QoL measurement scales (0-100) were included in the meta-analysis. We used fixed and random effects models to obtain Cohen's d with 95% confidence interval (CI). Heterogeneity among studies was evaluated by the I statistics.

Results: Information about 6145 breast cancer survivors diagnosed between 1995 and 2012 and followed for >1-10 years was analysed. Four studies used SF-36/RAND-36, three studies used EORTC QLQ-C30, one study used FACT-G and one study used FACT-B. The mean score of QoL for breast cancer survivors varied from 63.0 (RAND SF-36, 0-100) to 110.5 (FACT-B, 0-123). Two studies showed better, three studies showed similar and two studies showed poorer mean scores for breast cancer survivors compared with women with no history of breast cancer. The meta-analysis showed no significant differences in QoL for breast cancer survivors compared with women with no history of breast cancer (Cohen's d = -0.07, 95% confidence interval [CI] -0.14 to 0.00 and I = 83.7% for the fixed effect model; Cohen's d = -0.00, 95% CI -0.18 to 0.17 and I = 82.4% for the random effects model).

Conclusion: QoL did not differ between breast cancer survivors eligible for mammographic screening at diagnosis and followed for >1-10 years and women with no history of breast cancer.
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http://dx.doi.org/10.1016/j.puhe.2021.08.008DOI Listing
October 2021

Impact of Artificial Intelligence Decision Support Using Deep Learning on Breast Cancer Screening Interpretation with Single-View Wide-Angle Digital Breast Tomosynthesis.

Radiology 2021 09 6;300(3):529-536. Epub 2021 Jul 6.

From the Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Post 766, Nijmegen, the Netherlands (M.C.P., R.M.M., I.S.); ScreenPoint Medical, Nijmegen, the Netherlands (A.R.R.); Cancer Registry of Norway, Oslo, Norway (K.P., S.H.); Siemens Healthcare, Forchheim, Germany (J.W., S.K.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); and the Dutch Expert Centre for Screening, Nijmegen, the Netherlands (I.S.).

Background The high volume of data in digital breast tomosynthesis (DBT) and the lack of agreement on how to best implement it in screening programs makes its use challenging. Purpose To compare radiologist performance when reading single-view wide-angle DBT images with and without an artificial intelligence (AI) system for decision and navigation support. Materials and Methods A retrospective observer study was performed with bilateral mediolateral oblique examinations and corresponding synthetic two-dimensional images acquired between June 2016 and February 2018 with a wide-angle DBT system. Fourteen breast screening radiologists interpreted 190 DBT examinations (90 normal, 26 with benign findings, and 74 with malignant findings), with the reference standard being verified by using histopathologic analysis or at least 1 year of follow-up. Reading was performed in two sessions, separated by at least 4 weeks, with a random mix of examinations being read with and without AI decision and navigation support. Forced Breast Imaging Reporting and Data System (categories 1-5) and level of suspicion (1-100) scores were given per breast by each reader. The area under the receiver operating characteristic curve (AUC) and the sensitivity and specificity were compared between conditions by using the public-domain iMRMC software. The average reading times were compared by using the Wilcoxon signed rank test. Results The 190 women had a median age of 54 years (range, 48-63 years). The examination-based reader-averaged AUC was higher when interpreting results with AI support than when reading unaided (0.88 [95% CI: 0.84, 0.92] vs 0.85 [95% CI: 0.80, 0.89], respectively; = .01). The average sensitivity increased with AI support (64 of 74, 86% [95% CI: 80%, 92%] vs 60 of 74, 81% [95% CI: 74%, 88%]; = .006), whereas no differences in the specificity (85 of 116, 73.3% [95% CI: 65%, 81%] vs 83 of 116, 71.6% [95% CI: 65%, 78%]; = .48) or reading time (48 seconds vs 45 seconds; = .35) were detected. Conclusion Using a single-view digital breast tomosynthesis (DBT) and artificial intelligence setup could allow for a more effective screening program with higher performance, especially in terms of an increase in cancers detected, than using single-view DBT alone. © RSNA, 2021 See also the editorial by Chan and Helvie in this issue.
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http://dx.doi.org/10.1148/radiol.2021204432DOI Listing
September 2021
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