Head of University Clinic for Cancer Screening
Berit Andersen’s research focuses on public health interventions, especially public health perspectives in cancer screening programmes. Currently, the main areas are on elimination of cervical cancer through screening and vaccination, and on the potential of new technologies and approaches such as artificial intelligence (AI), and differentiated or personalised cancer screening to improve impact and reduce harms in cancer screening programmes.
Examples of ongoing research
- Use of AI in screening for breast-cancer
- Risk stratified cancer screening
- Interventions to target hard-to-reach populations
- Possible new cancer screening programmes
- Strategies for faster and balanced elimination of cervical cancer across ages and social groups
Professional distinctions
Berit Andersen is a member (or head) of the national steering committees (Danish Regions) and databases (sundk) for all three cancer screening programmes in Denmark, she is regularly providing advice to the Danish Health Authority regarding cancer screening - currently including an advisory group related to lung cancer screening, and she is a member of the scientific steering committee in Danish Comprehensive Cancer Center (DCCC). Further, she is a member of the Danish Council on Ethics.
Read more
- Danish Regions
- Sundk
- Danish Health Authority
- Danish Comprehensive Cancer Center (DCCC)
- The Danish Council on Ethics.
More about Berit Andersen's research
Senior Researchers
Pia Kirkegaard holds a Master of Art in Anthropology and a PhD. She is an Associate Professor at Department of Clinical Medicine, Aarhus University, and a Senior Researcher at UNICCA, Randers Regional Hospital.
She employs a social psychological approach and studies attitudes and perceptions of cancer screening, particularly from the citizens' perspective. Her work involves stakeholder engagement to ensure that screening interventions are tailored to preferences and different contexts in European countries.
Examples of ongoing research
- Combined cervical cancer screening and HPV vaccination for vulnerable populations in Denmark, Sweden, France, Spain and Romania
- Risk-based prostate cancer screening in Spain, Lithuania, Poland and Ireland
- Cervical cancer screening for vulnerable populations in Romania, Estonia and Portugal
Professional distinctions
Pia is scientific co-lead of HPV FASTER IMPLEMENT. She is principal investigator of PRAISE-U and and workpackage leader in CBIG-Screen.
Read more
More about Pia Kirkegaard's research
Mette Tranberg holds a Master of Science in Health Science and a PhD. She is an Associate Professor in gynaecological cancer prevention and diagnostics at Department of Clinical Medicine, Aarhus University, and a Senior Researcher at UNICCA & Department of Pathology, Randers Regional Hospital.
Mette is specialized in intervention, implementation, and laboratory research. Her research group focus on contributing with new evidence to solve the current problems within gynaecological cancer prevention and diagnostics. This is done by development and validation of novel and women-friendly screening and diagnostic methods, but also by exploring personalised and risk-based work-up instead of todays "one-size-fits-all" strategy.
Examples of ongoing research
- HPV and DNA methylation testing in first-void urine as a novel cervical cancer screening method
- DNA methylation in patient-collected vaginal and urine samples for endometrial cancer detection
- Use of molecular- and artificial intelligence-based biomarkers to guide diagnostic follow-up, treatment decisions and surveillance of elderly HPV-screen-positive women and women treated for high grade cervical pre-cancer lesions.
Professional distinctions
Mette Tranberg collaborates in various international partnerships such as Cancer Center Amsterdam, The Netherlands, Vaccinopolis, University of Antwerp, Belgium, Steinbeis Transfer Center for Medical Systems Biology, Germany, and National Cancer Institute, Rockville, USA.
She is also workpackage leader in HPV FASTER IMPLEMENT.
Read more
- Cancer Center Amsterdam
- Vaccinopolis
- Steinbeis Transfer Center for Medical Systems Biology
- National Cancer Institute
More about Mette Tranberg's research
Pinar Bor, Associate Professor
Contact information and information about Pinar Bors field of research can be found here shortly.
Postdoctoral Researchers
Line is a Medical Doctor specialised in gynaecology and a former PhD student within the Department.
Line is specialized in cervical cancer prevention from a clinical point of view and her primary focus is cervical cancer diagnostics and risk stratification in postmenopausal women.
More about Line Winter Gustafson's research
Tina Bech Olesen holds an MSc Epidemiology from London School of Hygiene and Tropical Medicine and an MSc and PhD in Public Health Science from the University of Copenhagen.
Tina specialises in epidemiological studies of cancer screening. Her main research areas are participation in cancer screening across the three cancer screening programmes, performance of the screening programmes according to European guidelines and improvements to the cancer screening programmes.
More about Tina Bech Olesen's research
Vibe Munk Bertelsen is a medical doctor and a PhD.
The aim of Vibe's PhD study is to improve the diagnosis of precancerous cervical lesions. Vibe's project includes a double-blinded study to investigate if the diagnosis of cervical precancerous lesions can be improved among elderly women aged ≥ 50 years by providing pretreatment with vaginal estrogen prior to the colposcopic examination.
Project title
Improving diagnostics in cervical dysplasia - testing new technology, evaluating pre-diagnostic treatment and evaluating present procedures.
Project period
September 2021 – August 2024
Supervisors
- Pinar Bor, Professor, UNICCA and Department of Gynaecology and Obstetrics, Randers Regional Hospital and Department of Clinical Medicine, Aarhus University.
- Lone Kjeld Petersen, Professor, Department of Obstetrics and Gynaecology, Odense University Hospital.
- Berit Booth, PhD, Department of Obstetrics and Gynaecology, Odense University Hospital.
- Mette Tranberg, Associate Professor, UNICCA, Randers Regional Hospital & Department of Clinical Medicine, Aarhus University.
PhD Students
Grace McKinney, PhD Student
Mail: GRAMCK@rm.dk
Grace McKinney holds a Master of Medical Science in Public Health. Her research focuses on prostate cancer screening from the perspective of the stakeholders.
The aim of Grace's PhD is to explore the barriers and facilitators experienced by clinicians, as well as other clinical and public health staff, to implementing a multi-step prostate cancer screening programme in the four pilot sites.
Her PhD project is part of the EU4Health project PRAISE-U in which a multi-step prostate cancer screening strategy will be developed, implemented and evaluated in four pilot sites: Poland, Lithuania, Ireland and Spain.
Project title
Barriers and facilitators to multi-step prostate cancer screening interventions in Europe: stakeholder perspectives.
Project period
July 2023 - June 2026
Supervisors
- Pia Kirkegaard, Associate Professor, UNICCA, Department of Public Health Programmes, Randers Regional Hospital & Department of Clinical Medicine, Aarhus University.
- Mette Bach Larsen, Associate Professor, Department of Research, Horsens Regional Hospital & Department of Clinical Medicine, Aarhus University, Denmark.
Karen Omann Binderup is a medical student and PhD student.
Her research focuses on the utility of DNA methylation markers in patient-collected urine and vaginal samples for endometrial cancer detection.
The aim of Karen’s PhD study is to validate methylation marker panels in urine and vaginal samples and compare the test performance for the detection of endometrial cancer to the current diagnostic method. This will facilitate timely diagnosis, lower the anxiety among patients, and reducing the pressure on the healthcare system.
Project title: The clinical utility of DNA methylation testing in patient-collected vaginal and urine samples: a novel, patient-friendly and simple diagnostic solution to detect endometrial cancer
Project period
September 2024 – June 2028
Supervisors
- Mette Tranberg, Associate Professor, UNICCA, Department of Public Health Programmes, Randers Regional Hospital & Department of Clinical Medicine, Aarhus University.
- Line Winther Gustafson, PhD, Senior Registrar, Department of Obstetrics and Gynecology, Aarhus University Hospital, UNICCA, Department of Public Health Programmes, Randers Regional Hospital.
- Lone Kjeld Petersen, Professor, Department of Obstetrics and Gynaecology, Odense University Hospital.
- Renske Steenbergen, Professor, Department of Pathology, Cancer Center Amsterdam, Amsterdam University Medical Centers, Netherlands.
- Katja Dahl, Associate Professor, Consultant, Department of Obstetrics and Gynecology, Aarhus University Hospital.
Morten Heath, PhD Student
E-mail: mortheat@rm.dk
Morten holds a medical degree (MD) and a bachelor's degree in Information Science and Arabic Studies. His PhD project aims to explore strategies to increase participation in colorectal cancer screening among men from underrepresented ethnic groups in deprived areas of Central Denmark.
Project title
Engaging Men from Underrepresented Ethnic Groups in Colorectal Cancer Screening.
Project period
August 2025 – July 2028.
Supervisors
- Berit Andersen, Clinical Professor, MD, PhD, Head of Department, Department of Public Health Programmes, Randers Regional Hospital & Department of Clinical Medicine, Aarhus University.
- Anne Mette Fløe Hvass, MD, PhD, Senior Consultant at Department of Social Medicin, Gødstrup Regional Hospital.
- Christian Wejse, MD, PhD, Professor, Department of Clinical Medicine, Aarhus University & Department of Infectious Diseases, Aarhus University Hospital.
Rikke Stokholm holds a Master of Science in Public Health.
The aim of Rikke's PhD study is to scientifically define the concept of knowledge in cancer screening. Knowledge is the foundation for making an informed choice about (non)participation in cancer screening.
It is therefore important that health authorities offer comprehensible and useful self-administered information materials providing the residents with sufficient knowledge to support them in making their informed choice about participation.
Project title
Defining and measuring knowledge in cancer screening – is there a need for new information materials?
Project period
February 2022 - January 2026
Supervisors
- Berit Andersen, Professor, UNICCA, Department of Public Health Programmes, Randers Regional Hospital & Department of Clinical Medicine, Aarhus University.
- Mette Bach Larsen, Associate Professor, Department of Research, Horsens Regional Hospital & Department of Clinical Medicine, Aarhus University, Denmark.
- Adrian Edwards, Professor, Division of Population Medicine, Cardiff University, Wales.
Signe holds a professional bachelor's degree in nursing from VIA University College and a health science master's degree from Aarhus University.
The aim of Signe’s PhD project is to explore the potential for a risk-based optimization of the national colorectal cancer screening programme by further utilizing the Fecal Immunochemical Test (FIT) values.
This includes investigating whether the screening interval can be extended for groups with the lowest FIT values and whether increasing in negative FIT values can be used to predict the risk of colorectal cancer. Additionally, the project explores citizens' perspectives on a risk-based optimization of the colorectal cancer screening program.
Project title
OPTIMIZED-FIT: Optimization of the Danish National Colorectal Cancer Screening Programme
Project period
June 2025 – May 2027
Supervisors
- Berit Andersen, Professor, UNICCA, Department of Public Health Programmes, Randers Regional Hospital & Department of Clinical Medicine, Aarhus University.
- Sisse Helle Njor, Professor, Research Unit for Cancer Screening and Epidemiology, University Hospital of Southern Denmark.
- Department of Clinical Medicine, Aarhus University & Department of Regional Health Research, University of Southern Denmark.
- Camilla Rahr Tatari, PhD, Research Unit for Cancer Screening and Epidemiology, University Hospital of Southern Denmark.
Sofie Meyer Andersen, PhD student
Mail: soiane@rm.dk
Sofie holds a Master of Science in Public Health. Her research focuses on prostate cancer screening from the perspective of the participants.
The aim of Sofie's PhD is to explore knowledge and attitudes towards prostate cancer screening, the psychosocial impact of different participation stages in screening, and the experiences of low-risk participants after risk stratification or a negative biopsy.
Her PhD project is part of the EU4Health project PRAISE-U in which a multi-step prostate cancer screening strategy will be developed, implemented and evaluated in four pilot sites: Poland, Lithuania, Ireland and Spain.
Project title
Psychosocial impact of multi-step prostate cancer screening in four European countries
Project period
April 2023 - March 2026
Supervisors
- Pia Kirkegaard, Associate Professor, UNICCA, Department of Public Health Programmes, Randers Regional Hospital & Department of Clinical Medicine, Aarhus University.
- Mette Bach Larsen, Associate Professor, Department of Research, Horsens Regional Hospital & Department of Clinical Medicine, Aarhus University, Denmark.
Research Year Students
Julie Maria Lühne, Research Year Student
Mail: juljuh@rm.dk
Julie is a medical student currently completing a research year focused on cervical cancer screening. Her project evaluates the implementation and impact of self-sampling offered with the second reminder in the national cervical cancer screening program.
Mathilde Kristine Kristensen, Research Year Student
Mail: makrki@rm.dk
Mathilde is in her final year of medical studies and currently a research year student at UNICCA. She works with a clinical study that aims to investigate the effectiveness of a non-invasive treatment for cervical dysplasia and HPV, while also evaluating patient satisfaction, treatment compliance, and characterizing the vaginal microbiome before and after treatment.
Research Assistants
Ann-Line Birkeskov Drejer Axelsen, Research Assistant
Mail: annaxe@rm.dk
Ann-Line holds a Master of Science in Public Health and works on the project HPV-FASTER IMPLEMENT which aim to improve cervical cancer prevention through combined HPV vaccination and HPV-based screening to vulnerable populations.
Lotte Krog Eriksen, Research Assistant
Mail: lottei@rm.dk
Lotte Krog Eriksen is a medical student who has been working as a part-time research assistant since summer 2025. She and Mette Tranberg are working to set up a clinical trial using urine-based self-sampling to enhance cervical cancer screening participation among women who rarely or never attend the regular routine screening programme.
Pernille Aakjær Mikkelsen, Research Assistant
Mail: pelmkk@rm.dk
Pernille holds a Master of Science in Public Health and works on the project CBIG-SCREEN which aim to secure implementation of tailored cervical cancer screening interventions to vulnerable women through stakeholder engagement.
Honorary Professors
Adrian Edwards is a Professor of General Practice and Co-Director of the Division of Population Medicine at Cardiff University, UK. Adrian Edwards has been an Honorary Professor at Aarhus University since 2012, and was affiliated to the Department of Public Health Programmes, Randers Regional Hospital, in 2016.
Key research interests include shared decision-making, risk communication, health literacy, and support to patients with chronic diseases. He is actively involved in the Department's research on screening participants' attitudes, decision-making, coping, and risk perception.
Lone Kjeld Petersen is Chief Physician and Professor at Department of Obstetrics and Gynaecology at Odense University Hospital and the University of Southern Denmark. Lone is appointed Honorary Professor at the University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, as per March 1st, 2024.
Key research areas include cervical cancer screening with specific interest in the diagnostic process, HPV diagnostics, self-sampling and screening derived gynecological activities. She is actively involved in the Department's research on cervical cancer screening.
More about Lone Kjeld Petersen’s research
PhD Alumni (since 2019)
Camilla identified barriers to cancer screening among some of the most vulnerable groups of people in Denmark and explored the potential for tailored interventions to increase participation in cancer screening for these groups.
Thesis
A qualitative study of cancer screening participation among people in vulnerable positions: potential for tailored interventions.
Summary
Social inequity in cancer is a global issue and vulnerable groups with low socioeconomic status face higher mortality rate for most cancer types. Cancer screening holds significant potential for preventing cancer or detecting cancer early, thereby reducing mortality. Non-participation in cancer screening is linked to low social status, including low income, living alone, and unemployment.
In this PhD thesis, Camilla identified barriers to cancer screening among men frequenting drop-in centres, marginalised Greenlanders, and socially isolated people. She found that participants across all groups showed interest in their health but were negatively impacted by loneliness, a difficult existence, and a lack of social networks. The results showed that barriers hindering participation included a lack of self-motivation, limited literacy skills, and the absence of strong social networks, which resulted in a lack of support and encouragement. Based on these findings, Camilla proposed a potential tailored intervention aiming to enhance participation through community engagement, awareness outreach, and improved accessibility.
Defended
December 2, 2024.
Assessment committee
- Katie Robb, Professor of Behavioural Science and Health, University of Glasgow, UK.
- Signe Agergaard, Professor, Department of Health Science and Technology, Aalborg University, Denmark.
- Lene Seibæk (Chairman), Associate Professor, Obstetrics and gynaecology, Aarhus University Hospital, Denmark.
Supervisors
- Berit Andersen, Professor, UNICCA, Department of Public Health Programmes, Randers Regional Hospital & Department of Clinical Medicine, Aarhus University.
- Pia Kirkegaard, Associate Professor, UNICCA, Department of Public Health Programmes, Randers Regional Hospital & Department of Clinical Medicine, Aarhus University.
Pernille evaluated the recommendations in the Danish national colorectal cancer screening programme for citizens who have a positive Faecal Immunochemical Test (FIT) and a subsequent colonoscopy with no colorectal cancer findings.
Thesis
Detection of Colorectal cancer after a positive FIT screening with no malignant findings – An evaluation of the Danish surveillance and screening guidelines.
Summary
In the Danish colorectal cancer (CRC) screening programme, guidelines for surveillance and screening after a FIT screen-derived colonoscopy are based on studies from non-FIT based settings.
New updated guidelines from 2023 recommend colonoscopy surveillance after 3 years in case of advanced neoplasia, a return to biennial FIT-screening in case of less severe findings, while individuals without abnormal colonoscopy findings are excluded from screening in 8 years.
Pernille studied the appropriateness of these guidelines in relation to detection of CRC among the respective risk groups.
The results indicated a significant risk of missed lesions in the FIT-based screening programme, likely due to high prevalence of colorectal cancer in a FIT-positive population, suggesting that the Danish screening programme should implement further measures to enhance colonoscopy quality and explore new methods for risk stratification.
The results supported the recent decision of extending the screening interval for the high-risk group from 1 to 3 years, while those referred back to biennial FIT screening should be informed about the importance of subsequent participation.
Her findings do not support the recommendation for screening exclusion for the group with a negative colonoscopy but suggest considerations on whether they should be offered biennial FIT screening or a more individualized follow-up.
Defended
September 25, 2024.
Assessment committee
- Mark Jenkins, Professor, School of Population and Global Health, The University of Melbourne, Australia.
- Magnus Løberg, Dean, Faculty of Medicine, University of Olso, Norway.
- Dorte Rytter (Chairman), Associate Professor, Department of Public Health, Aarhus University Hospital, Denmark.
Supervisors
- Sisse Helle Njor, Professor, Research Unit for Cancer screening and Epidemiology, University Hospital of Southern Denmark
Department of Clinical Medicine, Aarhus University & Department of Regional Health Research, University of Southern Denmark. - Berit Andersen, Professor, UNICCA, Department of Public Health Programmes, Randers Regional Hospital & Department of Clinical Medicine, Aarhus University.
Anne Dorte examined cross-programme synergies in the three cancer screening programmes in Denmark with the purpose of increasing participation and enhancing understanding of non-participants.
Thesis
Cross-programme synergies in the three cancer screening programmes in Denmark.
Summary
Cancer screening in Denmark is well-organised and population-based but the participation rates are not equally high in all three programmes. The breast cancer screening programme has a participation rate above 80%, while participation rates in both cervical and colorectal cancer screening programmes only reach 60%.
In this PhD thesis, Anne Dorte investigated the synergies across the three cancer screening programmes in Denmark for women invited to participate in all three. She found that providing self-sampling opportunities to women attending breast cancer screening increased their participation in cervical and colorectal cancer screening. Both under- and unscreened women participated more following the intervention, and satisfaction with breast cancer screening was not affected.
However, some women did not participate in any cancer screening programmes, and these women displayed the most socially vulnerable characteristics, why it is crucial to identify methods to engage these women in cancer screening in order to reduce inequity.
Defended
August 30, 2024.
Assessment committee
- Christine Campbell, Reader, Usher Institute of Population Health Sciences and Medical Informatics, University of Edinburg, UK.
- Henrik Bøggild, Associate Professor, Public Health and Epidemiology, Department of Health Science and Technology, Aalborg University & Unit of Clinical Biostatistics, Aalborg University Hospital, Denmark.
- Bodil Hammer (Chairman), Associate Professor, Research Unit for Epidemiology, Department of Public Health, Aarhus University, Denmark.
Supervisors
- Berit Andersen, Professor, UNICCA, Department of Public Health Programmes, Randers Regional Hospital & Department of Clinical Medicine, Aarhus University.
- Mette Bach Larsen, Associate Professor, Department of Research, Horsens Regional Hospital & Department of Clinical Medicine, Aarhus University, Denmark.
Line evaluated the clinical management of women aged ≥ 45 years referred to colposcopy following an abnormal cervical cancer screening result and investigated the potential of a new biomarker for risk stratification.
Thesis
Cervical cancer prevention in postmenopausal women – aspects of clinical management, risk stratification, and patient aspects
Summary
In Denmark, approximately 370 women are each year diagnosed with cervical cancer. Out of these women, approximately 100 die from the disease. The incidence and mortality of cervical cancer is higher among postmenopausal women than among younger women. The reason for this is multifactorial but may be partly explained by challenges in the diagnostic work-up (colposcopy and biopsies) due to age-dependent changes of the cervix.
In this PhD thesis, Line investigated if the clinical examination of women with an incomplete visualization of the transformation zone at colposcopy could be improved by offering a diagnostic cervical excision. She found that the detection rate of precancerous cervical lesions was significantly higher in the cervical excision specimens than in biopsies. However, the procedure also led to a substantial risk of overtreatment.
To avoid this, Line evaluated the potential of using the biomarker p16/Ki67 dual-stain cytology for risk stratification before having diagnostic cervical excision. The results showed that the predictive value was higher than cytology suggesting it could be used for risk-stratifying women with an abnormal screening result and thereby avoid excessive diagnostic cervical excisions while minimizing underdiagnosis.
Defended
June 14, 2022
Assessment committee
- Rebecca B. Perkins, Professor, Department of Gynecology, Boston Medical Center & Boston University, School of Medicine, Boston, USA
- Tine Henrichsen Schnack, Associate Professor, Department of Gynaecology and Obstetrics, Odense University Hospital, Denmark
Department of Clinical Medicine, University of Copenhagen, Denmark - Torben Steiniche (Chairman), Professor, Department of Clinical Medicine, Aarhus University & Department of Pathology, Aarhus University, Denmark
Supervisors
- Pinar Bor, Associated Professor, Department of Gynaecology and Obstetrics, Randers Regional Hospital & Department of Clinical Medicine, Aarhus University
- Berit Andersen, Professor, Department of Public Health Programmes, Randers Regional Hospital & Department of Clinical Medicine, Aarhus University
- Anne Hammer Lauridsen, Associated Professor, Department of Obstetrics and Gynaecology, Regional Hospital West Jutland & Department of Clinical Medicine, Aarhus University
- Lone Kjeld Petersen, Professor, Department of Obstetrics and Gynaecology, Odense University Hospital
Susanne evaluated the adherence to recommendations for follow-up after abnormal findings in the Danish breast and cervical cancer screening programmes as well as the derived resource use.
Thesis
Adherence to recommendations for follow-up in breast- and cervical cancer screening in Denmark
Summary
Timely and appropriate follow-up is crucial for the effectiveness of cancer screening programmes. However, there is a lack of knowledge on how the entire pathways of follow-up after abnormal screening results perform, whether the pathways follow recommendations and the derived resource use.
In her PhD, Susanne mapped the entire pathways of follow-up after abnormal findings in the cervical and breast cancer screening programmes using national health registries. The mapping showed that less than half of the women had follow-up in accordance with the national recommendations following an abnormal cervical cancer screening. In contrast, the majority of women had follow-up in accordance with the national recommendations after abnormal breast cancer screening. Furthermore, follow-up after cervical cancer screening was excessively long in many cases and the use of diagnostic tests and procedures higher than expected.
The results call for a more systematic monitoring of follow-up after abnormal screening and more evidence to develop guidelines on how to terminate these excessively long follow-up pathways in the cervical cancer screening program.
Defended
August 31, 2021
Assessment committee
- Solveig Hofvind, Professor, Cancer Registry of Norway, Section for Breast Screening, Oslo, Norway
- Marianne Waldstrøm, Associate Professor, Institute of Regional Health Research, University of Southern Denmark, Denmark
- Rikke Søgaard (Chair), Professor, Department of Public Health, Aarhus University, Denmark
Supervisors
- Prof. Berit Andersen, Department of Public Health Programmes, Randers regional Hospital
- Assoc. Prof. Sisse Helle Njor, Department of Public Health Programmes, Randers regional Hospital
- Senior Epidemiologist Matejka Rebolj, Cancer Prevention Group, King's College London
Sara investigated the interplay between childhood HPV vaccination attendance and subsequent routine cervical cancer screening attendance among different sub-populations in Denmark. The main focus of the project was patterns and reasons for combined non-attendance (un-vaccinated and un-screened), as non-attendees are considered potentially at high risk for developing cervical cancer.
Thesis
Non-attendance in Danish cervical cancer prevention programmes
Summary
Cervical cancer is a major global threat to women's health. However, in many western countries, like Denmark, women are offered organised and free-of-charge HPV vaccination and cervical cancer screening programmes. Women are recommended to attend both programmes. Women who attend neither vaccination nor screening (combined non-attendees) constitute a high risk group which needs to be identified and reasons for their non-attendance better understood.
The first birth cohorts vaccinated against HPV reached screening age (23 years) during 2016, thus making it possible to identify combined non-attendees, to investigate predictors for non-attendance and to understand the factors influencing non-attendance.
In her PhD, Sara found that girls who did not attend HPV vaccination were less likely to attend cervical cancer screening. She also identified that combined non-attendees were more often socioeconomically disadvantaged and of ethnic minority background. Those who attended both HPV vaccination and cervical cancer screening were more often socioeconomically advantaged and native Danes. Further, her study showed that almost one third of young women with ethnic minority background did neither attend HPV vaccination nor cervical cancer screening in comparison to one tenth of native Danes.
Among women with ethnic minority backgrounds, she also found a variation in non-participation among women from different geographical regions. Middle-Eastern and North African countries had the highest degree of combined non-attendance.
Finally, she investigated by means of an interview study the perception of HPV vaccination and cervical cancer screening among a group of Middle-Eastern and North African women. She found that their barriers to attend the programmes were rather complex involving cognitive, emotional as well as socio-cultural barriers on a personal, interpersonal, organisational, and community level.
Defended
September 4, 2020
Assessment committee
- Jo Waller, Reader in Cancer Behavioural Science. Cancer prevention Groups, Faculty of Life Science & Medicine. Kings College London.
- Maria Kristiansen, Associate Professor, Research group leader, Department of Public Health, University of Copenhagen.
- Lotte Ørneborg Rodkjær (Chair), Associate Professor, Department of Public Health, Aarhus University
Supervisors
- Assoc. Prof. Lene Seibæk, Department of Clinical Medicine, Aarhus University
- Prof. Jan Blaakær, Department of Obstetrics and Gynaecology, Odense University Hospital
- Prof. Lone Kjeld Petersen, Department of Obstetrics and Gynaecology, Odense University Hospital
- Prof. Berit Andersen, Department of Public Health Programmes, Randers Regional Hospital
Martin examined the quality of the colonoscopies offered to the participants subsequent to a fecal sample positive for blood in the national colorectal cancer screening programme.
Thesis
Colonoscopy performance indicators, Quality of screening colonoscopies in the Central Denmark Region
Summary
The national Danish colorectal cancer screening program was introduced in 2014. The quality of the program highly depends on the quality of the screening colonoscopies offered to the participants subsequent to a fecal sample positive for blood. To assess the quality of the screening colonoscopies, it is very important to identify suitable performance indicators.
Martin studied the evidence concerning colonoscopist dependent performance indicators through a systematic review.
The results revealed that colonoscopists having the highest adenoma detection rate, the highest rate of colonoscopies with cecal intubation and a withdrawal time of 6 minutes or more had the lowest incidence of interval cancers among their patients. Martin then investigated the quality of the data available in the Central Denmark Region concerning the quality of the screening colonoscopies.
The data showed to be of high quality, and was subsequently used to assess the quality of the screening colonoscopies by means of the above mentioned colonoscopists dependent performance indicators along with other relevant performance indicators and quality indicators. Finally, Martin examined the value of further educating colonoscopists by means of performance indicators.
Defended
October 28, 2019
Assessment committee
- Peter Christensen, Professor, Department of Surgery, Aarhus University Hospital, Central Denmark Region, Denmark
- Brendan John Moran, Professor, Basingstoke Hospital North Hampshire Foundation Trust Aldermaston Road, United Kingdom
- Øyvind Holme, Associate Professor, University of Oslo, Institute of health and Society, Faculty of Medicine, Oslo, Norway
Supervisors
- Berit Andersen, Professor, Head of Department, Department of Public Health Programmes, Randers Regional Hospital
- Søren Laurberg, Professor, MD, DMSc, Mave- og tarmkirurgi, Aarhus Universitetshospital
- Rune Erichsen, MD, ph.d., Mave- og tarmkirurgi, Aarhus Universitetshospital
Pernille investigated how citizens accept a newly developed decision aid and if a decision aid is able to increase the proportion of citizens making an informed choice of whether or not to participate in the colorectal cancer screening programme.
Thesis
To screen or not to screen - A decision aid to support informed decision making in colorectal cancer screening
Summary
All Danish citizens aged 50 to 74 years are invited to take up screening once every second year. Upon receiving the invitation, it is important, that the citizens can make an informed decision about screening uptake. The informed decision should be based on personal values and access to relevant knowledge.
Decision aids are information materials developed to support informed decision making by presenting objective information on benefits and harms regarding health-related choices. They increase the reader’s knowledge and the extend to which choices made are informed. The decision to take up colorectal cancer screening is made without any contact to health care professionals, and decision aids must therefore be self-administered.
Pernille developed and evaluated a web-based decision aid targeted to citizens with lower educational attainment. The decision aid was developed and tested in several steps involving both health care professionals and citizens from the target population. By using a simple layout and presenting information using both text and figures in combination with read-more options, diverging information needs were embraced, resulting in a decision aid well accepted, comprehensible and usable by citizens with lower educational attainment.
Pernille assessed the general level of knowledge, attitudes and worries about colorectal cancer screening in 53-74-year-old unscreened Danish citizens and examined whether health literacy was associated with these outcomes. She reached a 71% response rate by sending out questionnaires to more than 10,000 citizens. In general, Danish citizens eligible but not yet invited to screening have high levels of knowledge about, a positive attitude towards and few worries about colorectal cancer screening. This tendency did not seem to be associated with health literacy.
Pernille then tested the effectiveness of the developed decision aid on informed choice, as assessed by changes in knowledge, attitudes and screening uptake. She also investigated if the decision aid affected the level of decisional conflict or worries about colorectal cancer screening in a randomised controlled design. Screening uptake was statistically insignificantly increased by 7.6% points in the intervention group compared with the control group, but neither knowledge nor attitudes were affected by the decision aid. The level of decisional conflict decreased in the intervention group compared with the control group. The same tendency was observed for worry scores, but not at a statistically significant level.
Defended
April 5, 2019
Assessment committee
- Annelli Sandbæk, Professor, Head of Research Unit for General Practice, Research Unit for General Practice, Institute of Public Health, Aarhus University
- Dawn Stacey, Professor, School of Nursing, University of Ottowa, School of Epidemiology and Public Health, Ottowa, Canada & Ottowa Hospital Research Institute, Ottowa, Canada
- Jesper Bo Nielsen, Professor, Head of Institute of Public Health
Institute of Public Health, University of Southern Denmark
Supervisors
- Berit Andersen, Professor, Head of Department, Department of Public Health Programmes, Randers Regional Hospital
- Mette Bach Larsen, Senior researcher, Department of Public Health Programmes, Randers Regional Hospital
- Pia Kirkegaard, Senior researcher, Department of Public Health Programmes, Randers Regional Hospital
- Adrian Edwards, Professor, Head of Department, Cochrane Institute of Primary Care and Public Health, Cardiff University School of Medicine, England
Mette investigated if it is possible to increase cervical cancer screening participation by giving women the opportunity to collect a vaginal self-sample in their own home.
Thesis
Improving cervical cancer prevention by introducing HPV self-sampling to non-participants in the Danish Cervical Screening Programme
Summery
The Danish cervical cancer screening programme is challenged by insufficient participation as 45% of all cervical cancer cases are found among under-screened women.
It was investigated if it is possible to increase screening participation by giving non-participants the opportunity to collect a vaginal self-sample in their own home and send the sample to the laboratory for human papillomavirus (HPV) testing (HPV self-sampling) in a randomized controlled trial including women aged 30-64 from the Central Denmark Region.
The directly mailed intervention produced a significantly higher participation and made more unscreened women re-engage in screening than the opt-in and control groups did.
Findings showed that offering non-participants the opportunity of HPV self-sampling as an alternative to regular cytology screening by the doctor might lead to about 2,500 more invited women attending screening annually in the Central Denmark Region provided that the kit is mailed directly to the women.
Defended
April 2018.
Assessment committee
- Pinar Bor (Chairman), Clinical Associate Professor, Department of Obstetrics and Gynaecology, Randers Regional Hospital.
- Miriam Elfström, Post doc, Chief Development Officer for Cancer Prevention Activities, Department of Laboratory Medicine, Karolinska Institute and Regional Cancer Center of Stockholm-Gotland, Sweden.
- Christian Munk, Senior researcher, PhD, Danish Cancer Society, Unit of Virus, Lifestyle and Genes, Denmark.
Supervisors
- Berit Andersen, Professor, Department of Public Health Programmes, Randers Regional Hospital & Department of Clinical Medicine, Aarhus University.
- Bodil Hammer, Associate Professor, Section for Epidemiology, Department of Public Health, Aarhus University, Denmark.
- Jan Blaakær, Professor, Department of Obstetrics and Gynaecology, Odense University Hospital & Department of Clinical Medicine, University of Southern Denmark.