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As suggested by the randomised trials, widespread organised screening would be expected to reduce the incidence of advanced breast cancer that should be observable years before reductions in mortality.
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The social fabric is fraying, the underclass is growing — it is observable year upon year in the soup kitchen where I work — and the public-school system crumbling.
Importantly, Uganda incorporated childhood vaccination against hepatitis B into their national immunisation programme in 2002, so any impact of this highly effective preventive intervention on HCC rates will not likely be observable for years.
Thus, it is possible that changes in rates over time may differ for different categories of follow-up, for example, decreasing trend of breast cancer in survivors who received tamoxifen, which is only observable 8 years after treatment.
One US study reported a reduction in the number of people crossing a new road running through a neighbourhood and that this effect was still observable 30 years later [ 29].
Low-dose chronic exposures present greater challenges: health outcomes may not be known; effects of low-dose exposures are not observable for years or decades; effects may require repeated exposures over time; multiple agents may need to interact simultaneously or sequentially; and the effect may occur only in sensitive subpopulations or those with existing health conditions.
In Canada, with universal health insurance, the risk of death within 30 days of hospital admission for stroke was inversely associated with median neighbourhood income, and the excess risk was still observable a year after admission.
These changes are already observable in childhood years and remain apparent in adult life" [ 81].
Reductions in cervical cancer mortality by pre-adolescent HPV vaccination would not be observable for many years.
The efficacy of specialized stroke units in decreasing the morbidity and mortality after a stroke has been demonstrated in multiple studies, with the positive effects being observable for several years after the event [ 72– 72].
The expected reduction in bowel cancer mortality is unlikely to be observable for many years, and it is therefore important to study interim measures of performance to assess whether the screening programme is on track to achieve the expected benefit.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com