Due to the increased incidence of breast cancer and improved survival, more women are at risk of developing contralateral breast cancer (CBC). The aim of this thesis was to explore risk factors... Show moreDue to the increased incidence of breast cancer and improved survival, more women are at risk of developing contralateral breast cancer (CBC). The aim of this thesis was to explore risk factors associated with CBC. We observed significant associations for a polygenic risk score of common germline variants (PRS313) and for different adjuvant systemic therapy regimens with (subtype-specific) CBC risk. These factors may be incorporated in CBC risk prediction models together with other known and available risk factors. For support of clinical decision making more biological information is needed to understand CBC development in women with invasive breast cancer and DCIS. As a first step towards implementation of a risk prediction model, we performed an exploratory interview study, which showed that patients had varying preferences for graphical presentation of probabilities in a CBC prediction model. In future studies, the prediction model should be incorporated in a decision support tool and implemented in clinical practice. This tool can then help to better identify women at high risk of CBC who may benefit from prophylactic surgery, while the estimates can also be used to reassure patients who are at low risk of developing CBC. Show less
The longevity of total knee implants may be impaired by aseptic loosening of the components within the bone. Aseptic loosening remains the leading cause of revision surgery. In the past decades,... Show moreThe longevity of total knee implants may be impaired by aseptic loosening of the components within the bone. Aseptic loosening remains the leading cause of revision surgery. In the past decades, many implant design aspects and surgical techniques have been changed in an attempt to decrease the risk of loosening. Given that radiostereometric analysis (RSA) is a highly accurate method to detect early implant migration which is predictive for late loosening, new implant designs should ideally be tested with RSA before widespread introduction onto the market. In this thesis, we present the results of four randomized controlled trials studying the effect of such changes in design on implant migration with use of RSA. We also pooled several RSA studies to be able to analyze the effect of other possible risk factors, including patient characteristics and surgical technique. We show that slight changes in implant design may increase the risk of loosening considerably, while other factors that are often thought to be associated with an increased risk (such as a high body mass index) do not appear to have a large effect. Show less
In dit proefschrift is gekeken naar de kwaliteit van uitname en naar de uitkomsten na transplantatie om zo goed mogelijk om te gaan met het tekort aan donororganen. Met de ET-DSRI kan de kans op... Show moreIn dit proefschrift is gekeken naar de kwaliteit van uitname en naar de uitkomsten na transplantatie om zo goed mogelijk om te gaan met het tekort aan donororganen. Met de ET-DSRI kan de kans op acceptatie voor een donorlever ingeschat worden. Daardoor kunnen er in een vroeg stadium maatregelen genomen worden om de kans op transplantatie te vergroten voor suboptimale levers. Alhoewel het aantal levers geschikt voor transplantatie geoptimaliseerd kan worden zal het tekort de komende jaren blijven bestaan. Daarmee zal ook de toewijzing van levers aan patiënten op de wachtlijsten complex blijven. De uitkomst na transplantatie is daarin een belangrijk punt. De resultaten beschreven in dit proefschrift laten zien dat statistische modellen een goede benadering kunnen geven van deze uitkomsten. Het toepassen van deze modellen zal leiden tot een meer evidence-based manier van het selecteren, toewijzen en daadwerkelijk transplanteren van levers in patiënten op de wachtlijst. Show less
