Medical history risk factors for non-Hodgkin's lymphoma in older women.
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
A Ekbom
Publications and source records attributed to A Ekbom.
Diabetes mellitus and risk of large bowel cancer.
Explore the source record for details and available documents.
Colorectal Neoplasms↗
Risk of endometrial and breast cancer in patients with diabetes mellitus.
Diabetes mellitus patients have metabolic and endocrine alterations that could contribute to an increased incidence of hormone-related cancers. We assessed the incidence of endometrial and breast cancer among 80,005 women and the incidence of breast cancer among 73,847 men (total of 153,852 patients) identified in the Swedish In-patient Register as having been hospitalized for diabetes mellitus in the period 1965-1983. These patients underwent follow-up through 1989 via the Swedish Cancer Register and other nation-wide Swedish registers. The outcome measures were standardized incidence ratios (SIR) based on age-, sex- and calendar period-specific incidence rates from the entire Swedish population. To minimise the effect of selection bias, we excluded from the calculation of incidence ratios the first year of observation and cases diagnosed incidentally at autopsy. Only first cancers were considered for the estimates. A total of 328 endometrial cancers (SIR = 1.8; 95% confidence interval [CI] = 1.6-2.0), 1,145 female breast cancers (SIR = 1.3; 95% CI = 1.2-1.4) and 13 male breast cancers (SIR = 2.0; 95% CI = 1.0-3.4) were observed. We conclude that compared with the general population, patients with diabetes mellitus have an increased incidence of endometrial and breast cancers.
Adult↗
Long-term follow-up of patients with medullary carcinoma of the thyroid.
BACKGROUND: All patients with medullary carcinoma of the thyroid (MCT) diagnosed in Sweden during 1959 through 1981 were identified. There were 113 males and 134 females with a mean age of 51.6 years (range, 11-85 years). The cohort was followed with regard to survival to identify prognostic factors. The results 5 and 10 years after diagnosis have been presented previously. METHODS: The purpose of this study was to examine to what extent those prognostic factors found in the authors' previous analyses remained independent prognostic factors for survival 10 years or longer after diagnosis. The follow-up period was extended an additional 5 years and ranged between 11 and 32 years. RESULTS: The relative survival rate was 69.2% and 64.7%, respectively, 10 and 15 years after diagnosis. The survival rate was worse after excluding those patients with a family history of MCT (60.8% and 53.7%, respectively, 10 and 15 years after diagnosis). In multivariate analyses, age, tumor size, stage of the disease at diagnosis, tumor amyloid content and an euploid DNA pattern were found to be independent prognostic factors. However, in analyses of survival 10 years or longer after diagnosis only stage, tumor size, and age remained independent prognostic factors. CONCLUSIONS: There is still an excess mortality 10 years or longer after a diagnosis of MCT. However, the authors identified 3 groups of patients in whom the survival 10 years or longer after diagnosis did not differ from that of the general population: patients with a family history of MCT detected by screening, those with tumor size < 1 cm, or those with early stage disease at diagnosis.
Adolescent↗
Intrauterine environment and breast cancer risk in women: a population-based study.
BACKGROUND: The established risk factors for female breast cancer, including nulliparity, age at first birth, age at menarche, and age at menopause, do not adequately explain the occurrence pattern of this cancer. Therefore, additional factors need to be considered to advance our understanding of the causes of breast cancer. Evidence obtained from animals and humans indicates that the perinatal period may be particularly important. Our earlier studies, based on a subsample of the present investigation, suggested that factors thought to be positively associated with estrogen levels during pregnancy are positively associated with breast cancer risk. However, the associated confidence intervals (CIs) were generally wide, indicating considerable variability in the data. PURPOSE: We studied a large number of incident breast cancer case patients and evaluated several perinatal variables in relation to breast cancer risk. These variables included some not previously studied, such as gestational age and neonatal jaundice. We also investigated twin membership as a predictor variable and death from breast cancer, in addition to occurrence of breast cancer, as an alternative outcome variable. METHODS: Birth records for all deliveries at five different hospitals in Sweden during the period from 1874 through 1961 were used to define a large cohort of women. Incident case patients with breast cancer in this cohort were ascertained through the National Cancer Registry or the Uppsala Regional Cancer Registry from 1958 through 1994. In a case-control study nested in the cohort, we abstracted data from birth records on 1068 women with incident breast cancer and on 2727 control subjects individually matched to the case patients on date of birth. We modeled the data through conditional logistic regression. All P values were derived from two-sided statistical tests. RESULTS: We found a markedly reduced risk for breast cancer in women whose mothers had pregnancy toxemia (odds ratio [OR] = 0.41; 95% CI = 0.22-0.79) and an excess risk on women who had neonatal jaundice (OR = 2.16; 95% CI = 1.27-3.67) or who were born before 33 weeks of gestation (OR = 3.96; 95% CI = 1.45-10.81). Compared with the risk for breast cancer in the singleton, the risk for breast cancer in dizygotic twins was increased, although this increase was not statistically significant (OR = 1.72; 95% CI = 0.92-3.20). There was no evidence in these data for a statistically significant or substantial association of breast cancer risk with birth size indicators (i.e., weight and length at birth and placental weight). CONCLUSION AND IMPLICATIONS: Because pregnancy toxemia is associated with low levels of estrogens and neonatal jaundice, severe prematurity, and dizygotic twins with high levels of estrogens, our findings suggest that estrogens and other hormonal factors, known to influence breast cancer risk in the adult, may also play a critical role during the intrauterine period.
Breast Neoplasms↗
Pregnancy outcomes in women with inflammatory bowel disease--a population-based cohort study.
OBJECTIVE: Our purpose was to assess the frequency of adverse pregnancy outcomes in women with inflammatory bowel disease compared with the general population. STUDY DESIGN: Of all 239,773 pregnant women with single births in Sweden from 1991 to 1992, 756 women with inflammatory bowel disease could be analyzed for late fetal and infant death, preterm birth, low birth weight, small for gestational age, and cesarean section. Logistic regression analyses was used to estimate the odds ratios. RESULTS: Pregnancies in women with inflammatory bowel disease were associated with an increased risk of preterm birth at < 33 weeks (odds ratio 1.81, 95% confidence interval 1.06 to 3.07) and at 33 to 36 weeks (odds ratio 1.48, 95% confidence interval 1.10 to 1.99); low birth weight < 1500 gm (odds ratio 2.15, 95% confidence interval 1.11 to 4.15) or 1500 to 2499 gm (odds ratio 1.57, 95% confidence interval 1.12 to 2.22); small for gestational age (odds ratio 1.40, 95% confidence interval 0.97 to 2.02); and cesarean section (odds ratio 1.51, 95% confidence interval 1.27 to 1.89). CONCLUSIONS: Inflammatory bowel disease in pregnant women is associated with an increased frequency of adverse pregnancy outcomes.
Adolescent↗
Survival and daily physical activity in patients treated for advanced midgut carcinoid tumors.
BACKGROUND: Prospects for survival and quality of life ought to influence treatment strategies in patients with midgut carcinoids. METHODS: A total of 121 patients with midgut carcinoid received a combined medical and surgical treatment from 1980 to 1993. In all, 158 operations were undertaken for removal of mesentericointestinal lesions and occasional liver metastases or as repeat intervention for abdominal complications. Survival was analyzed together with estimates of daily physical activity during follow-up. RESULTS: Cause of death (63 patients) included carcinoid heart disease (41%) and cachexia (mesentericointestinal entrapment, 35%). Median survival was 11 years in patients with irresectable mesenteric metastases, 7 years with liver metastases, and 1 year with extraabdominal spread. Extensive liver metastases or substantial weight loss (9 kg or greater) reduced survival to a median of 4 to 5.5 years, and surgically treated intestinal ischemia reduced survival to a median of 8 years. Patients with carcinoid syndrome survived a median 7 years, those with 5-hydroxyindoleacetic acid values greater than 500 mumol/24 hr or a valvular heart disease survived a median of 5 years, those with heart failure a median of 2.5 years. Most patients retained an acceptable daily physical activity; impairment occurred in cases of malnutrition, high 5-hydroxyindoleacetic acid values, or heart valve fibrosis, and activity was markedly reduced in the presence of extraabdominal metastases or overt heart disease. CONCLUSIONS: Favorable survival statistics and the maintenance of daily physical activity support active medical and surgical management in patients with advanced midgut carcinoids.
Activities of Daily Living↗
Benign prostatic hyperplasia in Sweden 1987 to 1994: changing patterns of treatment, changing patterns of costs.
OBJECTIVES: To assess health care use and costs for benign prostatic hyperplasia (BPH) in Sweden from 1987 to 1994 when minimal invasive procedures, including transurethral microwave therapy (TUMT) and drugs, were introduced, in addition to conventional surgery. METHODS: Cross-sectional annual data on health care utilization based on national information systems and surveys were used for calculation of direct 1994 cost. RESULTS: The total number of men in the age group at risk for BPH was virtually constant, and the total direct health care costs for BPH treatment increased from 1987 to 1992. A slight decrease was evident for the years 1993 and 1994, notwithstanding the introduction of new ambulatory procedures in 1991 and of new drugs in 1992. The number of physician office visits changed little during the study period, although this estimate may be low. TUMT procedures were introduced rapidly but decreased; nevertheless, their share was never more than 3% of total costs. Drug sales were 15-fold those in 1992 and accounted for 12% of the total costs in 1994. Conventional transurethral resection of the prostate (TURP) operations decreased markedly after the introduction of the new treatments. CONCLUSIONS: The new treatments were adopted differently. TUMT procedures decreased as rapidly as they were introduced. Three years after the introduction of the new drugs, drug sales indicated that the number of men receiving drug treatment was greater than the annual number of men receiving TURP operations and TUMT procedures combined. Yet the total costs showed a slight decrease, mainly due to the decreasing numbers of TURP operations.
Aged↗
Breast cancer mortality in relation to self-reported use of breast self-examination. A cohort study of 450,000 women.
The benefits of breast self-examination (BSE) for reducing mortality from breast cancer are uncertain. We conducted an analysis of the relationship between self-reported practicing of BSE and mortality from breast cancer over 13 years in a cohort of over 548,000 women. The report of practicing BSE was unrelated to breast cancer mortality. There was a small beneficial effect in those women who were the thinnest, but this effect was small and not statistically significant. BSE was otherwise equally ineffective in subgroups defined by obesity level and family history of breast cancer. We conclude that BSE, as practiced by American women in 1959, did not reduce the risk of mortality from breast cancer.
Adult↗
Diet and the risk of papillary and follicular thyroid carcinoma: a population-based case-control study in Sweden and Norway.
A population-based case-control study was conducted in two regions of Sweden and Norway to investigate the association between dietary habits and the risk of thyroid cancer. The consumption of selected foods was reported in a self-completed food-frequency questionnaire by 246 cases with histologically confirmed papillary (n = 209) and follicular (n = 37) thyroid carcinoma, and 440 age- and gender-matched controls. Odds ratios (OR) and their 95 percent confidence interval (CI) were calculated as estimates of the relative risk using conditional logistic regression. High consumption of butter (OR = 1.6, CI = 1.1-2.5) and cheese (OR = 1.5, CI = 1.0-2.4) was associated with increased risks. Residence in areas of endemic goiter in Sweden was associated with an elevated risk, especially among women (OR = 2.5, CI = 1.3-4.9). High consumption of cruciferous vegetables was associated with increased risk only in persons who ever lived in such areas. A decreased risk was associated with consumption of iodized salt in northern Norway, and with use of iodized salt during adolescence among women (OR = 0.6, CI = 0.6-1.0). The results of this study suggest a role of diet and environment in the risk of thyroid cancer.
Adolescent↗
Parental cancer and risk of papillary and follicular thyroid carcinoma.
In a population-based case-control study in the Uppsala-Orebro Health Care Region of Sweden, the histories of cancer among parents of 517 histologically confirmed cases of papillary and follicular carcinoma and of a similar number of sex- and age-matched controls were compared. The parental history of cancer was compiled through information from death certificates and from the nationwide Cancer Register. The incidence of malignancies in a cohort of parents of cases of thyroid cancer was also compared with the incidence in the whole Swedish population. A maternal history of cancer was more common among women with follicular carcinoma than among their controls (OR 2.11, 95% CI 0.96-4.67). Parents of probands with papillary carcinoma had an increased risk of thyroid cancer (OR 4.25, 95% CI 1.16-10.89), and mothers of probands with follicular carcinoma had an increased risk of stomach cancer (OR 3.65, 95% CI 0.99-9.35) compared with the general population. Cancer of the lung, breast, and pancreas were less common than in the general population. Familial cases of thyroid cancer were not limited to the papillary type. An inheritable pattern of carcinogenesis is possible for certain differentiated non-medullary thyroid cancers, but shared environmental exposures may also explain the parent-child associations of cancer in this study.
Adenocarcinoma, Follicular↗
The risk of pancreatic cancer following pancreatitis: an association due to confounding?
BACKGROUND & AIMS: Chronic pancreatitis has been suggested as a causal risk factor for pancreatic cancer in a recent study. The aim of this study was to clarify the relationship between chronic pancreatitis and pancreatic cancer. METHODS: All patients in the Swedish inpatient Register with a discharge diagnosis of pancreatitis from 1965 to 1983 were identified. They were stratified into subcohorts as follows: (1) one episode of unspecified pancreatitis (n = 823); (2) one episode of acute pancreatitis (n = 24,753); (3) recurrent pancreatitis (n = 7328); and (4) chronic pancreatitis (n = 4546). We also identified those with associated diagnoses indicating gallbladder disease or alcoholism. The patients were followed up through record linkage to the nationwide Swedish Cancer Register, Death Register, and Migration Register. RESULTS: After exclusion of cancers occurring in the first year, there were excess risks for pancreatic cancer in all subcohorts. However, the risks declined with time in all subcohorts. A persistent excess risk after 10 years was restricted to patients with associated alcohol abuse (standardized incidence ratio, 3.8; 95% confidence interval, 1.5-7.9). CONCLUSIONS: The findings are not consistent with reports that pancreatitis is causally associated with a long-term risk of pancreatic cancer. Selection bias, alcohol consumption, and smoking may contribute to some of the patterns of risk that have been observed.
Adult↗
Diverticulitis of the sigmoid colon. A comparison of CT, colonic enema and laparoscopy.
PURPOSE: To evaluate the use of laparoscopy, CT, colonic enema (CE), and laboratory tests (white blood cell count (WBC), sedimentation rate (SR), and C-reactive protein (CRP) in diagnosing diverticulitis of the sigmoid colon. MATERIAL AND METHODS: The diagnostic methods were prospectively evaluated in 88 patients, 30 of whom were referred for laparoscopy. RESULTS: Fifty-two patients were found to have sigmoid diverticulitis: 20 patients by laparoscopy, 21 by CT, and 11 by CE combined with one positive laboratory test. Laparoscopy proved to be superior to the other diagnostic methods in diagnosing diverticulitis of the sigmoid colon. CT had a high specificity (1.0; 95% CI: 0.92-1.0) but low sensitivity (0.69; 95% CI: 0.56-0.79) in detecting diverticulitis. CE had a higher sensitivity (0.82; 95% CI: 0.71-0.90) but a lower specificity (0.81; 95% CI: 0.67-0.91) than CT. CONCLUSION: CT was the best method for diagnosing abdominal pathology outside the colon. CT can be recommended as the first examination in seriously ill patients where abscesses and other causes of the symptoms than diverticulitis must first be ruled out. Laparoscopy is probably the most accurate method in diagnosing diverticulitis.
Adult↗
Survival after colon cancer 1973-1990 in Sweden. Convergence between catchment areas.
OBJECTIVE: The objective of the study is to analyze the temporal trends in relative survival among patients with colon cancer in catchment areas of hospitals of different categories and regions in Sweden. BACKGROUND: In Sweden, cancer of the colon is the second most common type of cancer in women and the third most common in men, afflicting approximately 3000 individuals annually. During the past decades, survival has improved, but it is not clear what factors have contributed to this development. Changes in the natural history of the disease, altered alimentary habits, advances in diagnosis, and treatment have been suggested. The effects of centralized care still are debated. METHOD: Longitudinal observational study of relative survival of all patients with colon cancer from 1973 to 1993 in Sweden (n = 41,700) by period of diagnosis and hospital category of primary catchment area was conducted. Multivariate analyses of relative hazards of any interaction between length of follow-up, period of diagnosis, hospital category of the primary catchment area, age at diagnosis, and region were performed. RESULTS: Relative survival in patients with colon cancer improved substantially from 1973 through 1990. The prognosis in patients from primary catchment areas of regional-university hospitals did not change during this period, and the prognostic improvement was noted only in county and local hospital areas, where survival approached that of regional hospitals. Although new management regimens may have been introduced unevenly, improved perioperative care best explains this convergence. Low-incidence regions showed the lowest survival, but this improved with time, although not significantly. CONCLUSIONS: Although survival in patients with colon cancer improved and convergence between different catchment area categories was seen, a large initial gap as well as a remaining difference may warrant future monitoring to ensure equal prognosis, irrespective of domicile.
Aged↗
Cancer and diabetes--a follow-up study of two population-based cohorts of diabetic patients.
OBJECTIVES: To study the occurrence of cancer amongst patients with diabetes mellitus (DM). DESIGN: Population based cohort study. SETTING: Denmark. SUBJECTS: Two cohorts of patients with DM were identified. One cohort comprised 1659 conscripts diagnosed with type I DM before the age of 20 years. Another cohort comprised 1499 men and women with insulin treated DM identified by means of medical prescriptions on 1 July 1973. Both cohorts were followed until the end of 1992. MAIN OUTCOME MEASURES: The relative risk of cancer in the two cohorts was estimated as the ratio of observed to expected number of cancers in the cohort (SIR). RESULTS: No unusual risk of cancer was observed amongst the conscripts (SIR 0.9, n = 13) or amongst patients with onset of DM before the age of 30 years in the prescription cohort (SIR 0.9, n = 32). Amongst those aged 30 years or more at DM onset in the prescription cohort, the overall risk of cancer did not depart from normal (SIR 1.0, n = 103), however, pancreatic cancer occurred in excess both immediately (< 1 year) (SIR 190, n = 1), and during 1-9 years after DM onset (SIR 9.0, n = 4). Similarly, the risk of non-Hodgkin's lymphoma was increased significantly (SIR 3.3, n = 6), all cases occurring more than 10 years after DM onset. CONCLUSIONS: Our data suggest that there is no unusual risk of cancer associated with type I DM. Type II DM may be the first symptom of pancreatic cancer and may be associated with an increased risk of non-Hodgkin's lymphoma.
Adult↗
Inflammatory bowel disease: re-evaluation of the diagnosis in a prospective population based study in south eastern Norway.
BACKGROUND: The incidence figures for ulcerative colitis (UC) and Crohn's disease (CD) have been difficult to interpret, and geographical variations may be due to differences in classification criteria and study design. Few studies have based the incidence on prospective systematic follow up to confirm the initial diagnosis. METHODS: Between 1990 and 1993, in a prospective incidence study of inflammatory bowel disease (IBD) in south eastern Norway, 527 cases of UC, 228 cases of CD, 36 cases of indeterminate colitis (IND), and 55 cases of possible IBD were identified, yielding an annual incidence of 13.6, 5.9, 0.9, and 1.4 per 10(5) respectively. The diagnosis and all clinical data were reviewed by two gastroenterologists independently of each other. One to two years after diagnosis, all patients were offered a clinical follow up in which the initial diagnosis was assessed. RESULTS: Between the time of diagnosis and the follow up, 16 patients had died, four of complications related to IBD. Of the remaining 830 patients, 98% (814/830) were available for follow up, 93% (772/830) attended a clinical examination which included a colonoscopy in 77% (637/830), and the remainder had had a telephone interview, or reassessment based on hospital records, or both. Twenty seven patients were reclassified as not having IBD (3%), and 65 patients were characterised as possible IBD (8%). Of the patients initially classified as UC, 88% had their diagnosis confirmed, compared with 91% with an initial diagnosis of CD. In patients with indeterminate colitis, 33% were classified as definite UC and 17% as CD. This reclassification of patients yielded a corrected annual incidence of 12.8 for UC and 6.0 for CD. CONCLUSION: At follow up one to two years after the diagnosis of IBD, the initial incidence was only marginally altered. This is probably due to uniform inclusion criteria and careful diagnostic methods. The study also illustrates the importance of the re-evaluation of the initial diagnosis as close to 10%, both among patients with UC and CD, were reclassified at follow up.
Colitis, Ulcerative↗
Is there an excess risk for colorectal cancer in patients with ulcerative colitis and concomitant primary sclerosing cholangitis? A population based study.
BACKGROUND: Patients with ulcerative colitis have an increased risk of colorectal cancer. Duration, age, and extent of the disease at diagnosis are the only established risk factors. Patients with ulcerative colitis and concomitant primary sclerosing cholangitis (PSC) have been reported to have a higher frequency of colonic DNA aneuploidy and/or dysplasia than expected, findings indicating an increased risk of colorectal cancer compared with other patients with ulcerative colitis. METHODS: A population based cohort consisting of 125 patients with a verified diagnosis of PSC was followed up by linkage to the Swedish Cancer Registry for the occurrence of colorectal cancer. RESULTS: There were 12 colorectal cancers. Six cancers were diagnosed prior to the diagnosis of PSC. Among the 104 patients with an intact colon at the time of the diagnosis of PSC there was a cumulative risk for colorectal cancer of 16% after 10 years. Among the 58 patients with a diagnosis of ulcerative colitis and colorectal cancer prior to the diagnosis of PSC, there were five colorectal cancers corresponding to a cumulative risk of 25% after 10 years. CONCLUSIONS: Patients with ulcerative colitis and concomitant PSC seem to constitute a subgroup with a high risk for colorectal cancer.
Actuarial Analysis↗
Evaluation of surveillance programmes for colorectal cancer in ulcerative colitis patients by case-control studies: methodological considerations.
OBJECTIVES: The evaluation of the efficacy of colonoscopy screening in patients with ulcerative colitis for colorectal cancer is associated with methodological difficulties. Case-control studies can, however, be used to determine the efficacy of such a programme and the outline of the methodology in such a programme is presented. METHODS: The randomised controlled trial provides perspective for case-control studies of screening efficacy. Cases are selected from persons who have ulcerative colitis with manifestations of colorectal cancer: for example, those who have died of colorectal cancer or have symptomatic metastases. Controls are selected from persons who have ulcerative colitis, who had been alive when the case died of colorectal cancer, and who had been subject to the risk of dying from, but had not had, colorectal cancer diagnosed when the case was diagnosed with colorectal cancer. The relevant screening history for cases begins with the case's diagnosis of ulcerative colitis and ends with the cases diagnosis of colorectal cancer; that for controls should be comparable to that for cases to avoid bias. Cases and controls are compared with respect to their "exposure" to colonoscopy during their screening histories: the occurrence of any screening, which took place during the period of time that an occult tumour (or an identifiable lesion) may plausibly have been present. CONCLUSION: The proposed methodology can evaluate the efficacy of a screening programme rapidly, practically, and ethically.
Case-Control Studies↗