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Biomedical subjects

Anders Ekbom

Publications and source records attributed to Anders Ekbom.

At least 91 records · Page 5Linked to original sources
PubMed2003

Maternal lung cancer and testicular cancer risk in the offspring.

It has been hypothesized that smoking during pregnancy could increase the offspring's risk for testicular cancer. This hypothesis is indirectly supported by both ecological studies and studies of cancer aggregations within families. However, results from analytical epidemiological studies are not consistent, possibly due to methodological difficulties. To further study the association between smoking during pregnancy and testicular cancer, we did a population-based cohort study on cancer risk among offspring of women diagnosed with lung cancer. Through the use of the Swedish Cancer Register and the Swedish Second-Generation Register, we identified 8,430 women who developed lung cancer between 1958 and 1997 and delivered sons between 1941 and 1979. Cancer cases among the male offspring were then identified through the Swedish Cancer Register. Standardized incidence ratios were computed, using 95% confidence intervals. We identified 12,592 male offspring of mothers with a subsequent diagnosis of lung cancer, and there were 40 cases of testicular cancer (standardized incidence ratio, 1.90; 95% confidence interval, 1.35-2.58). The association was independent of maternal lung cancer subtype, and the risk of testicular cancer increased stepwise with decreasing time interval between birth and maternal lung cancer diagnosis. Our results support the hypothesis that exposure to cigarette smoking in utero increases the risk of testicular cancer.

Adult Children↗
PubMed2003

Pregnancy hormones, pre-eclampsia, and implications for breast cancer risk in the offspring.

The aim of this study is to prospectively assess pregnancy hormone levels as correlates of subsequent development of pre-eclampsia, a condition that has been shown to be inversely associated with breast cancer risk in the offspring. A cohort of 260 Caucasian women in Boston, Massachusetts, was followed through pregnancy. Maternal blood was collected at the 16th and 27th weeks of gestation, and 18 women were diagnosed with pre-eclampsia after blood collection. Information on sociodemographic variables and risk factors of pre-eclampsia was collected through an interviewer-administered questionnaire and review of medical records. At the 16th week, there was a nonsignificant positive association between progesterone levels and pre-eclampsia [relative risk (RR) = 1.63, 95% confidence interval (CI), 0.97-2.74, per 1 SD increase]. By the 27th week, the association between progesterone and pre-eclampsia was strengthened (RR = 2.65, 95% CI, 1.46-4.81, per SD), and sex hormone-binding globulin levels were somewhat inversely related to pre-eclampsia (RR = 0.61, 95% CI, 0.31-1.20, per SD). No difference was found with respect to prolactin, estradiol, and estriol levels. Our findings indicate that progesterone may have a role in the late manifestation of pre-eclampsia pathology but are also compatible with the hypothesis that increases in progesterone represent an early compensatory mechanism.

Adult↗
PubMed2003

Serum insulin-like growth factors in normal pregnancy and in pregnancies complicated by preeclampsia.

BACKGROUND: Lower levels of insulin-like growth factor I (IGF-I) have been shown to be associated with preeclampsia and also with a reduced risk of breast cancer later in life. Lower levels of IGF before clinical signs of preeclampsia could be one possible mechanism in the etiology of preeclampsia as well as for the reduced risk of breast cancer associated with preeclampsia. We have prospectively investigated maternal serum levels of IGF-I, IGF-II, and the main binding protein insulin-like growth factor binding protein 3 (IGFBP-3) in women with and without preeclampsia. METHODS: We used maternal serum samples from a Swedish-Norwegian cohort study obtained in the 17th and 33rd gestational week from 30 women who subsequently developed preeclampsia and 128 women who did not develop preeclampsia. RESULTS: There were no significant differences in serum concentrations IGF-I and IGFBP-3 in the 17th or the 33rd week of gestation between women who developed preeclampsia or not. Compared with nonpreeclamptic women, preeclamptic women had significantly higher serum levels of IGF-II in week 33, but there was no difference in week 17. CONCLUSION: In women who developed preeclampsia, we found no support for the hypothesis that the disease was preceded by lower serum levels of IGF-I and IGF-II, or higher serum levels of IGFBP-3. However, among women who later developed preeclampsia, serum levels of IGF-II were significantly higher in the 33rd gestational week.

Adult↗
PubMed2003

Sex-specific risks for pediatric onset among patients with Crohn's disease.

BACKGROUND & AIMS: Increases in the incidence of pediatric Crohn's disease might reflect increases in incidence for onset at all ages or diagnostic improvement. Alternatively, there might be etiologic differences between adult and pediatric-onset disease with different risks for pediatric disease. Differences in sex ratio between adult and pediatric disease suggest etiologic differences might exist and also suggest differences in sex-specific susceptibility during childhood. This study seeks to identify whether factors previously associated with overall risk of Crohn's disease (number of siblings and maternal age) are associated with pediatric as opposed to adult onset among patients with Crohn's disease and whether these associations vary by sex. METHODS: A nested case-control study of patients with Crohn's disease was designed to compare pediatric with adult-onset disease. The participants were all patients with Crohn's disease in the Swedish Inpatient Register born between 1960 and 1998; 46.6% of the 4826 patients were male. RESULTS: A notable association between mother's age at pregnancy and pediatric Crohn's disease was observed in female but not male patients. Compared with those whose mothers were younger than 21 years, female patients with older mothers, coded into ordered 5-year age categories, were at a higher risk of pediatric disease with adjusted odds ratios (95% confidence intervals) of 1.42 (0.85-2.37), 2.08 (1.19-3.66), 3.50 (1.83-6.69), 3.02 (1.35-6.75), and 12.64 (3.63-43.98). No statistically significant independent associations were observed for father's age or number of siblings. CONCLUSIONS: Females might be more susceptible or more often exposed to factors associated with older maternal age at pregnancy that increase their risk of pediatric-onset Crohn's disease.

Adolescent↗
PubMed2002

Cancer incidence in a population-based cohort of patients with Wegener's granulomatosis.

Wegener's granulomatosis is necrotizing granulomatous vasculitis of unknown origin, which untreated has a high mortality within the first year of onset. The introduction of corticosteroids and cyclophosphamide in the treatment has considerably improved survival rates, but past studies have indicated an increased cancer risk, including an increased risk for urinary bladder cancer. No large assessment of the general cancer occurrence in Wegener's granulomatosis has been reported. The aim of our study was to assess the general incidence of cancer in patients with Wegener's granulomatosis and to put this in relation to the risk for bladder cancer. We identified a population-based cohort of 1,065 patients with Wegener's granulomatosis in the Swedish In-patient Register. Through linkage with the Swedish Cancer Register, we followed the cohort for cancer occurrence for up to 26 years. Standardized incidence ratios (SIR) between observed and expected numbers of cancers were used as a measure of relative risk. There was a 2-fold overall increased risk for cancer in the cohort. The increase was most pronounced for bladder cancer (SIR = 4.8; 95% CI 2.6-8.1), squamous cell skin cancer (SIR = 7.3; 95% CI 4.4-12), leukemias (SIR = 5.7; 95% CI 2.3-12) and for malignant lymphomas (SIR = 4.2; 95% CI 4.2-8.3). The results confirm previous indications of an increased risk for cancer of the urinary bladder but also points to increased risks for cancer at other sites.

Adolescent↗
PubMed2002

Physical activity and risk for breast cancer a prospective cohort study among Swedish twins.

The epidemiologic association between physical activity and breast cancer has been corroborated in many studies. Some inconsistencies remain, possibly due to variation in life periods for exposure assessment, confounding and undetected effect modification. In our cohort study, we address some of these questions by taking into account physical activity in different periods of life and by investigating effect modification by birth cohort and body mass index (BMI). Altogether 9,539 same-sex twin women aged 42-70 years who answered a questionnaire about their work and leisure-time physical exercise from ages 25 to 50 during 1967 and 1970 were included in our cohort. During follow-up, 506 breast cancer cases occurred through 1997. We used multivariate Cox models to estimate relative risk (RR) with 95% confidence interval (CI). We found no associations between physical activity and breast cancer overall. Women born between 1901 and 1917 (aged 51-70 at baseline) who reported regular leisure-time activity had a borderline significant 40% lower risk compared with those who reported no activity (RR 0.6; 95% CI 0.4-1.0; test for trend, p = 0.07). This association appeared to be confined to women with a low BMI after the age of 50 and to women with a high BMI during the premenopausal period. We found no evidence that work activity reduces risk for breast cancer. The importance of physical activity for breast cancer risk seems to depend on birth cohort. The association may be limited to normal-weight postmenopausal women and overweight premenopausal women.

Adult↗
PubMed2002

Effect of caffeine exposure during pregnancy on birth weight and gestational age.

Epidemiologic studies have been unable to conclusively evaluate whether caffeine intake during pregnancy is associated with reduced birth weight and/or fetal growth restriction. The authors conducted a prospective, population-based cohort study to investigate the effect of caffeine on birth weight, gestational age, and birth weight standardized for gestational age (birth weight ratio). Of 953 women recruited in early pregnancy in Uppsala County, Sweden, from 1996 to 1998, 873 women delivering liveborn singleton infants were included in the analysis. Caffeine exposures were ascertained from in-person interviews at 6-12 and 32-34 completed gestational weeks, and maternal plasma was analyzed for cotinine levels as an indicator of smoking. Analysis of variance was used to estimate the effect of caffeine on birth weight, gestational age at delivery, and birth weight ratio after accounting for the effects of other covariates, such as maternal sociodemographic characteristics, plasma cotinine, and pregnancy symptoms. There were no associations between caffeine consumption and birth weight, gestational age, and birth weight ratio, neither when caffeine exposure was averaged from conception to the 32nd to 34th gestational weeks, nor when caffeine exposure was stratified by trimesters of pregnancy. These results do not support an association between moderate caffeine consumption and reduced birth weight, gestational age, or fetal growth.

Adult↗
PubMed2002

Perinatal exposure to infection and risk of childhood leukemia.

BACKGROUND: A population-based case-control study was conducted to investigate the association between childhood leukemia and infectious exposures during pregnancy and early neonatal period. PROCEDURE: Children born and diagnosed with leukemia between 1973 and 1989 in Sweden (578 lymphatic, 74 myeloid) were selected as cases. One control was randomly selected for each case and individually matched by sex, month, and year of birth. Children with Down's syndrome were excluded. Exposure data were blindly abstracted from antenatal, obstetric, and other standardized medical records. Odds ratios (OR) and 95% confidence intervals (CI) were calculated by conditional logistic regression. RESULTS: A history of maternal infection was not significantly associated with childhood leukemia, OR = 1.25 (95% CI 0.95-1.65). Maternal lower genital tract infection significantly increased the risk of childhood leukemia, OR = 1.78 (95% CI 1.17-2.72), and especially for children over 4 years of age at diagnosis, OR = 2.01 (95% CI 1.12-3.80). Neonatal infection was not associated with the risk of leukemia. The results remained unaltered after adjustment for potential confounders, and separate analyses for myeloid and lymphoid leukemia. CONCLUSIONS: We could document an association between exposure to maternal lower genital tract infection in utero, and a subsequent risk for childhood leukemia, which indicate the importance of an early exposure.

Acute Disease↗
PubMed2002

Hospital readmission after coronary artery bypass grafting: are women doing worse?

BACKGROUND: In studies of gender effects on outcome after coronary artery bypass grafting, early mortality has consistently tended to be higher among women, whereas long-term results have varied. The aim of this study was to identify predictors of hospital readmission and assess the effect of gender. METHODS: Between 1987 and 1996, 7,493 patients were discharged alive after primary coronary artery bypass grafting and were followed up to the first readmission, date of death, or December 31, 1996. The hazard ratios for the risk factors found were used to calculate a readmission risk score. RESULTS: A total of 4,780 (63.8%) patients were readmitted. The fraction not readmitted within 1, 5, and 10 years were 61%, 29%, and 14% (95% confidence intervals = 60 to 62, 28 to 30, and 12 to 16), respectively. The risk of readmission was highest early after operation and then gradually decreased. Older age, active smoking, diabetes, previous myocardial infarction, unstable angina, dyspnea, severe left ventricular dysfunction, advanced New York Heart Association functional class, bypass time of 2 hours or more, and length of stay all independently increased the risk of readmission. Female sex was a significant risk factor in univariate but not in multivariate analysis. In all age groups, women had a one unit higher risk score. Given the same risk score, the risk of readmission was similar between sexes. CONCLUSIONS: This study showed an acceptable risk of readmission after coronary artery bypass grafting. Women more often had risk factors related to readmission. However, given identical disease severity, the risk was similar in men and women.

Aged↗
PubMed2002

Hepatic and extrahepatic malignancies in primary sclerosing cholangitis.

BACKGROUND/AIMS: To assess the risk of hepatic and extrahepatic malignancies in a large cohort of Swedish primary sclerosing cholangitis (PSC) patients compared with that of the general Swedish population. METHODS: The study cohort comprised 604 PSC patients identified between 1970 and 1998. Follow-up was provided through linkages to the Swedish Cancer and Death registries. Cumulative incidence of malignancies and standard incidence ratio were calculated with the incidence rates in the Swedish population, taking into account: sex, age and calendar year as comparison group. RESULTS: Median time of follow-up was 5.7 years (range 0-27.8). Seventy-nine percent had concomitant inflammatory bowel disease. The cause of death was cancer in 44%. The frequency of hepatobiliary malignancies was 13.3% (81/604). Thirty-seven percent (30/81) of all hepatobiliary malignancies were diagnosed less than 1 year after the diagnosis of PSC. The risk for hepatobiliary malignancy was increased 161 times, for colorectal carcinoma 10 times and for pancreatic carcinoma 14 times, compared with that of the general population. CONCLUSIONS: In this national-based study including the largest cohort of PSC patients ever presented, the frequency of cholangiocarcinoma is 13%. The risk of hepatobiliary carcinoma is constant after the first year after PSC diagnosis with an incidence rate of 1.5% per year. The risk of pancreatic carcinoma is increased 14 times compared with the general Swedish population. These results are suggestive of an increased risk of pancreatic carcinoma in patients with PSC.

Adult↗
PubMed2002

Sociodemographic predictors of non-attendance at invitational mammography screening--a population-based register study (Sweden).

OBJECTIVE: To investigate the role of sociodemographic factors in predicting mammography uptake in an outreach screening program. METHODS: Linkage of data from a regional population-based mammography program with four Swedish nationwide registers: the Population and Housing Census of 1990, the Fertility Register, the Cancer Register, and the Cause of Death Register. We computed odds ratios (OR) and 95% confidence intervals (CI) for non-attendance by sociodemographic factors. Non-attendance was defined as failure to attend in response to the two most recent invitations. RESULTS: Multivariate analyses among 4198 non-attenders and 38,972 attenders revealed that both childless and high-parity women were more likely to be non-attenders (OR = 1.8, 95% CI: 1.6-2.0 and OR = 2.2, 95% CI: 1.8-2.7, respectively). Women living without a partner were less likely to attend (OR = 1.7, 95% CI: 1.5-1.9), as were non-employed women (OR = 2.1, 95% CI: 1.9-2.3). Those renting an apartment were more likely to be non-attenders compared with home-owners (OR = 1.8, 95% CI: 1.6-2.0), and immigrants from non-Nordic countries were more than twice as likely to be non-attenders compared with Swedish-born women (OR = 2.4, 95% CI: 2.0-2.8). CONCLUSIONS: There are identifiable subgroups in which mammography utilization can be increased. Special attention should be paid to women who have never attended, childless women, and non-Nordic immigrants.

Adult↗
PubMed2002

Transient increase in breast cancer risk after giving birth: postpartum period with the highest risk (Sweden).

OBJECTIVE: Identify time-points when the elevated postpartum maternal breast cancer risk peaks. METHODS: A case-control study nested within the Swedish Fertility Register included 34,018 breast cancer cases from the Swedish Cancer Register between 1961 and 1995. From the Fertility Register, 170,001 eligible subjects matched to the cases by age were selected as controls. Analysis contrasted risk between uniparous (7084 cases and 31,703 controls) and nulliparous (5411 cases and 22,580 controls) women and between biparous (13,239 cases and 65,858 controls) and uniparous women. Logistic regression analysis included indicator variables representing each year of age, ages at delivery, and time since delivery. RESULTS: Comparing uniparous with nulliparous women the transient increase in maternal breast cancer risk peaked 5 years following delivery (odds ratio= 1.49, 95% confidence interval 1.01-2.20) and leveled off 15 years postpartum. Biparous women had a transient increase in risk that was lower at its peak than that of uniparous women, occurring about 3 years following second delivery. CONCLUSIONS: A time window of 5 years postpartum when maternal breast cancer risk is highest was observed. Establishing timing of peak transient increase in postpartum breast cancer risk may define the latent period required for pregnancy hormones in promoting progression of breast cells that have undergone early stages of malignant transformation.

Adolescent↗
PubMed2002

Maternal age, anthropometrics and pregnancy oestriol.

It has been hypothesised that oestrogen exposure in utero influences the risk for breast cancer in adult life. Although several studies report associations between breast cancer and maternal factors associated with birthweight of the offspring - a marker for antenatal oestriol exposure - little is known about the relations between maternal oestrogen levels and these factors per se. We therefore analysed the association between oestriol levels in 188 women in the 17th, 25th, 33rd and 37th weeks of pregnancy, and maternal age, prepregnancy weight, height and pregnancy weight gain. Both maternal prepregnancy body mass index and maternal height were, after controlling for infant birthweight, independently and inversely associated with oestriol levels (P = 0.0021 and P = 0.0006 respectively). We found no association between maternal age or pregnancy weight gain and pregnancy oestriol levels. These findings suggest that the previously reported associations between maternal age and maternal pregnancy weight gain and the offsprings risk of breast cancer are due to factors other than antenatal exposure to oestriol.

Adult↗
PubMed2002

Cancer incidence in a population-based cohort of individuals hospitalized with celiac disease or dermatitis herpetiformis.

BACKGROUND & AIMS: Studies of cancer risk in celiac disease (CD) or dermatitis herpetiformis (DH) indicate increased risks for malignant lymphoma and occasionally other neoplasms, but are characterized by small numbers, lack of systematic cancer assessment, and subjects identified from referral institutions. METHODS: By using Swedish population-based inpatient and cancer registry data, we followed-up 12,000 subjects with CD or DH, and evaluated cancer incidence by using standardized incidence ratios (SIR). RESULTS: Adults (but not children and adolescents) with CD had an elevated overall risk for cancer (SIR = 1.3) that declined with time and eventually reached unity. Elevated risks were found for malignant lymphomas, small-intestinal, oropharyngeal, esophageal, large intestinal, hepatobiliary, and pancreatic carcinomas. The excess occurrence of malignant lymphomas was confined to adults, decreased with time of follow-up evaluation, and decreased over successive calendar periods. Decreased risks were found for breast cancer. Subjects with DH had a slightly increased overall cancer risk (SIR = 1.2) owing to excesses of malignant lymphoma and leukemia, but no increases of gastrointestinal carcinomas. CONCLUSIONS: Albeit increased, the relative risks for lymphomas and gastrointestinal cancers in this study are lower (and declining) than in most previous reports. The overall cancer risk is only moderately increased, and nonelevated during childhood and adolescence.

Adolescent↗
PubMed2002

Increased cancer incidence in a Swedish cohort of patients with systemic lupus erythematosus.

OBJECTIVE: To assess the risk of cancer in patients with systemic lupus erythematosus (SLE). METHODS: A population-based cohort of 5 715 hospitalised SLE patients was followed 1964-1995 through linkage of the Hospital Discharge Register to the National Swedish Cancer Register. RESULTS: In all, 443 malignancies occurred during the observation-period. The overall risk was increased by 25% (SIR= 1.25, CI 95% 1.14-1.37) and lymphomas constituted the major excess risk. The risk of non-Hodgkin's lymphoma (NHL) was nearly 3-fold increased (SIR = 2.86, CI 95% 1.96-4.04). There was also an increased risk of lung cancer (SIR= 1.73, CI 95% 1.25-2.32) and squamous cell skin cancer (SIR= 1.53, CI 95% 0.98-2.28), which was most pronounced at more than 15 years of follow-up. CONCLUSION: The major finding was a bimodal incidence pattern with an increased risk of lymphoma, mainly NHL, early during follow-up, but lung cancer and squamous skin cancer later on.

Adult↗
PubMed2002

Epidemiology of inflammatory bowel disease.

Despite the apparent continuous increase of the incidence of inflammatory bowel disease (IBD) in some populations, or some sections of populations such as British children, the origin of these conditions remains obscure. Epidemiological studies of specific risk factors continue to yield contradictory and inconclusive results. However, studies of exposure and comorbidity, coupled with genetic and molecular studies, expand our knowledge and will facilitate more sophisticated research in the near future. Our understanding of the genetic basis of IBD is improving, but genetic anticipation as an explanation for increasing incidence rates appears less probable. The benefit of giving up smoking has been demonstrated in Crohn's disease patients, because smoking influences disease activity. The increased cancer risk in IBD is a concern, but despite this, the overall mortality in IBD is no higher than that of the general population.

Journal Article↗