Way of life and cancer incidence in Finland.
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Ecology↗
Biomedical subjects
E Pukkala
Publications and source records attributed to E Pukkala.
[Decline in lung cancer in the Finnish population].
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Female↗
Second primary cancers in patients with carcinoma of the lip.
The occurrence of second primary cancers in patients with lip cancer was evaluated in order to test certain etiologic hypotheses. All cases of lip cancer reported to the Finnish Cancer Registry in 1953-74 (3303 men, 320 women) were followed up for a second (or third) primary cancer through the files of the Registry either to death or to 31 December 1974 (a total of 25 510 person-years). The expected numbers of cases were calculated on the basis of the incidence rates specific for sex, age, time and residence (urban or rural) in Finland. A higher than expected risk of cancer was found among both urban and rural male lip cancer patients; among women the observed number of new primary cancers did not differ from that expected. A significant excess risk among males was noted for cancers of the lung and larynx (rural patients) and for non-melanomatous skin cancer in locations other than the head and neck (urban patients). The association of cancers of the lip, lung and larynx found earlier on a geographic level supports the hypothesis that tobacco smoking is a common risk factor in these cancers. The differences in the relative risks between urban and rural patients, however, suggest that the risk factors in lip cancer in urban areas might be partially different from those prevalent in the rural population. The results do not support the hypothesis that sunlight is an important risk factor in lip cancer.
Adult↗
Selective screening: theory and practice based on high-risk groups of cervical cancer.
Using data taken from the organised mass screening system in Finland, risk indicators of cervical cancer were identified in order to define a high-risk group which could then be used for selective screening of cervical cancer. Single risk factors classified at best 39% of the cases into a high-risk group of 8%. A combination of risk factors by different statistical methods was applied, but the results were essentially the same. In order to find a high-risk group small enough to yield a reduction in costs, the number of cases originating from the low-risk group was increased. Theoretical calculations showed that for selective screening to be effective, the risk of disease in the high-risk group relative to that in the low-risk group must be greater than that implied by current knowledge of cervical cancer epidemiology. It was concluded that selective screening has only a limited applicability.
Female↗
Selective screening for cervical cancer. Experience of the Finnish mass screening system.
Names of women eligible to be screened for cervical cancer are taken from the national population registry and the women are invited by a personal letter. The data, from these mass screenings are analysed and stored at the screening registry. To reduced the costs of the system and to increase the yield of preinvasive lesions the idea of selective screening was considered. Tt was decided that if people were selected according to their risk factors, as recorded in the national population registry, the screening would be ineffective as many cases of invasive cancer were found in the low risk groups. High risk factors were determined from anamnestic data on systems and from previous cytological diagnoses. The proportion of women with symptoms of bleeding or the class II-V smears without positive histological results constituted fewer than 10% of the participants, but 20% and 40% respectively of invasive carcinomas were found in these groups during the subsequent follow-up period. Thus it is suggested that selective screening apart from that based on age has a limited application and should be restricted mainly to the interval between the organised screenings, which in Finland is five years.
Adult↗
Cancer incidence following chlorophenol exposure in a community in southern Finland.
Chlorophenols have contaminated the drinking water system and the local lake in the village of Järvelä in southern Finland. Local geology, ground water streams, and chemical analyses incriminated a local sawmill as the only plausible source of exposure. Cancer incidence in the municipality of Kärkölä (half of the population lives in Järvelä), compared with the rest of the local health-care district and with the greater cancer control region, indicated an excess of soft-tissue sarcomas and non-Hodgkin's lymphomas. A case-control study, which focused on cancers of the colon, bladder and soft tissues, lymphomas, and leukemia, demonstrated a significantly elevated risk ratio for non-Hodgkin's lymphomas among persons who consumed fish from the local lake, which was contaminated with chlorophenols. Probable exposure to chlorophenol-contaminated drinking water played a role in the increased incidence of non-Hodgkin's lymphomas and possibly was a factor in the development of soft-tissue sarcoma.
Animals↗
Risk for cancer of the pharynx and oral cavity among male painters in the Nordic countries.
In an effort to evaluate a hypothesis raised by findings in Denmark that painters might experience an increased risk for pharyngeal and oral cancer, data were collected about these cancers among painters in Norway, Sweden, and Finland. The possible confounding effects of alcohol and tobacco were gauged by collecting data about cancer of the lung, larynx, esophagus, liver, and bladder, and about mortality from liver cirrhosis. Consistently increased risks for lung cancer among painters were found. The risks for cancer of the oral cavity and/or pharynx were increased in Norway, Sweden, and Finland, but not to the same extent as was observed in Denmark. The risks for cancer of the esophagus were slightly increased as were the risks for cancer of the liver and for cirrhosis of the liver in Denmark and Finland. The data from Norway, Sweden, and Finland could thus neither substantiate nor disprove the hypothesis that painters may experience an increased risk for cancer of the pharynx and oral cavity as a result of occupational exposures.
Humans↗
Drinking water mutagenicity and leukemia, lymphomas, and cancers of the liver, pancreas, and soft tissue.
The acid, mutagenic compounds present in chlorinated drinking water have caused concern about the potential cancer risk of drinking-water mutagenicity. In this study, past exposure to drinking water mutagenicity was assessed for the years 1955 and 1970 in 56 Finnish municipalities, using the historical information on water quality and treatment. Cases of leukemia, lymphomas, and cancers of the liver, pancreas, and soft tissue were derived from the Finnish Cancer Registry for two periods: 1966-1976 and 1977-1989. Relative risk was estimated in an additive Poisson regression model, adjusting for age, gender, social class, urbanity, and time period. In an ordinary municipality that was supplied with mutagenic drinking water (3,000 net rev/l), the observed exposure-response relationship indicated a relative risk of 1.1-1.3 for lymphomas and 1.1-1.2 for pancreatic cancer, compared with municipalities in which nonmutagenic drinking water was consumed.
Adolescent↗
Hopelessness and risk of mortality and incidence of myocardial infarction and cancer.
We examined the relationship among low, moderate, and high levels of hopelessness, all-cause and cause-specific mortality, and incidence of myocardial infarction (MI) and cancer in a population-based sample of middle-aged men. Participants were 2428 men, ages 42 to 60, from the Kuopio Ischemic Heart Disease study, an ongoing longitudinal study of unestablished psychosocial risk factors for ischemic heart disease and other outcomes. In 6 years of follow-up, 174 deaths (87 cardiovascular and 87 noncardiovascular, including 40 cancer deaths and 29 deaths due to violence or injury), 73 incident cancer cases, and 95 incident MI had occurred. Men were rated low, moderate, or high in hopelessness if they scored in the lower, middle, or upper one-third of scores on a 2-item hopelessness scale. Age-adjusted Cox proportional hazards models identified a dose-response relationship such that moderately and highly hopeless men were at significantly increased risk of all-cause and cause-specific mortality relative to men with low hopelessness scores. Indeed, highly hopeless men were at more than three-fold increased risk of death from violence or injury compared with the reference group. These relationships were maintained after adjusting for biological, socioeconomic, or behavioral risk factors, perceived health, depression, prevalent disease, or social support. High hopelessness also predicted incident MI, and moderate hopelessness was associated with incident cancer. Our findings indicate that hopelessness is a strong predictor of adverse health outcomes, independent of depression and traditional risk factors. Additional research is needed to examine phenomena that lead to hopelessness.
Adult↗
Low incidence of colorectal cancer in patients with rheumatoid arthritis.
OBJECTIVE: Aspirin (ASA) and also nonsteroidal anti-inflammatory drug (NSAID) use has been associated with a low incidence of colorectal cancer. The incidence of colorectal cancer in a cohort of patients with rheumatoid arthritis (RA) is reported here. METHODS: Cancer incidence was studied in a cohort of 9469 persons hospitalized for RA during 1970-1991 in Finland. The follow-up time was about 65,400 person-years. RESULTS: The incidence of colon cancer was significantly lower than in the general population [standardized incidence ratio (SIR) 0.57; 95% confidence interval (CI) 0.33-0.93], and the combined SIR for colorectal cancer was 0.62 (95% CI 0.42-0.88), while the combined incidence of all malignancies (SIR 1.16; 95% CI 1.07-1.26) was higher in RA patients than in the general population. CONCLUSION: Chronic use of NSAIDs or ASA, including antiinflammatory doses, is probably the main explanation for the low incidence of colorectal cancer in RA patients.
Adult↗