Search PubMed⌕ Search

Biomedical subjects

H H Storm

Publications and source records attributed to H H Storm.

At least 73 records · Page 4Linked to original sources
PubMed1994

Cancers of the soft tissues.

Soft tissue sarcomas are rare and occur more frequently among males (0.9-4.3 per 100,000 age adjusted to the world standard population) than females (0.7-2.6 per 100,000). The international variation in incidence is small, and little change has occurred over time. Mortality rates were half or less than half the incidence and increased slightly in some areas, which is easily explained by changes in classification, coding and diagnosis over time, as well as instability of rates due to small numbers. Survival, in particular comparing data from the 1950s and 1960s with those from the late 1980s, has improved slightly. However, these observations must be interpreted with caution inasmuch as according to the ICD, STS are classified both with specified organs and with the connective tissue. In view of the Danish experience, this fact alone may account for recorded differences in incidence (and thus mortality) of 1 and 4 cases per 100,000 per year. No major risk factor has been clearly identified for soft tissue sarcoma, although genetic traits and certain environmental agents such as ionizing radiation and agricultural chemicals seem to be involved in some cases. The recent rise in AIDS related Kaposi's sarcoma indicates the importance of further studies into the role of infectious agents and immunological mechanisms. Future trends in soft tissue sarcoma should be studied after separating these tumours into Kaposi's sarcoma and other relevant aetiological subgroups.

Adolescent↗
PubMed1994

Brain and other nervous system tumours.

Interpretation of time trends in incidence rates for cancers of brain and other and unspecified parts of nervous system is complicated by variation in registration efficiency over time and place, statistical instability of rates, changes in the ICD classification of the tumours, variation in registration practice for the benign and unspecified tumours over time and changes in methods of diagnosis. The reader will undoubtedly have the impression that in this chapter there are too many differences in the content of the data over time and place to have confidence in any of the conclusions drawn. To derive a well documented and sustainable assessment on secular trends will require an international collaborative study collecting incidence data for the malignant, benign, uncertain and unspecified tumours of the brain and other parts of the nervous system by histology and by method of diagnosis. By providing a separate rubric for the meninges, the 10th Revision of the ICD (WHO, 1993) should--combined with the morphology rubrics of the second edition of the International Classification of Diseases-Oncology (Percy et al 1990)--make such an endeavour somewhat easier. The data presented above nevertheless suggest that, as for several other cancer sites, on the whole there has been a slow overall increase in the incidence of brain and other and unspecified nervous system neoplasms on the order of 1-2% per year over the past 30 years. Increases appear to have been greater in older people. The extent to which these increases are due to the unquestioned improvements in methods and precision of diagnosis is not clear. Birth cohort data suggest that in recent years, this influence may have been greatest for those birth cohorts born prior to 1900, and this effect is unlikely to disappear until cohorts born about 1910-1920 have passed on. There is currently little evidence to support the contention that the recent increase in older people cannot be largely explained by improvements in diagnostic methods, wider access to medical care and more intensive investigation. Further work is needed.

Adult↗
PubMed1994

Primary liver tumors among Danish patients exposed to Thorotrast.

The potential carcinogenic effects of internally deposited alpha-particle-emitting nuclides, notably plutonium, in the liver in humans are unknown but are of concern in relation to exposures from the nuclear industry. However, patients injected with the radiographic contrast medium Thorotrast are chronically exposed to alpha-particle radiation from 232ThO2 in the liver. Among 1003 patients injected with Thorotrast, 584 of whom were alive 15 years after the injection and 40 at the end of follow-up, a total of 127 liver cancers were diagnosed, 45 of which were hepatocellular carcinomas, 41 cholangiocarcinomas and 33 hemangiosarcomas. The median time from injection to diagnosis was 35 years (range 18-48) and the cumulative frequency was 55.4% after 48 years. In univariate and multivariate analyses, the cumulative frequency of liver cancer was best described as a function of the estimated mean cumulative alpha-particle radiation dose to the liver 15 years ago, being independent of age, gender and volume of injected Thorotrast. This may be interpreted to mean that the liver cancer rate is not related to the dose rate and that the period from malignant transformation to diagnosis of cancer is 15 years. The risk of liver carcinogenesis induced by alpha-particle radiation, assuming 15 years from induction to diagnosis, was estimated to be 712 cases/10(4) persons per gray. This value is considerably higher than estimated earlier.

Adolescent↗
PubMed1993

Pattern of mortality among Danish thorotrast patients.

The mortality pattern among 999 Danish patients who had been subjected to angiography of the carotid artery with the alpha-ray emitting X-ray contrast media Thorotrast during the period 1935-47 was assessed by record linkage with the National Death Registry through 1989. Standardized mortality ratios (SMR) were calculated relative to the general population. The overall SMR was increased by 18 times during the first 3 years after Thorotrast injection. This rate reflects the often serious, underlying neurological conditions for which angiography was performed, however, mortality was increased by 3-4 fold even for the follow up period after the first 3 years. The increase in mortality was evident for all categories of cause of death, the SMR being 11.1 (95% confidence interval (CI) 7.1-16.4) for cirrhosis of the liver, 4.7 (4.1-5.3) for cancer, 1.6 (1.3-1.9) for cardiac disease, 3.3 (2.6-4.2) for cerebrovascular diseases, 3.9 (3.3-4.5) for other natural causes, and 4.4 (3.4-5.6) for violent causes (including suicides). The SMR was generally related positively to young age at injection, to time since injection, and to the amount injected. The excess mortality can be explained only partially by underlying neurological conditions and by diseases known to be induced by Thorotrast (cirrhosis and cancer of the liver, leukaemia and other haematological diseases), and it is suggested that unspecific effects induced by the alpha-radiation of Thorotrast may have contributed.

Cause of Death↗
PubMed1993

Urban-rural variation in cancer incidence in Denmark 1943-1987.

Urban and rural cancer incidence in Denmark in 1943-1987 was analysed. A consistent urban excess was found for all sites combined for individuals of each sex, irrespective of age at diagnosis. The capital:rural incidence ratio was 1.42 for men and 1.25 for women, and these ratios were not affected to any great extent using another definition of urban areas. Urban:rural ratios were highest for cancers of the respiratory, urinary and upper digestive tracts. The differences cannot be explained by tobacco and alcohol consumption alone. Other risk factors linked to urbanisation may contribute importantly to the "urban factor", and analytical studies of data at an individual level are required to establish their relative importance. Our findings contradict the generally accepted view that there is no urban-rural difference in cancer incidence in the relatively small, homogeneous population of Denmark.

Denmark↗
PubMed1993

Incidence of second primary cancer following testicular cancer.

The incidence of second primary cancers was investigated in 6187 Danish men diagnosed with testicular cancer in the period 1943-1987. During the course of 59,000 person years, 459 subsequent primary cancers occurred. The relative risks were significantly increased for leukaemia, gastric cancer, pancreatic cancer, bladder cancer, non-melanoma skin cancer and kidney cancer. Increased incidence was furthermore suggested for cancer of the rectum, prostate and lung. The increased incidence of leukaemia appeared in the first 10 years after testicular cancer diagnosis. The excess incidence for gastric cancer, pancreatic cancer, rectal cancer and lung cancer was strongest 10-19 years after testicular cancer, while the relative risk of non-melanoma skin cancer and prostate cancer increased throughout the period of follow-up. The increased incidence of cancer in this cohort is most likely an effect of radiotherapy used for testicular cancer. It is proposed that the different incidence patterns over time after testicular cancer diagnosis reflect differences in the growth rate of tumours originating in different tissues.

Adult↗
PubMed1993

Survival of Danish cancer patients 1943-1987. Female genital organs.

In Denmark, about 1800 new cases of cancer of the female genital organs (i.e., uterine cervix, uterine corpus and ovary) occur every year. The similarity in incidence contrasts with the differences in survival patterns for these three cancer types, the crude five-year survival rates being 59% (cervix), 68% (corpus) and 27% (ovary). An overall increase in relative one-, two- and five-year survival rates was observed for cancers of the cervix, corpus and ovary between 1943 and 1987. For uterine cervical cancer there has been an equal improvement in one-, two- and five-year survival rates (12, 11 and 14%), whereas for uterine corpus cancer a greater improvement was seen in the five-year rates (19%) than in those one year after diagnosis (10%). These figures are contrasted by those for ovarian cancer, for which the improvement in one-year survival rate (21%) was nearly twice that for the five-year survival rate (12%). For all the three cancer types, the age at diagnosis increased significantly over the past 40 years. The improvement in survival from cancer of the uterine corpus was most pronounced for older women whereas that for ovarian cancer was greatest among women aged 59 or less. After 1970, there was a decrease in survival rates after cervical cancer among women 60 years or older at the time of diagnosis. This is in contrast to the pattern for younger women (less than 40 at diagnosis), whose survival rate has increased continuously since 1943.

Age Factors↗
PubMed1993

Survival of Danish cancer patients 1943-1987. Buccal cavity and pharynx.

Cancers of the buccal cavity and pharynx are anatomically related and (with the exception of cancers of the salivary glands and nasopharynx) share risk factors, i.e., tobacco and alcohol. For cancers of the lip ("lipstick area") exposure to sunlight is also an important risk factor. Cancers of the buccal cavity and pharynx are rare tumours, accounting for less than 2% of all malignant tumours in Denmark. The largest group is lip cancers (6545 cases in 1943-87) for which the survival rate remained high during the study period, 95-99% of patients surviving longer than five years. Survival from cancer of the tongue (1555 cases in 1943-87) and cancer of the mouth (2770 cases) also remained fairly constant during the period; the relative one-year survival rate for males were 57% for tongue cancer and 75% for mouth cancer in 1983-87. Survival (Kaplan-Meier estimates) from cancers at either site diagnosed in 1978-87 was better for females than for males; however, relative mortality was higher among males than among females for cancer of the tongue (16.3 after one year compared to 11.9 among females), while relative mortality for mouth cancer was 8.9 and 7.8, respectively. After five years, relative mortality was 1.6 and 2.6 for male patients and 1.7 and 1.6 for female patients with cancer of the tongue and mouth. Five-year survival rate after cancer of the salivary glands (2147 cases) fell from 73 in males and 81% in females in 1943-47 to 45 and 71% in 1983-87. During the same period, however, the incidence rate almost halved, and patients were generally older at presentation, with more advanced tumours. The one-year survival rate from tumours of the pharynx (2948 cases; 38% in the tonsils, 28% in the naso-pharynx and 25% in the hypopharynx) increased between 1943 and 1987 from 48% in males and 48% in females to 59% and 67%. After five years, relative mortality was still high in both males (2.5), and females, (4.9).

Age Factors↗
PubMed1992

Cancer incidence among Danish Thorotrast-exposed patients.

BACKGROUND: Studies of groups of patients given injections of the alpha-emitting x-ray contrast medium Thorotrast may provide information on human alpha-ray carcinogenesis. PURPOSE: We re-established a formerly identified cohort of neurological patients receiving injections of Thorotrast for cerebral arteriography and assessed their incidence of cancer. METHODS: Using the national population register, the Danish Cancer Registry, and other registers, we determined the incidence of cancer among Thorotrast-injected patients. Incidence ratios were standardized to the general population and computed for different cancer sites. RESULTS: The cumulative risk for cancer at all sites (excluding brain tumors where the standardized incidence ratio [SIR] was 28) reached 86% 50 years after Thorotrast injection. SIR was greatly elevated at all sites except the brain and CNS (3.3, 95% confidence interval = 3.0-3.7), mainly because of liver cancers (SIR = 126) as well as leukemia (SIR = 10) for which a relationship was found between the time since injection and the estimated dose (but not the age at injection). Other sites with significantly increased risks of cancer included the gallbladder and extrahepatic bile ducts (SIR = 14), peritoneum (SIR = 8.6), sites of multiple myeloma (SIR = 4.6), metastatic sites (SIR = 12), and unspecified sites (SIR = 11). Cancers of the lung and breast also occurred in significant excess, but no relationship between SIR and volume of injected Thorotrast or time since injection was observed. Cancer risk was increased at most other sites, although this increase was not statistically significant. CONCLUSION: Alpha radiation may account for the increased risk of tumors of the liver, gallbladder, and peritoneum as well as leukemia and multiple myeloma, whereas confounding factors most probably contribute to the increased risks at other sites.

Adult↗
PubMed1992

Adjuvant radiotherapy and risk of contralateral breast cancer.

BACKGROUND: The risk of contralateral breast cancer is increased twofold to fivefold for breast cancer patients. A registry-based cohort study in Denmark suggested that radiation treatment of the first breast cancer might increase the risk for contralateral breast cancer among 10-year survivors. PURPOSE: Our goal was to assess the role of radiation in the development of contralateral breast cancer. METHODS: A nested case-control study was conducted in a cohort of 56,540 women in Denmark diagnosed with invasive breast cancer from 1943 through 1978. Case patients were 529 women who developed contralateral breast cancer 8 or more years after first diagnosis. Controls were women with breast cancer who did not develop contralateral breast cancer. One control was matched to each case patient on the basis of age, calendar year of initial breast cancer diagnosis, and survival time. Radiation dose to the contralateral breast was estimated for each patient on the basis of radiation measurements and abstracted treatment information. The anatomical position of each breast cancer was also abstracted from medical records. RESULTS: Radiotherapy had been administered to 82.4% of case patients and controls, and the mean radiation dose to the contralateral breast was estimated to be 2.51 Gy. Radiotherapy did not increase the overall risk of contralateral breast cancer (relative risk = 1.04; 95% confidence interval = 0.74-1.46), and there was no evidence that risk varied with radiation dose, time since exposure, or age at exposure. The second tumors in case patients were evenly distributed in the medial, lateral, and central portions of the breast, a finding that argues against a causal role of radiotherapy in tumorigenesis. CONCLUSIONS: The majority of women in our series were perimenopausal or postmenopausal (53% total versus 38% premenopausal and 9% of unknown status) and received radiotherapy at an age when the breast tissue appears least susceptible to the carcinogenic effects of radiation. Based on a dose of 2.51 Gy and estimates of radiation risk from other studies, a relative risk of only 1.18 would have been expected for a population of women exposed at an average age of 51 years. Thus, our data provide additional evidence that there is little if any risk of radiation-induced breast cancer associated with exposure of breast tissue to low-dose radiation (e.g., from mammographic x rays or adjuvant radiotherapy) in later life.

Adult↗
PubMed1992

Trends in childhood leukaemia in the Nordic countries in relation to fallout from atmospheric nuclear weapons testing.

OBJECTIVE: To obtain further information about the risks of childhood leukaemia after exposure to ionising radiation at low doses and low dose rates before or after birth or to the father's testes shortly before conception. DESIGN: Observational study of trends in incidence of childhood leukaemia in relation to estimated radiation exposures due to fallout from atmospheric nuclear weapons testing during the 1950s and 1960s. SETTING: Nordic countries. SUBJECTS: Children aged under 15 years. MAIN OUTCOME MEASURES: Incidence rates of leukaemia by age at diagnosis, sex, country, and calendar year of diagnosis or year of birth; exposure category; relation between leukaemia and exposure for children aged 0-14 and 0-4 separately. RESULTS: During the high fallout period the average estimated dose equivalent to the fetal red bone marrow was around 140 mu Sv and the average annual testicular dose 140 mu Sv. There was little evidence of increased incidence of leukaemia among children born in these years. Doses to the red bone marrow of a child after birth were higher, and during the high exposure period children would have been subjected to an additional dose equivalent of around 1500 mu Sv, similar to doses received by children in several parts of central and eastern Europe owing to the Chernobyl accident and about 50% greater than the annual dose equivalent to the red bone marrow of a child from natural radiation. leukaemia incidence and red marrow dose was not related overall, but rates of leukaemia in the high exposure period were slightly higher than in the surrounding medium exposure period (relative risk for ages 0-14: 1.07, 95% confidence interval 1.00 to 1.14; for ages 0-4: 1.11, 1.00 to 1.24). CONCLUSIONS: Current predicted risks of childhood leukaemia after exposure to radiation are not greatly underestimated for low dose rate exposures.

Adolescent↗
PubMed1992

Suicides among Danish patients with cancer: 1971 to 1986.

The risk of suicide or other violent death was assessed among 296,331 patients with cancer in Denmark from 1971 to 1986 by linkage between the National Cancer Registry and mortality files. There were 1,637 violent deaths, of which 568 were suicides. The relative risk (RR) of suicide was significantly increased in the first 2 years after a cancer diagnosis, independent of age at cancer diagnosis. A lower suicide risk was seen after diagnosis of localized cancer (RR = 1.3; 95% confidence intervals [CI]: 1.1 to 1.4), compared with that seen after a nonlocalized cancer (RR = 1.9; 95% CI: 1.5 to 2.4). High risks for suicide were observed for patients of each sex after diagnoses of tumors of the brain and nervous system and with cancer of the lung, stomach, rectum, and kidney; high risks were found among male patients only after a diagnosis of lymphoma or pancreatic cancer. Surprisingly, the risk of suicide has increased significantly in more recent years.

Accidental Falls↗
PubMed1992

Supravaginal uterine amputation in Denmark 1978-1988 and risk of cancer.

In Denmark, total rather than subtotal hysterectomy has been recommended as treatment for benign conditions of the uterine corpus, primarily due to the risk of cervical cancer in the residual stump. Due to possible benefits during and after surgery, it has recently been argued that total hysterectomy for benign conditions could be substituted by subtotal hysterectomy, particularly since cancers of the cervix are declining as a consequence of screening. Cancer risk following supravaginal uterine amputation among 1104 Danish women undergoing operations during 1978-1988 was studied using record linkage techniques with the Danish Cancer Registry. No overall cancer risk, nor an overall increased risk of cancers coded as cervical, was observed. However, a 3.3 to 5.0-fold increased risk for cervical cancer was observed among women whose operations occurred at 50 years of age or older, possibly reflecting an increased risk of cancer in the endocervical area or in remaining uterine tissue. This observation, together with the difficulties in treating a cervical cancer of the stump when it does occur, should be taken into account before a change in surgical procedures from total to subtotal hysterectomies is recommended.

Adult↗
PubMed1992

Carcinogenic effects of adjuvant tamoxifen treatment and radiotherapy for early breast cancer.

The occurrence of new primary tumours among postmenopausal patients with primary breast cancer subsequent to adjuvant treatment in Denmark was assessed by linkage to the cancer registry. Following primary surgery, patients in low risk of recurrence (n = 1,828) received no further treatment while patients in high risk randomly received either adjuvant radiotherapy alone (n = 846) or radiotherapy + tamoxifen 30 mg daily for 48 weeks (n = 864). With a median follow-up of 8 years, the incidence of tumours in the contralateral breast was similar among tamoxifen-treated, and non-treated high-risk patients even after adjusting for tumours arising within the first year. The standardized incidence ratio for endometrial cancer was 1.9 (95% confidence interval 0.8-3.9) among tamoxifen treated, the cumulative incidence 1% compared to 0.3% among non-treated patients (p = 0.11). The cumulative risk of non-lymphocytic leukaemia was 0.9% and 0.1% among irradiated and non-irradiated patients respectively (p = 0.4). Prolonged follow-up of tamoxifen-treated patients with regard to new tumours is recommended.

Breast Neoplasms↗
PubMed1991

Incidence of new primary cancers after adjuvant tamoxifen therapy and radiotherapy for early breast cancer.

The incidence of new primary cancers was evaluated in 3538 postmenopausal patients who had received surgical treatment for primary breast cancer. Of these patients, 1828 with a low risk of recurrence received no further treatment. High-risk patients were randomly assigned to one of two groups. The first group (n = 846) received postoperative radiotherapy, while the second group (n = 864) received radiotherapy plus tamoxifen at a dose of 30 mg given daily for 48 weeks. The median observation time was 7.9 years. In comparison with the number of new cancers in the general population, the number of new cancers in the three groups was elevated mostly due to a high number of cancers of the contralateral breast and of colorectal cancers in the high-risk groups. The cumulative risk of nonlymphatic leukemia was increased among patients who received postoperative radiotherapy (P = .04). Cancer incidence in the high-risk tamoxifen-treated group relative to that in the high-risk group not treated with tamoxifen was not significant (1.3). No protective effect of tamoxifen on the opposite breast was seen (rate ratio for breast cancer = 1.1), but a tendency to an elevated risk of endometrial cancer was observed (rate ratio = 3.3; 95% confidence interval = 0.6-32.4). Continued and careful follow-up of women treated with tamoxifen is necessary to clarify the potential cancer-suppressive or cancer-promoting effects of this drug.

Aged↗