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Biomedical subjects

H O Adami

Publications and source records attributed to H O Adami.

At least 199 records · Page 11Linked to original sources
PubMed1994

Survival trend after invasive cervical cancer diagnosis in Sweden before and after cytologic screening. 1960-1984.

BACKGROUND: Cytologic screening can reduce mortality from cervical cancer by detection and removal of premalignant lesions. Conceivably, mortality is further reduced because more women with invasive disease are diagnosed at an earlier, curable stage. This hypothesis can be assessed in Sweden, where population-based screening programs were introduced successively over about a decade starting in 1964. METHODS: Record linkages permitted complete follow-up through 1986 of all 17,377 patients with invasive cervical cancer diagnosed in Sweden from 1960 through 1984. We analyzed relative survival rates that describe the survival of patients after elimination of the effects of causes of death other than cancer of the cervix. RESULTS: Prognosis improved substantially in patients younger than age 50 years at diagnosis; from 1960-1964 to 1980-1984, the 5-year relative survival rate increased from 69.8% to 88.8% at age 20-29 years, from 71.7% to 85.5% at age 30-39 years, and from 68.6% to 77.9% at age 40-49 years. The excess mortality was thus reduced by more than half in patients diagnosed when younger than 40 years. In contrast, only slight or no improvement was noted in those diagnosed at older ages when screening was less extensive. In all time periods, a strong association was found between older age at diagnosis and poorer prognosis. CONCLUSION: Although alternative explanations for our findings must be seriously considered, the most obvious interpretation is that cytologic screening reduces mortality from cervical cancer by earlier diagnosis of invasive disease.

Adult↗
PubMed1994

Risk of cancer following partial gastrectomy for benign ulcer disease.

The relative risk of developing cancer after partial gastrectomy for benign ulcer disease, expressed as the standardized incidence ratio, was examined in a population-based cohort comprising 6459 patients operated on between 1950 and 1958. Follow-up to 1983 revealed 1112 patients with cancer versus 1128 expected cases (relative risk 1.0 (95 per cent confidence interval (c.i.) 0.9-1.1)). The overall risk increased over time; it was higher in younger than in older patients but was not related to sex, surgical procedure (Billroth I or II gastrectomy) or diagnosis at operation (duodenal or stomach ulcer). There was an increased risk for lung cancer (relative risk 1.5 (95 per cent c.i. 1.2-1.7)), for oesophageal cancer in patients operated on for stomach ulcer (relative risk 2.2 (95 per cent c.i. 1.0-4.2)) and for cancer of the biliary tract in men (relative risk 1.9 (95 per cent c.i. 1.2-2.9)) and in those operated on for duodenal ulcer (relative risk 1.7 (95 per cent c.i. 1.0-2.8)). The overall risk for genital cancer in women was unchanged but decreased with increasing duration of follow-up and age. Cancers of the nervous system occurred less frequently than expected (relative risk 0.5 (95 per cent c.i. 0.3-0.8)), while the risk for cancer of the buccal cavity, lymphatic and haematopoietic systems, pancreas, breast, prostate, kidney and bladder was unchanged.

Adult↗
PubMed1994

Epidemiologic correlates of breast cancer laterality (Sweden).

Breast cancer laterality was studied in relation to age in 80,784 cases of invasive and 3,835 cases of pre-invasive breast cancer in women and 548 cases of invasive breast cancer in men reported to the Swedish Cancer Registry, 1970-89. In a subset of 11,274 women with invasive disease, data on parity were available through the Swedish Fertility Registry. Laterality also was evaluated in relation to age and reproductive variables in 3,986 cases from an international study from the 1960s. The overall incidence of pre-invasive and invasive cancer was higher in the left than in the right breast among both women and men. The excess incidence of invasive cancer in the left breast was evident only after the age of 45 years in women; a similar phenomenon may exist with pre-invasive disease in women and in men. The age-dependent laterality pattern did not appear to be confounded by menopausal status. Among women younger than 45 years, nulliparity, right handedness, and late age at menarche was associated with a somewhat higher incidence of cancer in the right breast. The laterality findings are likely to be due to factors operating early in the carcinogenic process, perhaps at the pre-initiation stage.

Adult↗
PubMed1994

Reduced risk of breast and endometrial cancer among women with hip fractures (Sweden).

To test the hypothesis that osteoporosis, which results partly from long-term estrogen deficiency, is associated with a lowered risk of breast and endometrial cancer, a population-based cohort study was performed in Sweden. Some 18,000 women were followed through record-linkages after a first hip fracture, on average for almost six years, to ascertain the incidence of breast and endometrial cancer. Expected numbers were derived from the general population. Overall, 253 cases of breast cancer were observed cf 300 expected (standardized incidence ratio [SIR] = 0.84; 95 percent confidence interval [CI] = 0.74-0.95). Forty-eight cases of endometrial cancer were found cf 55 expected (SIR = 0.87, CI = 0.54-1.16). There was no clearcut pattern of breast cancer risk by age at diagnosis of hip fracture, follow-up time, or calendar period. Our results are consistent with the a priori hypothesis that long-term estrogen deficiency is associated with a reduced risk of developing breast cancer as well as endometrial cancer.

Aged↗
PubMed1994

Mortality among patients with partial gastrectomy for benign ulcer disease.

Partial gastrectomy for benign ulcer disease may influence future risk of death, eg, through changes in life-style or metabolism. To reveal such possible long-term effects, we analyzed a population-based cohort of 6459 patients operated on from 1950 through 1958 and followed through 1985. We found a lower overall mortality than in the general Swedish population (standardized mortality ratio = 0.94; 95% confidence interval 0.91-0.97). Mortality was decreased among those with duodenal ulcers, Billroth II operations, and older age at operation but increased as time passed after operation. Mortality was significantly (P < 0.05) increased from tuberculosis, alcoholism, emphysema, stomach ulcer, intestinal obstruction, gallbladder or biliary disease, suicide, and accidental falls but decreased from ischemic heart disease and cerebrovascular disease. Preoperative selection of healthy patients and the probable increased prevalence of risk factors for ulcer disease (smoking, alcoholism, and lower socioeconomic status) in this cohort explain most of these findings. Apart from intestinal obstruction, gallbladder or biliary tract diseases, and tuberculosis, the surgical procedure did not appear to increase mortality beyond one year after operation.

Adult↗
PubMed1994

Methodological aspects on measurements of temporal trends in melanoma survival.

We compared measurements of temporal trends in cancer survival either based on observed survival or relative survival. Survival rates for cutaneous malignant melanoma diagnosed in Sweden 1960-1982 were used as an example. In a proportional hazards model based on observed survival, the hazard ratio for patients diagnosed during the period 1975-1979 was 0.56 (95% confidence limits 0.49-0.64) in men and 0.45 (0.38-0.53) in women when the period 1960-1964 was the reference. When relative survival was the outcome measure, during the same period, the hazard ratio decreased to 0.47 (0.39-0.56) in men and 0.36 (0.29-0.44) in women. Thus, the effect of period of diagnosis was larger when the analysis was based on relative survival rates. The reasons for the differences between these two alternative measurements are explained in the article and advantages/disadvantages of the two approaches are discussed.

Adult↗
PubMed1994

Risk factors for colorectal cancer in patients with ulcerative colitis: a case-control study.

BACKGROUND/AIMS: The risk of colorectal cancer increases in patients with ulcerative colitis, most markedly among young patients and/or those with extensive disease at onset. However, it is unknown whether individual risk can be predicted more precisely and whether cancer risk can be reduced by long-term treatment with sulfasalazine. METHODS: In a population-based cohort of 3112 patients with ulcerative colitis, we compared 102 cases of colorectal cancer and 196 matched controls without cancer. Hospital records were used to abstract information on pharmacological therapy, disease activity, and extraintestinal manifestations. The relative risk (RR) of cancer was estimated by conditional logistic regression. RESULTS: Pharmacological therapy, especially sulfasalazine, lasting at least 3 months was associated with a significant protective effect (RR, 0.38; 95% confidence interval [CI], 0.20-0.69) independent of disease activity. There was also a tendency to an independent protective effect for cigarette smoking (RR, 0.15; 95% CI, 0.02-1.25) and higher disease activity (RR, 0.80; 95% CI, 0.49-1.33). CONCLUSIONS: The risk of colorectal cancer among patients with ulcerative colitis can be reduced through pharmacological therapy. This finding is consistent with the reports of a protective effect of aspirin among individuals in the general population.

Adolescent↗
PubMed1994

Dual effect of parity on breast cancer risk.

This study examined whether breast cancer risk increased for a short period after childbirth, but decreased after a longer period of time. Data from an international case-control study on breast cancer conducted in the 1960s were used to study the modifying effect of age at enrolment on the relationship between parity and breast cancer risk, comparing first uniparous with nulliparous women, and then biparous versus uniparous women. The statistical analysis was performed by modelling through multiple logistic regression, adjusting for study site, age at menarche, menopausal status and obesity index. Comparing uniparous with nulliparous women, an early age at birth seems to be protective for all periods after birth, whereas a late age at birth imparts a higher risk than nulliparity in the period immediately after birth, which declines with the passage of time. The modification effect by age was not apparent when biparous women with different age at second birth were compared with uniparous women. The results support the hypothesis that pregnancy oestrogens impart a transient increase of maternal breast cancer risk when the full-term pregnancy occurs late in a woman's life.

Adult↗
PubMed1994

Oral contraceptives and prognosis in breast cancer: effects of duration, latency, recency, age at first use and relation to parity and body mass index in young women with breast cancer.

The aim of this study was to examine associations between oral contraceptive (OC) use, body mass index (BMI = weight/height2) and prognosis in invasive breast cancer diagnosed before the age of 45. Survival analyses of a consecutive sample of breast cancer patients were undertaken. The cases were initially registered in a nationwide case-control study of OC use and risk of premenopausal breast cancer in Sweden and Norway. All 422 cases were under 45 years of age at diagnosis, and recruited from the reports to cancer registries (Sweden) or from surgical departments (Norway) during May 1984 through May 1985. Detailed information about OC exposure was obtained in the initial face-to-face interview. With Cox's proportional hazards analyses, a significantly lower hazard rate [relative hazard (RH) = 0.54; 0.31-0.94] was seen in short-term users (< 4 years)--but not in long-term (> or = 4 years) users--than in never-users of OC. Non-significant estimates for RHs lower than 1.0, i.e. better prognosis, with long recency (> 5 years) and latency (> or = 10 years) of OC use were noted. Prognosis was not influenced by age at first OC use or of its timing in relation to the first pregnancy. A higher BMI was associated with a poorer prognosis, RH 5.9 (2.0-17.8) for BMI > or = 29 versus BMI < 19, but BMI was not a confounder or an effect modifier of the association between OC use and prognosis. This study does not indicate that OC use prior to the diagnosis of breast cancer has any adverse effect on the prognosis, at least not in women under 45 years of age at diagnosis.

Adult↗
PubMed1994

Season of birth and breast cancer risk in Sweden.

Recent research suggests that intrauterine exposures, perhaps factors that influence birth weight and other indicators of fetal growth, may affect future breast cancer risk. Because birth weight shows seasonal variation in Sweden, we assessed whether risk for breast cancer is associated with month of birth. The analyses included all 115,670 women, born between 1858 and 1968, who were reported to the Swedish Cancer Registry in 1958-89 as having breast cancer. Poisson regression models were used to examine the data. After adjustment for seasonality of number of live births in the population at risk, a significant seasonal pattern was identified for women born between 1880 and 1920. Women born in June had a 5% higher risk of breast cancer than those born in December. By contrast, there was no evidence of birth seasonality among 440,948 women with cancer at other sites. Exposures relevant to breast cancer risk later in life are unlikely to be related to month of birth. Thus, prenatal or early post-natal factors influence breast carcinogenesis, but the seasonal variation in these factors must have decreased over time.

Breast Neoplasms↗
PubMed1994

Trends in tumour characteristics and survival of malignant melanoma 1960-84: a population-based study in Sweden.

In Sweden, improvement in survival rates of patients with cutaneous malignant melanoma has counteracted the increase in incidence to produce a moderate rise in mortality. Our aim was to determine the possible impact of drift in diagnostic criteria, earlier diagnosis and changing biological features of the tumours upon trends in survival. We studied a stratified sample of 528 patients diagnosed between 1960 and 1984 in a strictly defined geographical region. No evidence of drift in diagnostic criteria was found. The proportion of patients with invasion level Clark II increased from 3.2% in 1960-64 to 22.5% in 1980-84, the proportion of thin melanomas (< or = 0.75 mm) increased from 9.4% to 31.5% and the tumour thickness decreased significantly between each 5 year period of diagnosis. These changes are most likely the results of earlier diagnosis. However, changes in tumour characteristics have occurred, since the proportion of superficially spreading malignant melanoma increased from 35% in 1960-64 to 51% in 1980-84 and the proportion of acral lentiginous melanoma decreased from 11% to 2%. The proportion of nodular melanomas remained fairly constant. The proportion of tumours with lymphocytic reaction did not change, whereas those with histological regression increased slightly. Proportional hazards analyses showed a significantly lower survival in patients diagnosed in 1960-64 but no apparent trend after 1965. This finding remained after adjustment for all studied clinical and histopathological factors which point towards changes in unmeasured biological features of the disease.

Cohort Studies↗
PubMed1994

Self-administered food frequency questionnaire: the effect of different designs on food and nutrient intake estimates.

BACKGROUND: Our objective was to determine the possible influence that different designs of a food frequency questionnaire might have on food, energy and nutrient intake estimates. METHODS: A population-based survey included 6783 women, 40-70 years old, living in central Sweden. Using a factorial study design, we compared eight different types of questionnaire covering combinations of three factors: increasing/decreasing frequency categories; addition of portion sizes; and addition of non-dietary questions. All questionnaires included the same list of 60 food items. One of the eight questionnaires was mailed to each subject according to a random assignment. The overall response rate was 77%. RESULTS: Compared with increasing frequencies, decreasing order of frequency categories entailed 3-11% higher estimates of mean intake for 7 of 14 food groups, 4% higher estimates for energy and 3-6% higher estimates for 13 of 18 nutrients. Addition of portion sizes had heterogeneous effects, both on dietary items (e.g. from -30% decrease for eggs to +76% increase for coffee) and on calculated nutrients (from -7% for beta-carotene to +19% for vitamin C). The inclusion of some additional non-dietary questions did not influence the estimated mean intake of any food or nutrient. CONCLUSIONS: The results of this study have implications for the design of questionnaires and for pooled analyses in nutritional epidemiology, when different food questionnaires are used.

Adult↗
PubMed1994

Handedness, age at menarche, and age at menopause.

OBJECTIVE: To investigate the relation between handedness and age at menarche or age at menopause, as both handedness and reproductive variables have been suggested to be influenced by the intrauterine endocrine environment. METHODS: Self-reported information on handedness, age at menarche, age at menopause, and other demographic and reproductive variables was recorded for 10,328 women still menstruating or in natural menopause. These women had been selected as controls in a multicenter case-control study of breast cancer conducted in the 1960s. Left-handedness (including ambidexterity) was modeled as the outcome variable through multiple logistic regression. RESULTS: After adjusting for center, age, menopausal status, age at menopause, years of schooling, and parity, there was no significant relation of handedness to age at menarche (odds ratio for each year delayed 1.01, 95% confidence interval [CI] 0.97-1.06) or age at menopause (odds ratio 1.00, 95% CI 0.98-1.02). CONCLUSION: These findings lend no support to the hypothesis that intrauterine endocrine variables associated with handedness also are related to reproductive variables.

Adolescent↗
PubMed1994

The role of obesity and weight fluctuations in the etiology of renal cell cancer: a population-based case-control study.

The causes of renal cell cancer (RCC) are poorly understood. Besides smoking, obesity remains the only risk factor that is fairly well established. The association between obesity and RCC appears stronger and more consistent in women than in men. We investigated the question of whether this apparent sex difference could be explained by repeated weight changes (weight cycling), less physical exercise, or pharmacological treatment of obesity in women. Structured face-to-face interviews were carried out with 379 (70% of all eligible) incident cases of RCC and 353 (72% of eligible) controls. The relationships between RCC and adult height, weight, and body mass index (BMI), defined as weight/height, were analyzed. Odds ratios (ORs) were estimated through logistic regression. No association was found between adult height and RCC. In men, weight and BMI appeared at most to be weakly related to risk of RCC. In women, higher adult weight and BMI (usual, highest, and lowest) and also high BMI at ages 30, 40, and 50 years were consistently associated with a significantly increased risk of RCC. Women with an usual adult BMI in the top 5% had a nearly 3-fold increased risk of RCC [OR, 2.67; 95% confidence interval (CI), 1.02-7.01]. Compared with individuals with no weight-loss periods, 2 or more such periods implied an OR of 0.96 (95% CI, 0.32-2.90) in men and 3.87 (95% CI, 1.20-12.45) in women. Physical activity at work reduced the risk of RCC in men but not women. Regular use of diet pills containing amphetamine was associated with an increased risk of RCC (OR, 4.06; 95% CI, 1.35-12.22).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Cancer risk in primary biliary cirrhosis: a population-based study from Sweden.

A cohort of 559 patients in Sweden who satisfied predetermined criteria for the diagnosis of primary biliary cirrhosis was followed with respect to the incidence of cancer during the period of 1958 to 1988. The mean follow-up time from the time of primary biliary cirrhosis diagnosis was 9.0 +/- 5.4 yr. During the follow-up period, 148 patients died and the primary cause of death was liver insufficiency. An overall excess risk for cancer, standardized incidence ratio 1.6; 95% confidence interval, 1.1 to 2.2, was found in the cohort. In contrast to previous reports, we found no excess risk for breast cancer (standardized incidence ratio, 0.9; 95% confidence interval, 0.3 to 2.1). The number of hepatocellular cancers in the primary biliary cirrhosis cohort did not significantly differ from expected (standardized incidence ratio, 2.91; 95% confidence interval, 0.4 to 10.5).

Adult↗
PubMed1993

Risk of extrahepatic bileduct cancer after cholecystectomy.

The aetiology of cancer of the extrahepatic bile duct is unknown. Gallstones have been proposed to be a risk factor on the basis of ecological and epidemiological evidence. As gallstones are formed in the gallbladder, the occurrence of extrahepatic bileduct cancer in patients after cholecystectomy is of interest. All patients (62,734) who had had a cholecystectomy during 1965-1983 within the Uppsala Health Care Region, Sweden, were followed up to the end of 1987. Excluding the first year of follow-up, 23 cancers of the extrahepatic bileduct occurred vs 26.3 expected for a standardised incidence ratio (SIR) of 0.88 (95% confidence interval [CI] 0.56-1.31). 10 years or more after operation there was a greater reduction of risk (SIR = 0.27; 95% CI 0.06-0.80). Similar patterns were observed for men and women, and among patients who had undergone cholecystectomy only compared with those who had had their common bileducts explored. To assess surveillance bias the incidence of primary liver cancer was also analysed: SIR = 1.15; 95% CI 0.91-1.44 overall, and 10 years or more after cholecystectomy SIR = 0.98; 95% CI 0.66-1.40. This study shows a reduced risk of extrahepatic bileduct cancer 10 or more years after cholecystectomy, indicating that gallstones may be a cause of this cancer.

Bias↗
PubMed1993

Diet and risk of gastric cancer. A population-based case-control study in Sweden.

A case-control study to evaluate risk factors of gastric cancer was carried out in areas with contrasting incidence rates in Sweden. Face-to-face interviews were conducted with 338 of 456 eligible histologically confirmed gastric-cancer cases and 669 of 880 eligible control subjects, sampled from population registers and frequency-matched by age and gender. We focused on 2 periods, adolescence and 20 years prior to interview. The association of gastric-cancer risk with dietary habits during adolescence were similar to that found for the period 20 years before interview; high consumption of wholemeal bread, fruit and vegetables was associated with reduced gastric-cancer risk. In addition, cheese, fish and tea had a protective effect during adolescence. Increased gastric-cancer risk was related to whole-milk consumption, but this association decreased substantially in a multivariate analysis including vegetables. There was a positive relationship between gastric-cancer risk and the age at which the interviewees started using refrigerators. This population-based study confirmed the protective effect of a high consumption of vegetables and fruit in the development of gastric cancer, but failed to find any association between intake of meat, sausage, cold cuts, liver, salt, coffee, the habit of frying, smoking or grilling foods, and risk of gastric cancer.

Adult↗