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Biomedical subjects

H O Adami

Publications and source records attributed to H O Adami.

At least 235 records · Page 13Linked to original sources
PubMed1992

Twin membership and breast cancer risk.

Pregnancy estrogens are substantially elevated in twin pregnancies and are likely to be more so in the case of dizygotic twins. If levels of pregnancy estrogens were positively related to breast cancer risk in the offspring, female twin members would be expected to be at slightly higher risk. Data from an international case-control study were utilized to assess this hypothesis. The analysis was based on 870 cases with breast cancer and 2,641 hospital controls from two sites: Glamorgan, Wales (1965-1967), and Boston, Massachusetts (1965-1966). Seventeen cases were members of twin pairs, and 8 of them had a twin brother; 33 controls were members of twin pairs and 14 had a twin brother. Among all women, the odds ratios for breast cancer were as follows: for twins with brothers, 1.54 (95% confidence interval (CI) 0.64-3.71); for twins with sisters, 1.30 (95% CI 0.58-2.92); and for all twins, 1.40 (95% CI 0.77-2.55). The odds ratios were higher among premenopausal women. These findings are not conclusive, but they are compatible with the hypothesis that pregnancy estrogens may affect the risk of breast cancer in the offspring.

Age Factors↗
PubMed1992

Evidence of prenatal influences on breast cancer risk.

Intrauterine exposure to high concentrations of endogenous pregnancy oestrogens may be important in the aetiology of breast cancer. In a nested case-control study we have assessed the relation between breast cancer risk and indicators of pregnancy oestrogen concentrations; pre-eclampsia/eclampsia is negatively related and measures of fetal size are positively related to oestrogen concentrations. Standard records for women born at Uppsala University Hospital between 1874 and 1954 were linked with records of invasive breast cancer cases, identified through their unique national registration numbers in the Swedish Cancer Registry during 1958-90. For each breast cancer case, we selected as potential controls female offspring of the first three mothers admitted to the hospital after the case's mother; only controls still living in Sweden and free from breast cancer when it was diagnosed in the case were finally included. Conditional logistic regression analysis was done for 458 breast cancer cases and 1197 matched controls. Pre-eclampsia/eclampsia was associated with a breast cancer rate ratio of 0.24 (95% confidence interval 0.09-0.70, p = 0.01). Linear trends for breast cancer incidence with increasing birth weight, birth length, and placental weight were positive but not significant. Thus, prenatal factors are important in breast carcinogenesis. Concentrations of pregnancy oestrogens may be one such factor, but other prenatal or perinatal factors cannot be excluded.

Adult↗
PubMed1992

Alcoholism and liver cirrhosis in the etiology of primary liver cancer.

The aim of this study was to determine the risk of developing primary liver cancer in patients with a diagnosis of alcoholism, liver cirrhosis, or both. Three population-based, mutually exclusive cohorts were defined on the basis of hospital discharge diagnosis between 1965 and 1983. Complete follow-up through 1984--excluding the first year of follow-up--showed that among 8,517 patients with a diagnosis of alcoholism, 13 cancers occurred, vs. 4.2 expected (standardized incidence ratio (SIR) = 3.1; 95% confidence interval (CI) = 1.6 to 5.3); among 3,589 patients with liver cirrhosis, 59 cancers occurred, vs. 1.7 expected (SIR = 35.1; 95% CI = 26.7 to 45.3), and among 836 patients with both diagnoses, 11 cancers occurred, vs. 0.3 expected (SIR = 34.3; 95% CI = 17.1 to 61.3). Thus, alcoholism alone entailed a moderately increased risk and alcoholism with liver cirrhosis did not increase the high relative risk for liver cancer more than cirrhosis alone. We conclude that alcohol intake may be a liver carcinogen only by being causally involved in the development of cirrhosis; and further, that the risk of developing liver cancer following cirrhosis in this population is similar to or higher than that after chronic hepatitis-B-virus infection in other Western countries.

Aged↗
PubMed1992

Maternal and perinatal risk factors for Wilms' tumor: a nationwide nested case-control study in Sweden.

This report describes maternal and perinatal risk factors for Wilms' tumor analyzed in a case-control study nested in a nationwide cohort in Sweden. The Swedish National Cancer Registry ascertained 110 cases from among successive birth cohorts from 1973 through 1984, identified by the Swedish Medical Birth Registry, the latter based on medical records. From the Birth Registry, we matched 5 controls without cancer to each case by sex and date of birth. Wilms'-tumor children were more likely to have mothers who had been exposed to penthrane (methoxyflurane) anesthesia during delivery than mothers of controls (odds ratio (OR) = 2.4; 95% confidence interval (CI) 1.1 to 5.1); this excess risk was higher in females than males and increased with age at diagnosis. Wilms'-tumor cases were also more likely to have had physiologic jaundice (OR = 2.3; 95% CI 1.1 to 5.0). Higher parity of the mother decreased the risk of Wilms' tumor among females (OR = 0.7; 95% CI 0.5 to 1.0). We were unable to confirm the reported increased risks of Wilms' tumor for those with high birth weights or with a maternal history of hypertension or fluid retention during pregnancy, nor did we find any association with mother's age at delivery, previous stillbirth, previous live birth, gestational length or height of the child.

Anesthesia, Obstetrical↗
PubMed1992

Alcoholism and cancer risk: a population-based cohort study.

The incidence of cancer was studied in a population-based cohort of 9,353 individuals (8,340 men and 1,013 women) with a discharge diagnosis of alcoholism in 1965-83, followed up for 19 years (mean 7.7). After exclusion of cancers in the first year of follow-up, 491 cancers were observed cf 343.2 expected through 1984 (standardized incidence ratio [SIR] = 1.4, 95 percent confidence interval [CI] = 1.3-1.6). A similar excess risk of cancer was seen among men (SIR = 1.4, CI = 1.3-1.6) and among women (SIR = 1.5, CI = 1.1-2.0). We observed the established associations with cancers of the oral cavity and pharynx (SIR = 4.1, CI = 2.9-5.7), esophagus (SIR = 6.8, CI = 4.5-9.9), larynx (SIR = 3.3, CI = 1.7-6.0), and lung (SIR = 2.1, CI = 1.7-2.6), although confounding by smoking likely increased these risk estimates. While there was evidence of increased risk for pancreatic cancer (SIR = 1.5, CI = 0.9-2.3), alcoholism did not elevate the incidence of cancer of the stomach (SIR = 0.9, CI = 6-1.4), large bowel (SIR = 1.1, CI = 0.8-1.5), prostate (SIR = 1.0, CI = 0.8-1.3), urinary bladder (SIR = 1.0, CI = 0.6-1.5), or of malignant melanoma (SIR = 0.9, CI = 0.3-1.9). Among women, the number of breast cancers observed was close to expected (SIR = 1.2, CI = 0.6-2.2), although a significant excess number of cervical cancers occurred (SIR = 4.2, CI = 1.5-9.1).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

Optimization of cervical cancer screening.

The aim of this study was to investigate how a screening program interacts with the dynamic natural history of cervical neoplasia in order to learn how screening for cervical cancer should be carried out most cost-effectively. For the purpose of optimization, the fundamental quantities of the natural history are the shape of the curve of age-specific prevalence rates of cancer in situ, and the duration of this stage before progression to invasive cancer. Since these quantities seem similar in different populations, the results probably can be generalized. Simulation studies revealed that optimal screening implies a nonperiodic schedule, and that this schedule is dependent not only on the number of screenings, but also on the efficiency of the screening rounds. With lower efficiency, the schedule should be concentrated into a shorter period. The effect of screening is also especially sensitive to the choice of age at the first and--to a smaller extent--last screening. The results concerning three different objectives also were compared, namely reduction of the cumulative number of invasive cancers, reduction of deaths due to cervical cancer, and reduction of years-of-life lost. The choice of objective also plays a role in the design of an optimal screening program. The theoretical approach in this analysis easily can be developed and accommodated to more complex individual situations such as prior screening histories and differing screening schedules in high- and low-risk women.

Adult↗
PubMed1992

Long-term consequences of estrogen and estrogen-progestin replacement.

Except for the control of smoking, hormone replacement therapy (HRT) is potentially one of the most useful means of preventing major causes of morbidity and mortality in older women, who are likely to spend more than one-third of their lives in a postmenopausal (estrogen-deficient) stage. A full assessment of the overall long-term effects of noncontraceptive estrogens--with and without cyclically added progestins--therefore is needed urgently. This paper briefly reviews the available epidemiologic findings to date, with emphasis on a prospective study in Uppsala, Sweden. An increase in the risk of endometrial cancer which is substantially dependent on dose and duration of the exposure has been established, whereas a biologically plausible protective effect of progestins has been documented in only a few studies. A moderate, perhaps twofold, increase in the incidence of breast cancer has been found in several recent studies, notably among long-term and/or current users of potent estrogens; there is no evidence that progestins counteract this adverse effect. The risk of osteoporotic hip fractures can be reduced substantially, at least during ongoing, treatment starting early after menopause. A 25 to 50 percent reduction in cardiovascular morbidity and mortality has been shown consistently and might outweigh any conceivable adverse effect of HRT. Notwithstanding these largely encouraging epidemiologic data--including evidence of lower all-cause mortality in users than in nonusers of HRT--it is argued here that randomized control trials are needed to provide the necessary basis for widespread preventive use of HRT.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

Survival and causes of death in patients with inflammatory bowel disease: a population-based study.

Relative survival up to December 31, 1986 was analyzed for all patients diagnosed with ulcerative colitis (UC) (n = 2,509) and Crohn's disease (CD) (n = 1,469) within the Uppsala Region, Sweden 1965-1983. After 10 years survival was 96% of that expected for UC and CD. Patients with ulcerative proctitis, left-sided colitis, and pancolitis at diagnosis had relative survival rates of 98%, 96%, and 93% respectively. Survival did not differ by extent at diagnosis for patients with CD. After including prevalent cases, 684 deaths occurred compared with 481.1 expected deaths [standardized mortality ratio (SMR) = 1.4; 95% confidence interval (CI) = 1.3-1.5]. Inflammatory bowel disease was the main reason for this excess mortality. Colorectal cancer increased mortality (50 deaths observed vs. 15.2 expected). Death from other cancers were not greater than expected. Obstructive respiratory diseases, especially bronchitis, emphysema, and asthma increased mortality SMR = 1.5 (95% CI = 1.1-2.2) in UC. Cerebrovascular disease mortality occurred less often than expected (SMR = 0.7; 95% CI = 0.5-1.0). Mortality for other diseases and groups of diseases was close to that expected.

Cause of Death↗
PubMed1992

Determinants of the psycho-social outcome after operation for breast cancer. Results of a prospective comparative interview study following mastectomy and breast conservation.

In a prospective interview study, designed to compare the psycho-social outcome after a breast-conserving vs. a mastectomy operation, we analysed possible predictors of the psycho-social adjustment. 99 women with breast cancer histopathological TNM stages I and II were consecutively admitted to the study. Half-structured interviews, based on the Social Adjustment Scale and a scale by P. Maguire, were performed 4 and 13 months after the operation. Living together with the spouse seems to protect women from developing psycho-social problems postoperatively. Women who were gainfully employed or who were given radiotherapy had a higher risk of poor adjustment after 4 months. At 13 months, the scorings indicate that radiotherapy has a reassuring effect. Type of surgery was controlled for in the analysis and showed that, of the risk factors studied, the most consistent trend for an overall better outcome was in the breast-conserved group except for sexual disturbances.

Adult↗
PubMed1992

Trends in mortality rates from malignant melanoma in Sweden 1953-1987 and forecasts up to 2007.

To monitor mortality rates from malignant melanoma we analysed all patients in Sweden (6,324) who died of malignant melanoma in 1953 through 1987. Age-standardised rates per 10(5) increased from 1.1 to 4.0 in men and from 1.0 to 2.6 in women. The average annual increase levelled off in men from 4.6% during 1953-1967 to 2.0% in 1978-1987; and in women from 3.7% to 0%. Multivariate analyses showed that the change in rates for men was mainly due to a birth-cohort effect, whereas in women the rates changed similarly in all age-groups in accordance with a time-period effect. The risk of dying of malignant melanoma increased in men for birth cohorts up to 1932, whereas in women the rise continued for cohorts born as late as 1947. The best-fitted multivariate models were extrapolated to the year 2007, among men a slight increase in mortality rates seemed likely, whereas among women the rates will probably remain unchanged.

Adult↗
PubMed1992

Reduced risk of hip fracture in women with endometrial cancer.

The effect of excessive endogenous oestrogens on the risk of hip fracture was investigated in a population-based cohort of 2111 women with endometrial carcinoma who were followed up from age 50 years regarding the occurrence of a first hip fracture. Overall, 77 cases of hip fracture were observed, as against 120.8 expected, which meant a significantly reduced relative risk, standardized incidence ratio (SIR) = 0.6, 95% confidence interval (CI): 0.5-0.8. This possible protective effect was significant for cervical fractures, SIR = 0.6 (95% CI: 0.4-0.8), but not for trochanteric, SIR = 0.8 (95% CI: 0.5-1.1). Age at endometrial cancer diagnosis was not a determinant of the risk of hip fracture. A lowered relative risk was present regardless of age at diagnosis and persisted during the entire follow-up period and into advanced ages. A case-control analysis within the cohort, and based on medical record data, indicated that a higher weight might be associated with a greater protective effect, as compared with a lower weight. Exposure to exogenous oestrogens was infrequent and could not have explained the present results. We conclude that persistent influence of oestrogens, notably of endogenous origin, can reduce the risk of hip fractures, and that this protective effect may be long-lasting and extend to advanced ages.

Adult↗
PubMed1992

Effects of different designs and extension of a food frequency questionnaire on response rate, completeness of data and food frequency responses.

The authors studied how the introduction of several modifications to a basic food frequency questionnaire can influence the results of dietary surveys. Modifications covered eight combinations based on three levels: increasing versus decreasing order of frequency categories; questionnaires without versus with questions about portion sizes, and questionnaires without versus with extra non-dietary questions. The sample included 6783 women between the ages of 40 and 70 years who took part in mammography screening. The women were randomly assigned to one of the eight study groups. All of the women in each group received one of the eight differently modified questionnaires. The forms extended in length by extra non-dietary questions and portion size categories resulted in a 20% higher total non-response compared to the shorter basic form. Partial non-response was significantly lower for all four questionnaire types that included portion sizes. When portion sizes were included in the questionnaire, the reported mean frequency of consumption was significantly reduced for fat (-10 times per month), milk (-6), bread (-5), vegetables (-2) and fish (-0.4). The decreasing order of responses to the frequency categories was associated with a statistically significant increase in the frequency responses for bread (2.6 times per month), vegetables (2) and fish (0.6). These data provide evidence that the design and extension of food frequency questionnaires influence the results of dietary studies.

Adult↗
PubMed1992

The risk of acute myocardial infarction after oestrogen and oestrogen-progestogen replacement.

OBJECTIVE: To determine the relative risk of developing a first acute myocardial infarction after treatment with oestrogens alone or oestrogen-progestogen combinations. DESIGN: Prospective cohort study utilizing a prescription-based and record linkage system for a follow-up period from 1977 to 1983. Average individual observation time was 5.8 years. SETTING: The entire female population of the Uppsala Health Care Region (1.4 million inhabitants), one-sixth of the total Swedish population. SUBJECTS: 23,174 women aged 35 years and older, identified from pharmacy records as having been prescribed non-contraceptive oestrogens during 1977-1980. OUTCOMES: Admissions to hospitals for first acute myocardial infarctions. RESULTS: Overall, 227 cases of a first acute myocardial infarction were observed as against 281:1 expected, RR = 0.81 (95% confidence limits 0.71 to 0.92). Women who were younger than 60 years at entry into the study and prescribed oestradiol compounds (1-2 mg) or conjugated oestrogens (0.625-1.25 mg) showed a significant 30% reduction of the relative risk (RR = 0.69, 0.54 to 0.86). Those prescribed a combined oestradiol-levonorgestrel brand also demonstrated a significantly lowered relative risk (RR = 0.53, 0.30 to 0.87). The risk estimates were near unity during the first year of follow-up but decreased during subsequent years. Exposure to the weak oestrogen oestriol did not alter the risk. CONCLUSION: Hormonal replacement therapy with oestrogens alone, and maybe also when cyclically combined with progestogens, can reduce the risk of acute myocardial infarction.

Adult↗
PubMed1992

Trends in childhood and adolescent cancer survival in Sweden 1960 through 1984.

The temporal changes in childhood and adolescent cancer survival in Sweden 1960-1984 were analyzed. Complete follow-up through 1986 of 6,262 patients younger than 20 years at diagnosis revealed that the overall 5-year survival rates increased from 36.1 to 65.7% in males and from 43.6 to 73.6% in females. The temporal trends differed markedly between age groups and tumour sites and types. Over the study period, 5-years, survival for testicular cancer increased from 46.9 to 87.2%, kidney cancer, predominantly Wilms' tumour from 35.5 to 77.1% (with a higher rate of 89.1% in 1975-1979), Hodgkin's disease from 61.2 to 91.9%, non-Hodgkin's lymphoma from 32.5 to 76.6%, and all leukemias from 8.9 to 58.7%. Only a moderate improvement was noted for tumours of the bone, muscle and connective tissue, and survival rates for tumours of the nervous system remained largely unchanged. Our data reflect the remarkable therapeutic improvements that have occurred for cancer in the young and indicate that these improvements have rapidly become available in Sweden.

Adolescent↗
PubMed1992

Age as a determinant of axillary node involvement in invasive breast cancer.

We analyzed the age at diagnosis and the tumor size as determinants of axillary node involvement in 725 consecutive patients with breast cancer. The prevalence of nodal involvement increased consistently with tumor diameter from 18.9% in tumors smaller than 10 mm to 72.9% in those measuring 40 mm, or more. The risk also varied with age, the lowest prevalence being found in the youngest and the oldest patients and the highest one in the 40-59-year age group. When analyzed as a continuous variable age was best fitted as a second order term and it was a statistically significant (p = 0.04) determinant of axillary metastases in a multivariate model where tumor diameter, histopathological classification and estrogen receptor concentration were taken into account as possible confounding variables. The findings indicate that the parallelism between the establishment of metastases in lymph nodes and at distant sites may vary with age. The prognostic value of nodal status may therefore depend on age at diagnosis.

Adult↗
PubMed1991

Stressful life events and Graves' disease.

The role of stressful life events in the onset of Graves' disease (toxic diffuse goitre) is controversial. However, the numerous early clinical reports that supported such an association were not adequately controlled and specificity of the diagnosis could be questioned. Later studies have not shown a causal relation, but these studies were small, did not have proper controls, or epidemiological methods were inappropriate. To assess possible associations between life events, heredity, social support, and Graves' disease, we have done a population-based case-control study in a defined area with about 1 million inhabitants. Over 2 years, 208 (95%) of 219 eligible patients with newly-diagnosed Graves' disease and 372 (80%) of all selected matched controls answered an identical mailed questionnaire about marital status, occupation, drinking and smoking habits, physical activity, familial occurrence of thyroid disease, life events, social support, and personality. Compared with controls, patients claimed to have had more negative life events in the 12 months preceding the diagnosis, and negative life-event scores were also significantly higher (odds ratio 6.3, 95% confidence interval 2.7-14.7, for the category with the highest negative score). Individuals who had relatives with thyroid disease (especially first-degree and second-degree relatives) were more likely to have Graves' disease (3.6, 2.2-5.9). Slightly more patients than controls were divorced (1.8, 1.0-3.3) and reported a less frequent intake of alcohol (0.4, 0.2-0.8). When results were adjusted for possible confounding factors in multivariate analyses, risk estimates were almost unchanged. These findings indicate that negative life events and hereditary factors may be risk factors for Graves' disease.

Adult↗