Search PubMed⌕ Search

Biomedical subjects

H O Adami

Publications and source records attributed to H O Adami.

At least 289 records · Page 16Linked to original sources
PubMed1990

Cytologic screening for cancer of the uterine cervix in Sweden evaluated by identification and simulation.

Parameters characterising the progression of cervical neoplasia were estimated from population-based cancer and mortality statistics in Sweden for 1958-1981 by means of a dynamic computer model. Proceeding from that model and these data, the incidence and prevalence curves were constructed, the effects of the extensive cytological screening measures introduced during the 1960s were assessed, and future gains due to the measures already undertaken up to 1981 could be simulated. About 4,000 cases of cancer in situ were diagnosed annually in Sweden after the end of the 1960s, most of them in women born later than 1919. The maximum reduction in the number of invasive cancers up to 1981 was 42% for women born in 1919-1923, but increased progressively for later birth cohorts and reached 69% for those born in 1934-1938. The corresponding reduction in mortality rates was of the same magnitude. The screening measures up to 1981 will ultimately result in a reduction of invasive cancer by about 12,500 cases and of the number of deaths due to this disease by about 4,100. Only a part of the total gain in the number of lives saved had been revealed at the end of the study period in 1981.

Adult↗
PubMed1990

Absence of association between reproductive variables and the risk of breast cancer in young women in Sweden and Norway.

A population-based case-control study was conducted in Sweden and Norway to analyse possible associations between breast cancer occurring before the age of 45 and several different characteristics of the women's reproductive life. A total of 422 (89.2%) of all eligible patients, and 527 (80.6%) of all eligible controls were interviewed. In univariate analyses, different characteristics of child-bearing (parity, age at first birth, years between last birth and diagnosis, duration of breast-feeding, and number of induced and spontaneous abortions), measures of the fertile or ovulating period (age at menarche, years between menarche and first pregnancy, and estimates of the menstruation span) and symptoms of anovulatory cycles or infertility were all seemingly unrelated to, or at most weakly associated with breast cancer. Adjustment for possible confounding factors in multivariate analyses resulted in largely unaltered risk estimates with odds ratios close to unity and without any significant trends when the exposure variables were studied in categorised or in continuous form. We conclude that reproductive factors did not explain the occurrence of breast cancer before the age of 45 in this population.

Abortion, Spontaneous↗
PubMed1990

The incidence of ovarian cancer in Sweden, 1960-1984.

Trends in the incidence of ovarian cancer among 23,239 cases reported to the Swedish Cancer Registry from 1960 through 1984 were analyzed. Trends in age-standardized incidence rates were best described by a nonlinear model with a highly significant negative second-order term, which showed an initial increase followed by stabilization and, in later years, a decline. In multivariate models, both time period of diagnosis and birth cohort were found to have significant effects. These separate models provided consistent evidence for an increasing risk in women born during the last decades of the 19th century, and a slowly decreasing risk in recent years and in the youngest birth cohorts. The very high population exposure to oral contraceptives, which may protect against ovarian cancer, is one conceivable explanation for the decreasing trend.

Adult↗
PubMed1990

Hip fractures in women with breast cancer.

The authors investigated whether the incidence of first hip fracture, an indicator of osteoporosis, is lower in breast cancer patients, who are assumed to have higher levels of endogenous estrogens, than in other women. A population-based Swedish cohort comprising 9,673 women with invasive breast cancer diagnosed from 1958 through 1983 was followed up with respect to the occurrence of a first hip fracture during the period 1965-1983. Overall, the number of observed acute fractures (n = 387) was slightly higher than expected (n = 348.6) (standardized incidence ratio (SIR) = 1.1, 95% confidence interval (CI) 1.0-1.2). Risk for trochanteric fractures was slightly higher than expected (SIR = 1.2, 95% CI 1.0-1.4), but risk for cervical fractures was not (SIR = 1.0, 95% CI 0.9-1.1). Risk for trochanteric fracture decreased with increasing age at breast cancer diagnosis, reaching standardized incidence ratios close to unity after the age of 70 years. Duration of follow-up appeared to be unrelated to the risk of either type of fracture. The authors conclude that the incidence of first hip fracture is not lower in breast cancer patients than in other women.

Adult↗
PubMed1990

Trends in the incidence of malignant melanoma in Sweden, by anatomic site, 1960-1984.

This study was based on 15,376 patients in Sweden with cutaneous malignant melanoma diagnosed during the 25-year period 1960-1984. Trunk melanoma increased substantially during that period among men, with age-standardized rates rising from 1.1 to 7.0 per 10(5). Among women, the greatest increases occurred in melanoma of the upper extremity (rising from 0.4 to 2.3), lower extremity (rising from 1.6 to 4.4), and trunk (rising form 0.6 to 3.1), but the rates for the latter two sites seemed to level off after 1978. Multivariate analyses showed that models based on a common parameter ("drift"), including linear birth cohort and/or time periods effects, were significantly superior to simple age models for explaining incidence trends for each separate site. Further, in men with melanoma of the trunk and upper and lower extremities, birth cohort effects had significant effects compared with drift. In contrast, in women, time period effects were a significant improvement on drift for melanoma of the trunk and lower extremity. The relative risk of malignant melanoma among men leveled off in later-born cohorts for all separate sites. A similar trend was found in women, except for melanomas of the trunk, in which the increase in relative risk persisted. The results indicate sex-specific differences in temporal trends of exposure to factors causing malignant melanoma.

Adult↗
PubMed1990

Perinatal risk factors for inflammatory bowel disease: a case-control study.

To examine perinatal risk factors for Crohn's disease and ulcerative colitis, the authors analyzed birth records for 257 known case participants delivered from 1924 through 1957 at the University Hospital in Uppsala County, Sweden, and compared them with records for 514 controls delivered at the hospital. The two groups were matched by date of birth, sex, and either maternal age or parity. Eleven study variables were abstracted from standard forms that recorded health events during the pregnancy and the delivery hospitalization. Participants were more likely than controls to have a recorded health event (odds ratio (OR) = 4.4; 95% confidence interval (CI) 3.0-6.4). In a multivariate model, this increased risk was evident for infectious (OR = 3.8; 95% CI 2.6-5.8) and noninfectious (OR = 3.5; 95% CI 2.0-6.3) events. Perinatal health events may have contributed to 40% of the inflammatory bowel disease cases in our study. Infants from families with low socioeconomic status had greater risk of inflammatory bowel disease than did infants from families with high socioeconomic status (OR = 3.0, 95% CI 1.5-6.1). Perinatal health events and low socioeconomic status independently increased the risk of inflammatory bowel disease.

Analysis of Variance↗
PubMed1990

The risk of large bowel cancer after partial gastrectomy for benign ulcer disease.

The relative risk (standardized incidence ratio [SIR] for colorectal cancer after partial gastrectomy for ulcer disease was examined in a population-based cohort comprising 6459 patients operated during 1950 to 1958. Follow-up through 1983 revealed 131 cases of colorectal cancer versus 150.3 expected cases (SIR = 0.87; 95% confidence limits 0.73, 1.03). The relative risk was decreased during the first 19 years of follow-up (SIR = 0.75; 0.58, 0.96) and close to equal thereafter (SIR = 1.02; 0.79, 1.29). Sex, age at operation, type of operation, and diagnosis at operation (stomach or duodenal ulcer) did not affect the relative risk significantly. Confounding by socioeconomic status is one conceivable explanation for the decreased relative risk during the first years of follow-up, whereas the increasing risk with longer duration of follow-up might be a consequence of the surgical procedure itself.

Adult↗
PubMed1990

Incidence of sporadic and familial medullary thyroid carcinoma in Sweden 1959 through 1981. A nationwide study in 126 patients. Swedish MCT Study Group.

Medullary thyroid carcinoma (MTC) was identified in 276 patients (in 27 diagnosed at autopsy) by a review of virtually all 6,513 notifications of primary thyroid cancer ot the National Cancer Registry in Sweden 1959 through 1981. The diagnosis was confirmed in 268 of the 276 cases by histopathological and histochemical reexamination. Anamnestic data and morphological characteristics indicated that 208 (75%) patients had sporadic and 68 (25%) familial MTC. The mean ages at diagnosis of these two groups were 57.0 and 42.6 years respectively. The age-standardized incidence rate per 10(5) inhabitants was 0.18 for males and 0.23 for females. The age-specific incidence of sporadic MTC increased markedly with age, whereas no unequivocal rise was found after the age of 20 for familial disease. Standardized morbidity ratios (SMR), calculated separately for each of the six Swedish health care regions, revealed a roughly two-fold and mostly non-significant geographical variation in the occurrence of sporadic MTC. SMR for familial disease varied, however, between 0 and 306 and deviated highly significantly from the national average in four of the six regions. Regional differences in diagnostic intensity were considered unlikely as the sole explanation of this finding.

Adult↗
PubMed1990

Long-term survival in sporadic and familial medullary thyroid carcinoma with special reference to clinical characteristics as prognostic factors. The Swedish MTC Study Group.

All the 249 patients with medullary thyroid carcinoma (MTC) diagnosed during a 23-year period in Sweden were followed up completely for 4-27 years. The overall relative survival was 79.9% at 5 years after diagnosis and 68.6% at 10 years. After 5 years of follow-up, the relative survival rate was 5 percentage points higher in females than in males; 30 percentage points higher in patients aged less than 40 than in those 60-69 years at diagnosis; 24 percentage points higher in patients with familial disease detected at screening than in those with sporadic MTC; 20, 26 and 48 percentage points lower in patients with stage II, III, and IV, respectively, than in those with stage I; and almost 30 percentage points lower in the group of patients with a large tumor (greater than 3 cm) than in the group with a small one (less than 1 cm). In multivariate proportional hazards analyses of all these important determinants of outcome, the prognostic information provided by age and stage was still significant when several morphologic characteristics were taken into account (nuclear DNA content, calcitonin immunoreactivity, amyloid content, argyrophil reaction and state of the tumor capsule).

Adolescent↗
PubMed1989

Risk of cancer in women receiving hormone replacement therapy.

Cancer risk following treatment with non-contraceptive estrogens was studied in a population-based cohort of 23,244 women. Complete follow-up for an average of 6.7 years revealed 1,087 incident cancers versus 962.5 expected (relative risk/RR/ = 1.13; 95% confidence interval 1.10-1.20). We confirmed the recent findings of a more detailed analysis of the same cohort, based on a 1-year shorter follow-up period, namely: a markedly increased risk of endometrial cancer (RR = 1.8; 1.5-2.1), notably in women receiving potent estrogens, i.e., conjugated estrogens or estradiol (RR = 2.0; 1.6-2.4), and a slightly increased risk of breast cancer (RR = 1.1; 1.0-1.2). A slightly decreased risk of invasive cervical cancer (RR = 0.8; 0.5-1.2) is most likely due to more frequent smear taking than in the background population. There was no increase in the risk of cancer of ovary (RR = 1.0; 0.8-1.2), pancreas (RR = 0.8; 0.5-1.2), large bowel (RR = 1.0; 0.8-1.2) or kidney (RR = 1.0; 0.7-1.4). The risk of developing cancer in liver or biliary tract was lower than expected (RR = 0.4; 0.2-0.7), particularly in women who had used potent estrogens (RR = 0.3; 0.1-0.6), an unexpected finding which warrants further studies. Increased risks of malignant melanoma (RR = 1.5; 1.0-2.1) and lung cancer (RR = 1.3; 0.9-1.7) need cautious interpretation because of their low magnitude, the absence of a biological gradient when subgroups were analyzed and the slightly higher prevalence of smokers in the cohort than in the background population.

Climacteric↗
PubMed1989

Increasing survival trend after cancer diagnosis in Sweden: 1960-1984.

We analyzed the survival trend after cancer was diagnosed by complete follow-up through 1986 of 591,456 (99.4%) of all those patients in whom a first malignant disease was diagnosed in Sweden from 1960 to 1984. From 1960-1964 to 1980-1984, the 5-year relative survival increased from 34.2% to 47.1% in males and from 48.7% to 56.9% in females. The mean loss of expected life among cancer patients decreased from 9.6 to 7.0 years. During the first 5 years after diagnosis, the cancer-specific hazard rate decreased by 34% in males and 30% in females. Thus several analytical approaches revealed a substantial increase in cancer patient survival since 1960.

Adult↗
PubMed1989

The survival pattern in male breast cancer. An analysis of 1429 patients from the Nordic countries.

A joint Nordic study was conducted to elucidate the survival pattern in male breast cancer by means of regression analysis of annual relative survival rates. A total of 1429 (98.4%) of all patients diagnosed during a 25-year to 30-year period and reported to the Nordic cancer registries were available for follow-up through 1982. The relative survival rate was lower in older patients; the relative excess risk of dying (from breast cancer) during the first 5 years of observation, calculated by multiple regression modelling, increased in a regular fashion more than three-fold from patients younger than 40 years at diagnosis to those aged 80 years or older. Significantly lower rates were found among males in Denmark and Finland, the relative excess risks of dying (compared with Sweden) being 1.39 (1.06-1.80) and 1.73 (1.22-2.45), respectively, during the first 5 years. The authors concluded first that important differences exist between male and female patients with breast cancer in the relation between survival and age at diagnosis, and secondly that a later stage at presentation or national differences in the natural history are the most likely explanations for the worse prognosis in Denmark and Finland.

Adult↗
PubMed1989

Psychosocial adjustment after mastectomy and breast-conserving treatment.

The possible advantages of breast-conserving surgery over mastectomy with respect to psychosocial adjustment were assessed in an interview study. Consecutive patients 40 to 80 years of age with invasive breast cancer of Stages I and II were eligible for the study. Of 161 women, 99 agreed to participate; 37 received breast-conserving treatment and 62 received a modified radical mastectomy. The study method consisted of a semistructured interview at 4 and 13 months after primary treatment based on the Social Adjustment Scale (SAS) and two scales for the estimation of anxiety, depression, and adjustment to a sexual relationship. The women's ratings in the SAS inventory for adjustment to work, social life, marriage, sexual relationship, and parental role showed no statistically significant differences between the two groups. In the interviewer's global rating in the SAS protocol of the overall adjustment after 13 months, 22.0% of the women in the mastectomy group versus 5.4% of those with a preserved breast were rated as having significant disturbances. A statistically nonsignificant tendency (P greater than 0.05) emerged for the other ratings in the interviewer's assessment in SAS and in the estimation of anxiety, depression, and adjustment to sexual relationships. The consistent tendency indicates that there might be clinically important differences in the psychosocial adjustment after the two treatment methods. Larger trials focused more sensitively on the problems after breast loss versus breast preservation in breast cancer surgery are needed to further explore this field.

Adult↗
PubMed1989

The risk of breast cancer after estrogen and estrogen-progestin replacement.

To examine the risk of breast cancer after noncontraceptive treatment with estrogen, we conducted a prospective study of 23,244 women 35 years of age or older who had had estrogen prescriptions filled in the Uppsala region of Sweden. During the follow-up period (mean, 5.7 years) breast cancer developed in 253 women. Compared with other women in the same region, the women in the estrogen cohort had an overall relative risk of breast cancer of 1.1 (95 percent confidence interval, 1.0 to 1.3). The relative risk increased with the duration of estrogen treatment (P = 0.002), reaching 1.7 after nine years (95 percent confidence interval, 1.1 to 2.7). Estradiol (used in 56 percent of the treatment periods in the cohort) was associated with a 1.8-fold increase in risk after more than six years of treatment (95 percent confidence interval, 0.7 to 4.6). No increase in risk was found after the use of conjugated estrogens (used in 22 percent of the treatment periods) or other types, mainly estriols (used in 22 percent of the treatment periods). Although the numbers of women were smaller, the risk of breast cancer was highest among the women who took estrogen and progestin in combination for extended periods. The relative risk was 4.4 (95 percent confidence interval, 0.9 to 22.4) in women who used only this combination for more than six years. Among women who had previously used estrogens alone, the relative risk after three years or more of use of the combination regimen was 2.3 (95 percent confidence interval, 0.7 to 7.8). We conclude that in this cohort, long-term perimenopausal treatment with estrogens (or at least estradiol compounds) seems to be associated with a slightly increased risk of breast cancer, which is not prevented and may even be increased by the addition of progestins.

Adult↗
PubMed1989

Histopathologic characteristics and nuclear DNA content as prognostic factors in medullary thyroid carcinoma. A nationwide study in Sweden. The Swedish MTC Study Group.

Complete follow-up for 4 to 27 years was achieved for virtually all 249 patients with medullary thyroid carcinoma (MTC) diagnosed in Sweden in a 23-year period. Tumor specimens from 241 patients were re-examined with regard to calcitonin immunoreactivity, amyloid content, argyrophil reaction, tumor capsule condition, and nuclear DNA content. In univariate analyses, these factors, with the exception of the argyrophil reaction, were strong predictors of survival. There were twofold-to-threefold differences in hazard rate between patients with a high (greater than 50%) and low (less than 10%) frequency of calcitonin-immunoreactive tumor cells, between those with amyloid-containing and amyloid-free tumors, and between those with an intact and a nonintact tumor capsule. Calcitonin immunoreactivity and the amyloid content also provided prognostic information in multivariate analyses that adjusted for all the other factors mentioned above and in the full multivariate model, which in addition considered age, sex, heredity, stage of the disease, tumor size, and treatment. The strong prognostic capacity of the nuclear DNA content found in univariate analyses became considerably weaker when other morphologic characteristics were considered.

Adult↗