[Chlamydia infections in women. Severe sequelae demand diagnostic sharpness].
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Chlamydia Infections↗
Biomedical subjects
H O Adami
Publications and source records attributed to H O Adami.
[Cancer, aging and death from an epidemiologic point of view].
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Aged↗
Trends in survival from malignant melanoma: remarkable improvement in 23 years.
Trends in incidence of and mortality and survival from malignant melanoma in Sweden for 1960 through 1982 were analyzed. Incidence rates increased annually by 5.4% for females and by 5.8% for males, whereas mortality rates increased annually by 2.7% for females and 3.3% for males. For females, the 5-year relative survival (RS) rates increased by approximately 15 percentage points before 1970. In contrast, males before 1970 had a successive improvement in RS rates of 4.6-8.2 percentage points for each 5-year period of diagnosis. Multivariate analyses revealed that during the study period the malignant melanoma-specific hazard decreased by 71% [95% confidence interval (CI) = 59%-79%] for females and by 64% (95% CI = 54%-73%) for males during the first 5 years of follow-up.
Aged↗
Natural history of localised prostatic cancer. A population-based study in 223 untreated patients.
In a population-based study, disease progression and survival were evaluated in untreated patients with newly diagnosed cancer of the prostate without distant metastases. Complete follow-up was achieved in 223 of 227 (98%) consecutively diagnosed, eligible patients of all ages. After 5 years, the cumulative progression-free survival (with 95% confidence interval) was 71.8 (65.5-78.1)% and survival corrected for causes of death other than prostatic cancer was 93.8 (88.3-97.6)%. Univariate and multivariate analyses showed no association between age at diagnosis and the natural course. Local progression was less common in localised, non-palpable tumours than in larger tumours. The rate of progression was 18.7 (6.1-57.1) times higher and that of disease-specific death 216.0 (31.2-1496) times higher in patients with poorly than in those with highly differentiated tumours. It is concluded that tumour grade at diagnosis is an excellent predictor of local and distant progression. The low death rate, especially in patients with highly and moderately differentiated tumours, means that any local or systemic therapy intended for patients with early prostatic cancer must be evaluated in clinical trials with untreated controls for comparison.
Actuarial Analysis↗
Clinical characteristics in sporadic and familial medullary thyroid carcinoma. A nationwide study of 249 patients in Sweden from 1959 through 1981.
All patients with medullary thyroid carcinoma (MTC) diagnosed in Sweden during 1959 through 1981 were recruited for study from the Swedish Cancer Registry. Among a total of 249 patients, 66 were diagnosed in 1959 through 1969 and 183 from 1970 through 1981. Apparently sporadic MTC was present in 186 patients, and familial MTC in 63. Twenty-seven patients with familial MTC were diagnosed from clinical symptoms and 36 by screening. In both the sporadic group and the symptomatic familial group, approximately 80% of the patients had palpable thyroid tumors. Lymph node metastases were present in 44% of the sporadic group and in 37% of the group with symptomatic familial MTC, and distant metastases in approximately 20% of the patients in each of these groups. The patients detected by screening differed significantly from the two groups of symptomatic cases by having a lower frequency of palpable thyroid lesions (50%), smaller tumors, and lower frequencies of cervical lymph node metastases (14%) and distant metastases (0%). Multivariate analyses revealed no significant differences between sporadic cases and symptomatic familial cases regarding tumor size or stage. Large tumors (greater than 3 cm) were more frequently accompanied by palpable cervical lymph nodes and were associated with an approximately four times higher risk of distant metastases than tumors smaller than 1 cm. Women had significantly smaller tumors and a more favorable stage distribution than age-related men.
Adult↗
Risk of endometrial cancer after treatment with oestrogens alone or in conjunction with progestogens: results of a prospective study.
OBJECTIVE: To determine the relative risk of developing endometrial neoplasia after treatment with oestrogens alone or in conjunction with progestogens. DESIGN: Prospective cohort follow up study, average observation period 5.7 years for each patient. To have a 90% chance of detecting a relative risk of 2.0 with 95% significance the study required 78,000 person years of observation. SETTING: Community based cohort. PATIENTS: Women aged over 35 who were prescribed non-contraceptive oestrogens in the Uppsala health care region during April 1977 to March 1980 were identified from pharmacy records. Of all prescriptions issued, 95% were identified. Patients from the cohort who developed endometrial neoplasia were identified from the cancer registry of the Uppsala health care region. Compliance, sociodemographic data, and lifetime exposures to oestrogen and cyclically added progestogen were assessed by questionnaire in a sample of the cohort. The final cohort consisted of 23,244 patients (133,373 person years). The prevalence of university education, oophorectomy, and hysterectomy was higher in the cohort than the general population; no other confounding factors were identified. MEASUREMENTS: The total number of person years was divided into exposure groups by inference from the data from the questionnaire. Compensation was made for the excess of hysterectomies. Specimens from all cases of endometrial neoplasia in the cohort and 90% of cases in the general population were studied blind histopathologically. Characteristics of treatment of all women who had endometrial neoplasia were assessed by questionnaire. Relative risks and 95% confidence intervals were calculated. RESULTS: Seventy four cases of carcinoma and 33 cases of premalignant lesions occurred in the cohort. The relative risk of endometrial carcinoma was 1.8 (95% confidence interval 1.1 to 3.2) after exposure to any oestrogen compound without progestogen for more than six years; 2.2 (1.2 to 4.4) after more than three years' exposure to conjugated oestrogens without progestogen; and 2.7 (1.4 to 5.1) after more than three years' exposure to oestradiol compounds without progestogen. When carcinoma and premalignant lesions were considered together the results were similar but the relative risk was higher. Risk of carcinoma did not increase when progestogens were cyclically added to oestrogens for the entire treatment period (relative risk 0.9 (0.4 to 2.0]. CONCLUSIONS: Use of oestrogens without progestogens is associated with a twofold to threefold increase in risk of endometrial neoplasia. Use of progestogens either removes this increased risk or delays its onset. A further follow up of the cohort is essential to analyse the risks with greater statistical power.
Adult↗
Incidence of male breast cancer in Scandinavia, 1943-1982.
Male breast cancer incidence was examined in a collaborative study of data from the cancer registries in Denmark, Finland, Norway and Sweden, comprising a total of 1,529 cases diagnosed from 1943 to 1982. Effects of age, time of diagnosis, birth cohort and country of residence were evaluated by using statistical models of the multiplicative Poisson type. The logarithm of incidence increased linearly with the logarithm of age and had a slope of about 5. In Denmark, male breast cancer incidence increased significantly with time, about 1% per year. No significant time effects were observed in the other countries. A significant effect of birth cohort appeared in Sweden only, but there was no particular trend in incidence by year of birth. In relation to Denmark, the risk of male breast cancer was lower in Sweden, Norway and Finland, the relative risk estimates with 95% confidence intervals being 0.82(0.72-0.94), 0.72(0.61-0.84) and 0.53(0.43-0.64) respectively. The variation within Scandinavia is similar for female breast cancer, pointing to common factors being involved in the etiology of breast cancer in both sexes.
Adolescent↗
Breast cancer and oral contraceptives: patterns of risk among parous and nulliparous women--further analysis of the Swedish-Norwegian material.
A Swedish-Norwegian case-control study comprising 473 women less than 45 years old with newly diagnosed invasive breast cancer diagnosed in 1984-85, and 722 age-matched control women, was reanalyzed to evaluate if nulliparous women who had used oral contraceptives (OCs) were at particular risk for breast cancer. The relative risk for nulliparous women who had used OCs for eight years or more was 4.3 (95% confidence interval, 1.4-13.1), and parous women with the same duration of use had relative risk 1.7 (0.7-4.2) as compared to nulliparous and parous women, respectively, who had never used OCs. Parous women who had used OCs for twelve years or more after their first full-term pregnancy had a relative risk of 3.0 (1.3-7.4). The findings from the study suggest that nulliparous women may be particularly susceptible to the risk for breast cancer with long-term OC use.
Adult↗
The association between anatomic site and survival in malignant melanoma. An analysis of 12,353 cases from the Swedish Cancer Registry.
The relationship between site and survival in cutaneous malignant melanoma was investigated by a follow-up of 12,353 Swedish patients diagnosed in 1960-1982. In males, the poorest prognosis was found for tumors located on the scalp-neck region (5-year relative survival rate, RS51%), followed by the lower extremity (RS66%) and trunk (RS68%). Among females, the poorest prognosis was noted for tumors located on the external ear (5-year RS 71%), trunk (RS 78%) and scalp-neck (RS 78%). The prognosis varied considerably between the sites of the head-neck region--for eyelid and facial lesions the prognosis was good, but for external ear and scalp-neck tumors it was poor. Multivariate analysis taking into account age and year of diagnosis showed the highest relative hazards (RH) for female lesions of the trunk (1.40) and male scalp-neck tumors (1.65), with the upper extremity used as reference (RH = 1.00). Except for lesions of the trunk, no significant differences in RH were found between the various sites after 4 years of observation.
Adult↗
Natural history of cervical neoplasia: consistent results obtained by an identification technique.
Swedish population-based incidence and mortality rates for cancer of the uterine cervix, both in situ and invasive, during the period 1958 to 1981 were determined by means of a dynamic model. This new approach describes without any preconceptions the development of the disease as a sequential process over the stages cancer in situ, invasive cancer before and after diagnosis, and death. The strong disturbance of the steady-state situation that occurred after the introduction of cytological mass screening in the early 1960s permitted the use of a computerized identification technique. The whole natural history of cervical cancer could thus be identified and described consistently, with the mutual compatibility between statistical data, structure, parameters, and the states and flows between the states. The estimated age-specific incidence of cancer in situ increased rapidly to a maximum of 650 per 10(5) woman-years at the age of 30 years, after which it declined, and that of invasive cancer to a maximum of 55 per 10(5) at the age of 43. The natural history of cervical neoplasia did not differ appreciably between eight successive 5-year birth cohorts. The proportion of cases of new cancer in situ that progressed to invasive cancer was 12.2%, with a mean duration of the in situ stage in these cases of 13.3 years. The preclinical phase of the invasive stage (without screening) lasted on average about 4 years.
Adolescent↗
Oral contraceptive use and premenopausal breast cancer in Sweden and Norway: possible effects of different pattern of use.
Different use of oral contraceptives (OCs) in relation to reproductive histories and age might explain the conflicting results found in studies from different countries of OC use and premenopausal breast cancer. A population-based case-control study in Sweden and Norway has been analysed separately for the two countries. The study consists of 317 Swedish and 105 Norwegian cases diagnosed 1984-1985 with 317 Swedish and 210 Norwegian controls. The results for each country separately are consistent with the joint analysis showing increased risk for breast cancer with increased duration of OC use with the exception of that for women with more than 15 years since first use. The relative risk of breast cancer for more than four years of use among Norwegian women was 0.6 (95% confidence internal (Cl), 0.2-1.8). In both countries there was a non-significant higher risk associated with increasing duration of use before first full-term pregnancy. Analyses for surveillance bias show no evidence of bias as explanation for the association between total duration of OC use and breast cancer.
Adult↗
Prognosis after breast cancer diagnosis in women exposed to estrogen and estrogen-progestogen replacement therapy.
The association between survival in breast cancer and menopausal hormone treatment prior to diagnosis was analyzed by comparing 261 women who developed the disease in a population-based cohort of estrogen-treated women with 6,617 breast cancer patients without any recorded estrogen treatment drawn from the same population. Complete follow-up was achieved during the 0-9 years of observation. The relative survival rate was significantly higher (p = 0.02), by about 10 percentage points at eight years, in patients who had received estrogen treatment--corresponding to an approximately 40% reduction in excess mortality. The more favorable course could be confirmed only in patients aged 50 years or more at diagnosis (p less than 0.01) and was most pronounced in recent users, that is, in women whose treatment was ongoing (p less than 0.01) or had been discontinued within one year prior to diagnosis. The time from first use to diagnosis and the total duration of estrogen medication were virtually unrelated to survival when the effect of recency was taken into account in multivariate analyses. The authors were unable to examine the effect of stage at diagnosis on the results. Several factors, particularly selection bias and surveillance bias, might have affected the results in favor of the women receiving hormone replacement therapy, but there is a possibility that exogenous female sex hormones affect survival in women with breast cancer.
Adult↗
Time trends in incidence rates of first hip fracture in the Uppsala Health Care Region, Sweden, 1965-1983.
Time trends from 1965 through 1983 for age-specific and age-standardized rates of first hospital admission for a proximal femur fracture were studied in the Uppsala Health Care Region, Sweden, using a centralized register for inpatient care. During the 19-year study period, 29,277 hospital admissions for a first hip fracture were recorded in this population of about 1.5 million persons. The total number of first hip fracture admissions per year increased for both sexes. Age-standardized admission rates for both cervical and trochanteric fractures increased in men (average change per year of 1.8% and 2.6%, respectively) in contrast to the decreased admission rate for cervical fractures (-1.6% per year) and a stable rate for trochanteric fractures (0.4% per year) in women. The cumulative rate of cervical or trochanteric fracture at ages 30-79 years increased 46% in men (from 42/1,000 population in 1965 to 61.5/1,000 population in 1983) in contrast to a 24% decrease in women (from 134/1,000 population in 1965 to 101.5/1,000 population in 1983). The female:male ratio of age-standardized incidence rates decreased for both types of fracture during the study period. This finding of stable or decreasing rates of hip fracture in women contrasts with the findings of most previous studies.
Adult↗
Mammographic parenchymal patterns in women receiving noncontraceptive estrogen treatment.
Two population-based registers, one of women with at least one estrogen prescription, and the other of women who had undergone mammographic screening, were linked by means of the national registration number, revealing 3,436 estrogen-treated women who had attended the mammography screening program. Their mammographic parenchymal pattern was classified according to the criteria of Wolfe into two groups, one with a low risk and the other with a high risk of development of breast cancer. Estrogen replacement therapy was more common in women with a high risk than in those with a low risk mammographic parenchymal pattern (standardized morbidity ratio = 1.3). The increased probability of receiving noncontraceptive estrogen treatment in women with a high risk mammographic parenchymal pattern remained when the impact of several possible confounding factors had been taken into account in a logistic regression analysis (odds ratio = 1.36, 95% confidence interval 1.24-1.49). No evidence was found of a shift toward the unfavorable mammographic parenchymal pattern during treatment, which suggests that the treatment itself was not responsible for the high proportion of P2 and DY patterns. The mammographic parenchymal pattern must therefore be looked upon as a confounder in the context of studying breast cancer risk after estrogen treatment.
Adult↗
Non-contraceptive hormones and rheumatoid arthritis: possibilities of using a Swedish population-based cohort.
We report the possibility of, and the methodological problems associated with, using a large population-based cohort of 23,000 Swedish women, ascertained from a drug prescription database to have received non-contraceptive oestrogens; to further investigate the relationship between such therapy and the postulated protection against development of rheumatoid arthritis (RA). Although this study was primarily designed to look at cancer risk, it should be possible to study the relationship with RA.
Adult↗
The prevalence of cancer in Sweden 1984.
A total of 772,492 (99.3%) of all patients with a newly diagnosed malignant disease notified to the National Swedish Cancer Registry during 1958 through 1984 could be followed up with respect to survival or emigration by means of computerized record linkages. The number of cancer patients still alive on December 31, 1984, totalling 194,389, was divided by the appropriate population denominator. The crude prevalence rate in Sweden of individuals who have or have had any cancer was 1,840 per 10(5) in males and 2,808 per 10(5) in females. At ages 40 through 59, the rates in females were 2.2 to 2.5 times higher than those in males, whereas after the age of 75 cancer was more prevalent in males. Prostate cancer was the most common tumour in males, 24.5% of the crude prevalence rate (451 per 10(5), followed by colorectal cancer, cancer of the bladder and malignant melanoma. In females, the breast was the dominating cancer site, accounting for 32.7% (917 per 10(5), followed by cancer of the large bowel, uterine corpus and uterine cervix. We conclude that prevalence rates provide important information about the magnitude of the cancer problem over and above that revealed by incidence and mortality statistics. The high, and probably increasing, prevalence rates over time emphasize that important savings in economic and other resources can be achieved by strictly evaluated and cost-effective regimens for follow-up.
Adolescent↗
[Trends in cancer epidemiology].
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Animals↗
[Alcohol and cancer--a connection proved only for some forms of cancer].
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Alcohol Drinking↗