[Screening with mammography--a critical attitude is supported by new findings].
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Adult↗
Biomedical subjects
L Janzon
Publications and source records attributed to L Janzon.
Mammographic screening and mortality from breast cancer: the Malmö mammographic screening trial.
STUDY OBJECTIVE: To determine whether mortality from breast cancer could be reduced by repeated mammographic screening. DESIGN: Birth year cohorts of city population separately randomised into study and control groups. SETTING: Screening clinic outside main hospital. PATIENTS: Women aged over 45; 21,088 invited for screening and 21,195 in control group. INTERVENTIONS: Women in the study group were invited to attend for mammographic screening at intervals of 18-24 months. Five rounds of screening were completed. Breast cancer was treated according to stage at diagnosis. END POINT: Mortality from breast cancer. MEASUREMENTS AND MAIN RESULTS: All women were followed up and classed at end point as alive without breast cancer, alive with breast cancer, dead from breast cancer, or dead from other causes. Cause of death was taken from national mortality registry and for patients with breast cancer was validated independently. Mean follow up was 8.8 years. Altogether 588 cases of breast cancer were diagnosed in the study group and 447 in the control group; 99 v 94 women died of all causes and 63 v 66 women died of breast cancer (no significant difference; relative risk 0.96 (95% confidence interval 0.68 to 1.35)). In the study group 29% more women aged less than 55 died of breast cancer (28 v 22; relative risk 1.29 (0.74 to 2.25)). More women in the study group died from breast cancer in the first seven years; after that the trend reversed, especially in women aged greater than or equal to 55 at entry. Overall, women in the study group aged greater than or equal to 55 had a 20% reduction in mortality from breast cancer (35 v 44; relative risk 0.79 (0.51 to 1.24)). OTHER FINDINGS: In the study group 100 (17%) cancers appeared in intervals between screenings and 107 (18%) in non-attenders; 51 of these women died from breast cancer. Cancers classed as stages II-IV comprised 33% (190/579) of cancers in the study group and 52% (231/443) in the control group. CONCLUSIONS: Invitation to mammographic screening may lead to reduced mortality from breast cancer, at least in women aged 55 or over.
Age Factors↗
Cloning of a chromosomal locus (exp) which regulates the expression of several exoprotein genes in Staphylococcus aureus.
Insertion of the erythromycin resistance transposon Tn551 into a single site of the Staphylococcus aureus chromosome resulted in decreased production of alpha-toxin, serine and metallo-proteinases and several other extracellular proteins and a simultaneous increase in the production of protein A. The site of insertion, designated exp, was separate from the structural gene for alpha-toxin and protein A. Hybridization analysis showed that the effect of the insertional mutation on the expression of the alpha-toxin and protein A was at the level of transcription. The chromosomal DNA flanking the transposon and the corresponding DNA of the wild-type strain was cloned in Escherichia coli. Northern blot hybridization experiments revealed that the exp locus codes for a major RNA of approximately 3.5 kb. This RNA was not found in the insertional mutant nor in a spontaneous exp mutant. A map of the exp locus constructed by Northern blot and restriction enzyme analysis showed that the insertional mutation was located in the middle of the coding sequence of the 3.5 kb RNA. The insertional mutant was reverted to wild type by inserting a recombinant plasmid containing most of the coding sequence of the 3.5 kb RNA.
Bacterial Proteins↗
Social anchorage and blood pressure in elderly men--a population study.
The present study was designed to test the hypothesis that there is an independent association between the three concepts of psychosocial factors, social network, social support, social influence and blood pressure (see Materials and methods for definition). The study sample chosen (n = 621) comprised a randomly selected group of half the male residents of Malmö born in 1914, 500 (80.5%) of whom participated. A study based on a model with clearly defined criteria was used to measure the different aspects of social network, social support and social influence. In multiple regression analysis, social anchorage (a subconcept of social network) was shown to have an association with both systolic (P = 0.03) and diastolic blood pressure (P less than 0.001), when adjustments for social class, marital status, medication for hypertension, alcohol consumption, smoking habits, body mass index (BMI) and physical activity were made. Social anchorage is a concept on a structural level, that describes to what degree the individual belongs to and is anchored within formal and informal groups in society. As such, it may contribute to a deeper understanding of mechanisms behind high blood pressure and could thus be significant in the field of health promotion.
Aged↗
Methods to assess alcohol consumption in 68-year-old men: results from the population study 'Men born in 1914' Malmö, Sweden.
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Aged↗
The oral glucose tolerance test in men under 55 years of age with intermittent claudication.
Blood glucose at sixty, ninety, and one hundred twenty minutes after a standardized oral glucose load was compared in healthy middle-aged men and patients with intermittent claudication. No difference was found when the authors compared blood glucose at zero and sixty minutes. At both ninety and one hundred twenty minutes, however, they found a relative hypoglycemia in patients with peripheral arteriosclerotic disease in an early stage.
Administration, Oral↗
Motilin response to a glucose load aberrant in smokers.
Smoking is known to influence the blood glucose response to an oral glucose load, possibly by altering the gut motility. Because the peptide hormone motilin might be involved in the regulation of the gastric emptying pattern, we studied 12 heavy smokers and 9 non-smokers after an overnight fast and tobacco abstinence. After an oral glucose load non-smokers showed falling serum motilin levels, as expected, whereas the smokers had initially increasing values. We conclude that smoking affects the gastrointestinal tract, not only during acute nicotine exposure but also chronically.
Blood Glucose↗
Social and demographic characteristics of 20-29-year-olds attending the emergency room for dyspepsia.
Ulcer-like epigastric symptoms constitute the most common presentation in acute abdominal complaints. A prospective study of such patients attending a surgical emergency unit is presented. Among the patients with dyspepsia, the numbers per thousand population varied between different parts of the city from 0 to 45. Most of the patients with dyspepsia were seen early in the week. Men, unmarried persons and immigrants were overrepresented in the dyspepsia group, and the relative figures for low educational status, history of alcohol abuse and smoking were higher than expected from city averages. Sick-listing during the preceding year exceeded 90 days in 17% of this group. The observed associations indicated the advisability of preventive measures.
Abdomen, Acute↗
Evaluation of possibilities for mass screening for colorectal cancer with Hemoccult fecal blood test.
Data from a health survey including the Hemoccult fecal blood test, together with official cause-specific death rates, were used to assess the magnitude of a controlled trial that would be required to prove a 25 percent reduction of the mortality from colorectal cancer associated with screening. All men in three age groups in the city of Malmö, Sweden, were invited, but 46 percent did not participate in, the Hemoccult screening. One carcinoma and 89 adenomas were detected in 56 of the 2422 who did. With the risk function used in our calculation and a compliance rate of 60 percent, a study population among 45- to 69-year-olds of 605,000 is required to prove an expected 25 percent reduction of the mortality with 90 percent power. Considering the size of such a trial, we question whether a controlled trial is feasible. With known risk functions for death from all causes and death from colorectal cancer, the study population was calculated using variable statistical power, participation rate, and risk reduction. Statistical methods and computer programs are given. In addition, alternative study models to assess the benefits associated with screening are discussed.
Adenoma↗
Factors influencing participation in health surveys. Results from prospective population study 'Men born in 1914' in Malmö, Sweden.
Base line data together with data in public registers and a structured phone interview of 94 of the 121 non-attenders was used for an assessment of factors influencing participation in the prospective population study 'Men born in 1914' in Malmö, Sweden. The overall attendance rate was 80.5% but varied among areas in the city from 27% to 100%. The lower participation rate among single men remained, when correcting for social class, significant only for single men in social class III. Men who did not feel well and/or had been admitted to hospital during the last 12 months had a lower participation rate. A negative attitude towards health surveys in general was the most common reason for non-participation. The phone interview turned out to be a feasible method to reach non-attenders to assess whether the sample was representative of the population and to learn more about reasons for non-participation.
Aged↗
The effect of beta-blockade on leg blood flow in hypertensive patients with intermittent claudication.
The present study was designed to assess the short-term effects of beta-blocking antihypertensive treatment on leg blood flow in patients with peripheral artery disease. Seven patients with intermittent claudication were randomly allocated to treatment with atenolol 100 mg or pindolol 10 mg. Patients switched therapy after one month of treatment. Venous occlusion plethysmography on the calves was used to assess the effects on leg blood flow after one and two months of treatment. The average 10% reduction of the systolic and diastolic blood pressures was not associated with any reduction of blood flow at rest. There was on average 3.4 ml reduction of peak flow which had no influence on the painfree or total walking distance.
Adult↗
Distribution and reproducibility of aryl hydrocarbon hydroxylase inducibility in a prospective population study of middle-aged male smokers and nonsmokers.
Aryl hydrocarbon hydroxylase (AHH) inducibility was determined in a lymphoblast test system in 2,000 consecutive middle-aged male smokers, 304 ex-smokers, and 218 never-smokers in the same birth-year cohorts. Intraindividual, intraobserver, and interobserver, as well as temporal, reproducibility was checked in a special double-blind quadruplet sample series from 20 other consecutive middle-aged men. The results showed a three-modal phenotype distribution of AHH inducibility with high (fold induction greater than or equal to 3.6), intermediate (2.6-3.6) and low (less than or equal to 2.5) levels ranging between 7.6% to 10.5%, 38.5% to 43.0%, and 46.5% to 53.9%, respectively, in all the smoking categories. The reproducibility of the measurements was excellent, with one-way variance in the order of 0.007 to 0.033, and the applied assay method can therefore be used in large-scale prospective population investigations. Such are required in order to establish a cause-effect association between high AHH inducibility and smoking-related malignancies of the respiratory tract and oral cavity, as has been suggested from earlier retrospective studies in more limited clinical materials of cancers and precanceroses of these varieties.
Aryl Hydrocarbon Hydroxylases↗
The feasibility of large scale population screening.
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Aged↗
Mammographic breast cancer screening--a randomized trial in Malmö, Sweden.
A randomized trial is presented on the effect of repeated invitation to breast cancer screening with mammography on mortality from breast cancer. The invited group and the control group each consisted of approximately 21,000 women aged 45-69 yr at the start of the screening. The attendance rate was 74% at the first screening and 70% at the two subsequent screening rounds. The cancer detection rate was 7.5 per 1000 women examined in the first screening round and 2.2 and 2.0 per 1000 woman-years in the second and third screenings with an incidence of 0.9 in the intervals. The incidence in the control group was 2.7 per 1000 woman-years. The proportion of positive biopsies was 61% in the first screening round, 33% in the second, and 58% in the third. After the prevalence screening, the stage distribution was more favourable in the invited group (including non-attenders) than in the control group. In the two most recent periods of the programme, 62 out of 160 women with cancer (39%) in the invited group were in stage II-IV compared with 91 out of 159 (57%) in the control group. More than 60% of cancers detected at screening were either non-invasive or invasive with a diameter of 1 cm. The corresponding percentage in the control group was 27%. The importance of sampling bias is discussed. Although data on mortality still have to be awaited, the results so far clearly indicate a positive effect of screening.
Adenocarcinoma↗
Blood lipid variability in relation to relative weight and biochemical markers of tobacco and alcohol consumption.
Carboxyhaemoglobin (COHb%) and gamma-glutamyl-transferase (GGT) are today frequently used as objective indicators of tobacco and alcohol consumption. The relationships between COHb%, GGT and relative body weight, cholesterol, triglyceride and apolipoprotein AI (Apo-AI) were studied in middle-aged men attending a preventive medical programme in Malmö, Sweden. Although statistically significant the influence of COHb% on cholesterol and triglyceride was found to be clinically insignificant. GGT and body weight had, independent of each other, a significant influence on cholesterol and triglyceride. GGT was found to have a positive correlation to Apo-AI whereas body weight was found to have a negative correlation to Apo-AI. Four per cent of the cholesterol variability, 16% of the triglyceride variability and about 10% of the variability in Apo-AI could, in this study, be accounted for by COHb%, GGT and relative body weight.
Alcohol Drinking↗
Ultrasonographic screening for gallstone disease in middle-aged women. Detection rate, symptoms, and biochemical features.
Five hundred and forty-seven middle-aged women, selected at random from the population of Malmö, Sweden, were invited to a screening survey for gallstone disease; 424 participated (77.5%). Forty-one had previously been operated on for gallbladder disease. The prevalence of gallstone disease, on the basis of a positive finding at ultrasonography and cholecystography, was 11%. The predictive value of a positive finding at ultrasonography was 86%. Six out of 10 women with gallstone were classified as asymptomatic. Body weight, blood pressure, liver enzymes, fasting blood glucose, and blood lipids, including apolipoprotein-A, did not differ significantly in women with and without gallstone disease. At least 9 out of 10 gallstones appeared to be cholesterol stones. Approximately half were of a size that would make them accessible for dissolution therapy.
Cholecystography↗
Aryl hydrocarbon hydroxylase induction levels in patients with malignant tumors associated with smoking.
The levels of aryl hydrocarbon hydroxylase (AHH) inducibility were assessed in 173 patients with cancers statistically associated with smoking, i.e., squamous cell and transitional cell carcinomas, at various sites. In 34 patients with carcinomas of the oral cavity, 41 patients with laryngeal carcinomas, and 22 patients with pulmonary carcinomas there was a highly significant overrepresentation of high inducers, whereas 30 patients with carcinomas of the renal pelvis and ureter and 46 patients with urinary bladder carcinomas did not differ significantly in this respect from a control population comprising 92 subjects with no history of neoplastic disease. The results add further support to the concept of AHH as a major activator of carcinogens belonging to the group of polycyclic aromatic hydrocarbons (PAH) when these affect the oral cavity and/or the respiratory tract. The role of AHH in urothelial carcinogenesis seems to be less explicit.
Adult↗
Mutagen sensitivity, smoking habits and enzyme induction in healthy middle-aged men.
Unscheduled DNA synthesis (UDS) (excision-repair) of N-acetoxy-2-acetylaminofluorene (NA-AAF) damage to the DNA of human lymphocytes and levels of 3H-labeled NA-AAF bound to the DNA (carcinogen binding) of lymphocytes after 18 hr of culturing were measured in a consecutive subsample of healthy middle-aged males attending a multiphasic health screening program at the Department of Preventive Medicine in Malmö during 3 weeks in November-December 1981, and compared relative to their smoking habits, body weight, serum cholesterol, and gamma-glutamyltransferase levels as well as aryl hydrocarbon hydroxylase inducibility. This study group numbered 66 males and was uniform in sex, age, and investigation time. No case of significant arterial hypertension was present. The UDS and carcinogen binding results showed no correlation with the other factors measured, with the exception of smoking which was strongly (P less than 0.01) associated with increasing levels of both the UDS and carcinogen binding values. It is concluded that under ordinary circumstances smoking may represent the most important exogenous factor which may modulate risk to cardiovascular disease and cancer by influencing individual mutagen sensitivity.
Acetoxyacetylaminofluorene↗