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T Hakulinen

Publications and source records attributed to T Hakulinen.

At least 55 records · Page 3Linked to original sources
PubMed1999

No excess risk of cervical carcinoma among women seropositive for both HPV16 and HPV6/11.

Human papillomavirus (HPV) types 16 and 18 are the major risk factors for cervical carcinoma, whereas HPV types 6 and 11 cause benign genital lesions. We wanted to study the joint effect of simultaneous infections with the oncogenic and non-oncogenic HPV types on risk of subsequent development of cervical carcinoma. A cohort of 530,000 women who had donated blood samples to Nordic serum banks between 1973 and 1994 was followed up by linkage to national cancer registries. We identified 182 prospective cases with invasive cervical carcinoma and selected 538 matched controls at random. HPV 6, 11, 16, 18 and 33 seropositivity was used as a marker for the different HPV infections, and seropositivity for Chlamydia trachomatis and cotinine were used as markers for risk-taking sexual behavior and smoking respectively. The adjusted odds ratio (OR) of cervical squamous-cell carcinoma (SCC) was 2.2 for HPV6/11 among HPV16 seronegatives and 5.5 for HPV16 among HPV6/11 seronegatives. Assuming multiplicative joint effect, the expected OR for seropositivity to both HPV6/11 and HPV16 would have been 12, but the observed OR was 1.0. The antagonistic interaction was statistically significant (p = 0.001) and present also under deterministic considerations of possible misclassification bias. Antagonistic interactions were also detected for combinations of HPV16 and HPV18 and of HPV16 and HPV33. The results are in line with the concept that HPV-specific immunity protects against SCC and support primary prevention of SCC by vaccination against the HPVs.

Adult↗
PubMed1999

Risk of colorectal and other gastro-intestinal cancers after exposure to nitrate, nitrite and N-nitroso compounds: a follow-up study.

N-nitroso compounds are potent carcinogens detected in foodstuffs. The importance of dietary nitrosamines in relation to human cancer development is, however, uncertain. We studied the relationship between intake of nitrates, nitrites and N-nitrosodimethylamine (NDMA) and risk of cancers of the gastro-intestinal tract in a cohort of 9,985 adult Finnish men and women. During a follow-up period of up to 24 years, 189 gastro-intestinal cancer cases were diagnosed in the cohort, initially free from cancer. Intake of nitrate, nitrite and NDMA were estimated, based on food-consumption data from a 1-year dietary history interview covering the total diet of the participants. A significant positive association was observed between intake of NDMA and subsequent occurrence of colorectal cancer with a relative risk (RR) between the highest and lowest quartiles of intake of 2.12 [95% confidence interval (CI) 1.04-4.33]. Of various sources of N-nitroso compounds, intake of smoked and salted fish was significantly (RR = 2.58, 95% CI 1.21-5.51) and intake of cured meat was non-significantly (RR = 1.84, 95% CI 0.98-3.47) associated with risk of colorectal cancer. No similar association was observed for intake of other fish or other meat. No significant associations were observed between NDMA intake and cancers of the head and neck combined or of the stomach or between nitrate or nitrite intake and risk of cancers of the gastro-intestinal tract. Our results are in line with the idea that N-nitroso compounds can induce colorectal cancer in humans.

Adolescent↗
PubMed1999

Mixture models for cancer survival analysis: application to population-based data with covariates.

The interest in estimating the probability of cure has been increasing in cancer survival analysis as the curability of many cancer diseases is becoming a reality. Mixture survival models provide a way of modelling time to death when cure is possible, simultaneously estimating death hazard of fatal cases and the proportion of cured case. In this paper we propose an application of a parametric mixture model to relative survival rates of colon cancer patients from the Finnish population-based cancer registry, and including major survival determinants as explicative covariates. Disentangling survival into two different components greatly facilitates the analysis and the interpretation of the role of prognostic factors on survival patterns. For example, age plays a different role in determining, from one side, the probability of cure, and, from the other side, the life expectancy of fatal cases. The results support the hypothesis that observed survival trends are really due to a real prognostic gain for more recently diagnosed patients.

Age Factors↗
PubMed1999

Second primary cancers in patients with squamous cell carcinoma of the skin: a population-based study in Sweden.

We studied second primary cancer among 25,947 patients diagnosed with squamous cell carcinoma of the skin (SCC) in Sweden between 1958 and 1992. In total, 5,706 patients developed a second primary cancer at any site, compared with an expected number of 2,651 [standardized incidence ratio (SIR) = 2.15; 95% confidence interval (CI) = 2.10-2.21]. Men below 60 years of age at diagnosis of SCC had higher SIR (2.5; CI = 2.2-2.8) with the highest risk during the first year of follow-up (SIR = 9.2; CI = 6.9-12.2). If second primary SCC was excluded, the SIR was reduced to 1.30 (CI = 1.25-1.34); the relationships by sex, age and time since diagnosis remained similar. For skin cancer, the SIR for second SCC was markedly elevated (SIR = 15.6) and the risk of malignant melanoma was elevated 3-fold. Significantly increased risks were found for most second cancers in squamous cell epithelium: lip (SIR = 5.2), respiratory organs (SIR = 1.7), esophagus (SIR = 1.5), cervix uteri (SIR = 2.2), and vulva including vagina (SIR = 2.3). There was a generally increased risk of almost 2-fold for second cancer in hematopoietic or lymphoproliferative tissues. Slightly increased rates (SIR = 1.0-1.5) were seen for second tumors in digestive tissues. Finally, a high SIR (SIR = 5.5) was observed for second primary cancer in salivary glands. In conclusion, patients with SCC are at increased risk to develop new primary cancer, especially in skin, squamous cell epithelial and tobacco-related tissues. Common risk factors among the tumor types might explain our findings, however, an intrinsic susceptibility among SCC patients to develop cancer is also possible.

Age Distribution↗
PubMed1999

Variations in survival for invasive cervical cancer among European women, 1978-89. EUROCARE Working Group.

OBJECTIVES: To analyze cervical cancer survival trends in 10 European countries using models that estimate the proportion of cured patients (having the same life expectancy as the general population) and the survival of fatal cases (who die from cervical cancer). METHODS: We considered 40,906 cases diagnosed over 12 years (1978-89) collected from cancer registries participating in EUROCARE. RESULTS: From 1978 to 1989, 5-year relative survival in Europe improved (60%-->63%). The proportion of cured patients increased slightly but significantly (53%-->55%, p = 0.05). For countries with poorer survival at the end of the 1970s the proportion of cured patients increased faster than average, particularly evident in England (49%-->56%) and Scotland (44%-->53%). By contrast, in Finland, Sweden and Germany with organized screening, 5-year survival and cure rate did not improve, but incidence declined to very low levels. CONCLUSIONS: Cervical screening can explain the trends in cervical cancer survival: this identifies premalignant lesions, reduces incidence and selectively prevents less aggressive cancers. The decreased proportion of the latter means that survival does not improve in countries with low incidence of cervical cancer. The increased proportion of cured patients with time shows that survival improvement was not due simply to earlier diagnosis with no patient advantage.

Adolescent↗
PubMed1999

Methodological problems in comparing incidence and prevalence of leukaemias and lymphomas: ascertainment and age adjustment.

For a reliable incidence of a disease, all the cases that occurred in the area during the period of interest should be diagnosed, registered and classified correctly. It is very important to know in comparisons which data sources a particular cancer registry is utilizing and for how long it is waited until a publication of incidence is released. Examples from Finland show that deficits of up to 5-25% are possible in leukaemia and multiple myeloma. The populations to be compared may also have large differences in the age distribution. As the risk of all cancer, also for leukaemia and lymphomas, increases strongly by age, it is crucial that care is taken about the age adjustment before showing the incidence rates for comparisons. The age adjustment can be done using different methods and standards. In practice, the choice of methods for comparative purposes is often not crucial. It is also essential to evaluate the age-specific rates when making comparisons between populations. For cancer prevalence it would be important to know which patients can be considered cured. A population-based cancer registry does not, as a rule, have this information. However, if a cancer registry follows up the patients, survival rates of the patients may, after a number of follow-up years, start to resemble those in a comparable general population group. This is an indication that the living patients are cured and should be deducted from cancer prevalence. Advances would also be needed in statistical methods and improvement in the quality and coverage of cancer registration.

Adolescent↗
PubMed1999

Relationships between family dynamics of Finnish child-rearing families, factors causing strain and received support.

The aim of this study was to determine the relationships between family dynamics, the factors causing strain on child-rearing parents and the support available to families from public health nurses. Family dynamics was defined as the family's unique way of functioning and was conceptualized by means of six different dimensions. Questionnaires were sent to 118 families, and of these 85 mothers and 79 fathers participated in the study. According to the findings the majority of parents involved in bringing up children aged 3-4 years assessed their families to be well-functioning. There was a correlation between a low level of factors causing strain on the family and a positive evaluation of family dynamics based on the various dimensions. According to the mothers the support, i.e. emotional, appraisal and instrumental support, received from public health nurses, along with a small number of strain-causing factors on the partner relationship, correlated well with their positive assessments of the mutuality and flexibility of their families.

Adult↗
PubMed1999

Cancer patient survival--patterns, comparisons, trends--a population-based Cancer Registry study in Finland.

The effects of primary site, sex, age, stage and histological type on cancer patient survival were analysed on the basis of the population-based material of the Finnish Cancer Registry from 1985 to 1994. In addition, trends in survival were constructed for the period 1955-1994. Detailed site-specific data are published as Supplement 12 to Vol. 38 of Acta Oncologica. Within a given site, the survival differences by gender were not large. However, because of different site distributions, the average prognosis for female patients, all sites taken together, was superior to that of males: the 5-year relative survival rates (RSR) were 58% and 43%, respectively. In general, older patients had a poorer outcome compared with younger patients (partly because of different stage and histology distributions). Stage was a strong determinant of patient survival. In some cancers with a poor average prognosis the 5-year RSR for localized tumours was reasonable, e.g. 61% for stomach cancer, males, 34% for gallbladder cancer, females, and 29% for lung cancer, males. Most of the survival rates clearly increased over time. In addition to improvements in cancer treatment, changes over time in several other factors affect the trends, such as changes in the stage distribution (early diagnosis as a result of health education, improved diagnostic methods, screening, etc.) and in the composition of the patient material because of changing definitions of cancer (e.g. papilloma versus papillary carcinoma of the bladder, occult carcinoma of the thyroid, and early prostate cancer). The large Cancer Registry material (466,000 patients) enabled accurate estimates of the survival rates of cancer patients in Finland. These rates reflect the effectiveness of the healthcare system as a whole and are useful for planning and evaluation purposes. However, the estimated survival rates are based on grouped data, and cannot be directly applied for predicting the prognoses of individual patients, although they can be used as guidelines.

Female↗
PubMed1999

Survival of cancer patients in Finland 1955-1994.

INTRODUCTION: The study of survival of cancer patients is essential for monitoring the effectiveness of cancer control. The previous monograph describing cancer patient survival in Finland was published by the Finnish Cancer Registry in 1981 and covered patients diagnosed in 1953-1974. This new supplement assesses cancer patient survival up to the year 1995. MATERIAL AND METHODS: The study includes over 560000 tumours registered at the Finnish Cancer Registry with a date of diagnosis between 1955 and 1994. Patients were followed up to the end of 1995. Trends in relative survival rates are studied over four 10-year diagnostic periods from 1955 to 1994. In addition, detailed results are presented for patients diagnosed during 1985-1994, including relative survival rates tabulated by stage, sex, and age. Additional sections describe differences in cancer patient survival according to social class and region of residence and a comparison of cancer patient survival in Finland to other European countries. RESULTS: Patient survival improved over time for almost all anatomical sites. The main exception is in cancer of the cervix uteri, where patient survival has decreased slightly from 1965-1974 to 1985-1994 due to the selective prevention of less aggressive tumours through cytologic screening. Very few differences in patient survival are observed between males and females. A substantial improvement in survival can be seen for childhood cancers. CONCLUSION: The increasing survival rates reflect improvements that have taken place in various areas of cancer control, from health education and early diagnosis to treatment and aftercare. This study provides valuable reference information for both clinicians and health administrators, as well as a baseline for more detailed studies of patient survival for individual anatomical sites.

Adolescent↗
PubMed1999

Do morphology and stage explain the inferior lung cancer survival in Denmark?

Danish lung cancer patients diagnosed during 1983-1987 experienced 5-yr relative survival rates 2-7% inferior to patients in the other Nordic countries, despite the similarity of cancer registration and healthcare systems in the Nordic countries. Is the inferior relative survival in Denmark due to differences in morphology or stage of lung cancers? The present study compared in detail the survival of 92,719 patients diagnosed with lung cancer during 1978-1992 in Denmark, Finland, and Norway. In particular, differences in morphology and extent of disease were studied. A poor survival rate for small cell anaplastic lung carcinoma compared with all other morphologies was confirmed. However, this could not explain the relative survival differences observed between countries. Extent of disease was the most important predictor of survival. Part of the observed survival differences could be explained by a less favourable stage distribution in Denmark, combined with a slightly lower relative survival rate for those with metastatic disease. Differences in treatment are unlikely to explain the findings, although delays in diagnosing and treating patients in Denmark compared with neighbouring countries could partially explain the lower patient survival in Denmark. In conclusion, the main factor in the lower survival rate in Denmark is unfavourable stage distribution.

Aged↗
PubMed1999

Low levels of serum vitamins A and E in blood and subsequent risk for cervical cancer: interaction with HPV seropositivity.

Nutritional factors have been associated with risk of cervical cancer, but it is unclear whether the associations are of etiological significance or secondary to human papillomavirus (HPV) exposure. A delineation of this question requires a prospective study with invasive cancer as the end point. We conducted a nested case-control study in Finland and Sweden within a joint cohort of 405,000 women followed up for, on average, 4 years. Blood samples from 38 prospective cases of invasive cervical cancer diagnosed between 1985 and 1994 and 116 controls matched for age, country, and sample storage time were available for the study. Levels of retinol or unoxidized alpha-tocopherol in the blood were not risk factors for cervical cancer. However, joint-effect analysis of low levels of retinol disclosed statistically significant (p = 0.023) synergistic (more than multiplicative) interaction with HPV (HPV16, HPV18, or HPV33) seropositivity (observed relative risk = 2.6, 95% confidence interval = 0.7-8.8, expected relative risk = 0.3). Retinol might act as an effect modifier of the HPV-associated risk for cervical cancer; exposed women may require adequate levels for immunologic surveillance of HPV.

Adult↗
PubMed1998

Drinking water mutagenicity and urinary tract cancers: a population-based case-control study in Finland.

The detection of mutagenic and carcinogenic chlorination by-products in chlorinated drinking water has raised concern in many countries over the potential health effects of long-term exposure to these products. The relation between estimated exposure to historical drinking water mutagenicity and cancer was studied in Finland by using a population-based case-control study comprising 732 bladder cancer cases, 703 kidney cancer cases, and 914 controls. The cases were obtained from the nationwide Finnish Cancer Registry for the years 1991-1992. The controls, frequency matched by age and sex, were randomly selected from the national population registry. Information on past drinking water sources and confounding factors was acquired through a questionnaire. Historical exposure to drinking water mutagenicity was estimated by using information on past residence, past water source, and historical data on water quality and treatment. Odds ratios were calculated for an increase of 3,000 net revertants per liter (net rev/liter) in average exposure from 1950 to 1987, adjusting for age, sex, socioeconomic status, and smoking in logistic regression models. A small, statistically significant, exposure-related excess risk was found for kidney cancer for men (odds ratio = 1.49, 95 percent confidence interval (CI) 1.05-2.13) for 3,000 net rev/liter exposure level. For women, the association remained nonsignificant, with a lower odds ratio of 1.08 (95% CI 0.69-1.68). For bladder cancer, the odds ratio for both men and women was 1.22 (95% CI 0.92-1.62) for 3,000 net rev/liter exposure. However, a higher odds ratio of 2.59 (95% CI 1.13-5.94) for 3,000 net rev/liter exposure was observed for male nonsmokers.

Adult↗
PubMed1998

Variation in survival of adult patients with thyroid cancer in Europe. EUROCARE Working Group.

The survival of patients with thyroid cancer was analysed using population-based EUROCARE II data from 1978-1989 (trends in survival) and 1985-1989 (cross-sectional comparisons between areas). The data consisted of 7504 patients and covered 37 cancer registration areas in 17 European countries. In 90% of the patients the diagnosis was histologically confirmed. The prognosis of patients with thyroid cancer was relatively favourable. The overall 5-year relative survival rate was 72% for men and 80% for women. Substantial variation in this 5-year rate was observed between countries ranging from 59 to 83% in men and from 72 to 84% in women. Higher than average survival rates were observed in Finland, Iceland, The Netherlands and Sweden. Countries with lower than average rates were Denmark, England, Estonia, Slovakia, Slovenia and Poland (women). Elderly patients had lower survival rates than the younger ones. Time trends in survival (which could be analysed only in selected countries with sufficient numbers of cases) were irregular but generally showed slight increases compared with rates in 1978-1980. Different distributions in the histological subtypes of thyroid cancer is one plausible explanation for the variation in the survival rate. Other likely factors contributing to this are differences in the stage distribution and varying efficacy of treatment. The EUROCARE II data did not permit specific analyses of the roles of various prognostic factors.

Adenocarcinoma, Follicular↗
PubMed1998

Relationships between infant temperament, demographic variables, and family dynamics of childrearing families.

Relationships between infant temperament, demographic variables, and family dynamics of child-rearing families were investigated in this study. The revised Infant Temperament Questionnaire (RITQ), the Family Dynamics Questionnaire (FDQ) and the Family Dynamics Measure (FDM) were sent to 118 families who had participated in the first stage of the study as child-bearing families. About 8 months after childbirth 96 mothers and 95 fathers completed the questionnaires. The characteristics of infant temperament and demographic variables related to the variance of dimensions of family dynamics. Characteristics of the temperamentally easy baby related to more positive family dynamics perceived by child-rearing parents. Fathers rearing their first child reported that their families functioned better than fathers with their second infant. In child health clinics families rearing their second child should also be supported, especially families with arrhythmic and negative mood infants.

Adolescent↗
PubMed1998

Relative survival of cancer patients--a comparison between Denmark and the other Nordic countries.

The results of a Nordic collaborative project revealed that Danish cancer patients had a poorer prognosis than patients in the other Nordic countries for some major cancer sites. The present study was undertaken to further explore the differences in survival between Denmark and the other Nordic countries. All cancer cases diagnosed in the Nordic countries during 1958 to 1991/92 were included in the analysis. Relative survival and excess mortality were calculated for intervals in the first five years after diagnosis. Since the 1950s, the prognosis of cancer patients has improved in all the countries, but more moderately in Denmark. For cancers of the stomach, colon, rectum, breast (female), and prostate, the Danish patients had a markedly lower relative survival than the patients in the other countries. They also had the lowest proportion of localized tumours. It appears that Danish cancer patients are diagnosed at a later stage of disease than patients in the other Nordic countries.

Adolescent↗
PubMed1998

Measuring social class differences in cancer patient survival: is it necessary to control for social class differences in general population mortality? A Finnish population-based study.

STUDY OBJECTIVES: Estimation of cancer patient survival by social class has been performed using observed, corrected (cause specific), and relative (with expected survival based on the national population) survival rates. Each of these measures are potentially biased and the optimal method is to calculate relative survival rates using social class specific death rates to estimate expected survival. This study determined the degree to which the choice of survival measure affects the estimation of social class differences in cancer patient survival. SETTING AND PARTICIPANTS: All Finnish residents diagnosed with at least one of 10 common malignant neoplasms during the period 1977-1985 were identified from the Finnish Cancer Registry and followed up for deaths to the end of 1992. DESIGN: Survival rates were calculated by site, sex, and age at 5, 10, and 15 years subsequent to diagnosis for each of three measures of survival; relative survival, corrected (cause specific) survival, and relative survival adjusted for social class differences in general mortality. Regression models were fitted to each set of rates for the first five years of follow up. MAIN RESULTS: The degree of variation in relative survival resulting from social class decreased, although did not disappear, after controlling for social class differences in general mortality. The results obtained using corrected survival were close to those obtained using relative survival with a social class correction. The differences between the three measures were largest when the proportion of deaths from other causes was large, for example, in cancers with high survival, among older patients, and for longer follow up times. CONCLUSIONS: Although each of the three measures gave comparable results, it is recommended that relative survival rates are used with expected survival adjusted for social class when studying social class variation in cancer patient survival. If this is not an available option, it is recommended that corrected survival rates are used. Relative survival rates without the social class correction overestimate social class differences and should be used with caution.

Adolescent↗