The dynamic growth of the skeleton during childhood and adolescence renders it vulnerable to adverse effects of cancer treatment. The lifetime risk and patterns of skeletal morbidity have not been ...described in a population‐based cohort of childhood cancer survivors. A cohort of 26 334 1‐year cancer survivors diagnosed before 20 years of age was identified from the national cancer registries of Denmark, Finland, Iceland and Sweden as well as a cohort of 127 531 age‐ and sex‐matched comparison subjects randomly selected from the national population registries in each country. The two cohorts were linked with data from the national hospital registries and the observed numbers of first‐time hospital admissions for adverse skeletal outcomes among childhood cancer survivors were compared to the expected numbers derived from the comparison cohort. In total, 1987 childhood cancer survivors had at least one hospital admission with a skeletal adverse event as discharge diagnosis, yielding a rate ratio (RR) of 1.35 (95% confidence interval, 1.29‐1.42). Among the survivors, we observed an increased risk for osteonecrosis with a RR of 25.9 (15.0‐44.5), osteoporosis, RR 4.53 (3.28‐6.27), fractures, RR 1.27 (1.20‐1.34), osteochondropathies, RR 1.57 (1.28‐1.92) and osteoarthrosis, RR 1.48 (1.28‐1.72). The hospitalization risk for any skeletal adverse event was higher among survivors up to the age of 60 years, but the lifetime pattern was different for each type of skeletal adverse event. Understanding the different lifetime patterns and identification of high‐risk groups is crucial for developing strategies to optimize skeletal health in childhood cancer survivors.
What's new?
The dynamic growth of the skeleton during childhood renders it vulnerable to adverse effects of cancer treatment. In this comprehensive, large‐scale population‐based retrospective cohort study, childhood cancer survivors were more likely to be hospitalised for skeletal adverse events than matched population comparison subjects. Although the risk of adverse events was highest in the period close to the cancer treatment, the excess risk continued for decades. Osteonecrosis, osteoporosis, fractures, osteochondropathies, and osteoarthrosis all showed different lifetime patterns. Understanding the lifetime patterns of skeletal adverse events and identifying high‐risk groups could help develop strategies to optimise skeletal health in childhood cancer survivors.
Airway micro-aspiration might contribute to the proposed associations between gastroesophageal reflux disease (GERD) and some lung diseases, including lung cancer. This study aimed to examine the ...hypothesis that antireflux surgery decreases the risk of small cell carcinoma, squamous cell carcinoma and adenocarcinoma of the lung differently depending on their location in relation to micro-aspiration.
Population-based cohort study including patients having undergone antireflux surgery during 1980–2014 in Denmark, Finland, Iceland, Norway or Sweden. Patients having undergone antireflux surgery were compared with two groups: 1) the corresponding background population, by calculating standardised incidence ratios (SIRs) with 95% confidence intervals (CIs) and 2) non-operated GERD-patients, by calculating hazard ratios (HRs) with 95% CIs using multivariable Cox regression with adjustment for sex, age, calendar period, country, chronic obstructive pulmonary disease and obesity diagnosis or type 2 diabetes.
Among all 812,617 GERD-patients, 46,996 (5.8%) had undergone antireflux surgery. The SIRs were statistically significantly decreased for small cell carcinoma (SIR = 0.57, 95% CI 0.41–0.77) and squamous cell carcinoma (SIR = 0.75, 95% CI 0.60–0.92), but not for adenocarcinoma of the lung (SIR = 0.90, 95% CI 0.76–1.06). The HRs were also below unity for small cell carcinoma (HR = 0.63, 95% CI 0.44–0.90) and squamous cell carcinoma (HR = 0.80, 95% CI 0.62–1.03), but not for adenocarcinoma of the lung (HR = 1.03, 95% CI 0.84–1.26). Analyses restricted to patients with objective GERD (reflux oesophagitis or Barrett's oesophagus) showed similar results.
This all-Nordic study indicates that patients who undergo antireflux surgery are at decreased risk of small cell carcinoma and squamous cell carcinoma of the lung, but not of adenocarcinoma of the lung.
•Among 812,617 patients with gastroesophageal reflux disease from the Nordic countries, 46,996 had undergone antireflux surgery.•Antireflux surgery decreased the risk of lung small cell carcinoma and squamous cell carcinoma.•Antireflux surgery did not decrease the risk of lung adenocarcinoma.•Analyses in patients with reflux oesophagitis or Barrett's oesophagus showed similar results.
The impact of an inherited BRCA2 mutation on the prognosis of women with breast cancer has not been well documented. We studied the effects of oestrogen receptor (ER) status, other prognostic factors ...and treatments on survival in a large cohort of BRCA2 mutation carriers.
We identified 285 breast cancer patients with a 999del5 BRCA2 mutation and matched them with 570 non-carrier patients. Clinical information was abstracted from patient charts and pathology records and supplemented by evaluation of tumour grade and ER status using archived tissue specimens. Univariate and multivariate hazard ratios (HR) were estimated for breast cancer-specific survival using Cox regression. The effects of various therapies were studied in patients treated from 1980 to 2012.
Among mutation carriers, positive ER status was associated with higher risk of death than negative ER status (HR=1.94; 95% CI=1.22-3.07, P=0.005). The reverse association was seen for non-carriers (HR=0.71; 95% CI: 0.51-0.97; P=0.03).
Among BRCA2 carriers, ER-positive status is an adverse prognostic factor. BRCA2 carrier status should be known at the time when treatment decisions are made.
Purpose
As obesity and type 2 diabetes (T2D) have been increasing worldwide, we investigated their association with breast cancer incidence in the Reykjavik Study.
Methods
During 1968–1996, ...approximately 10,000 women (mean age = 53 ± 9 years) completed questionnaires and donated blood samples. T2D status was classified according to self-report (
n
= 140) and glucose levels (
n
= 154) at cohort entry. A linkage with the Icelandic Cancer Registry provided breast cancer incidence through 2015. Cox regression with age as time metric and adjusted for known confounders was applied to obtain hazard ratios (HR) and 95% confidence intervals (CI).
Results
Of 9,606 participants, 294 (3.1%) were classified as T2D cases at cohort entry while 728 (7.8%) women were diagnosed with breast cancer during 28.4 ± 11.6 years of follow-up. No significant association of T2D (HR 0.95; 95% CI 0.56–1.53) with breast cancer incidence was detected except among the small number of women with advanced breast cancer (HR 3.30; 95% CI 1.13–9.62). Breast cancer incidence was elevated among overweight/obese women without (HR 1.18; 95% CI 1.01–1.37) and with T2D (HR 1.35; 95% CI 0.79–2.31). Height also predicted higher breast cancer incidence (HR 1.03; 95% CI 1.02–1.05). All findings were confirmed in women of the AGES–Reykjavik sub-cohort (
n
= 3,103) who returned for an exam during 2002–2006. With a 10% T2D prevalence and 93 incident breast cancer cases, the HR for T2D was 1.18 (95% CI 0.62–2.27).
Conclusions
These findings in a population with low T2D incidence suggest that the presence of T2D does not confer additional breast cancer risk and confirm the importance of height and excess body weight as breast cancer risk factors.
Background: Occupational exposure has been identified as the most important risk factor for bladder cancer second to smoking. The objective of this study was to estimate the occupational variation in ...risk of bladder cancer that is not attributable to smoking.
Material and methods: In the Nordic Occupational Cancer study (NOCCA), 111,458 cases of bladder cancer and 208,297 cases of lung cancer cases were observed among men in Denmark, Finland, Iceland, Norway and Sweden during 1961-2005. Relative smoking prevalence in an occupation was estimated based on standardized incidence ratio (SIR) for lung cancer in the given occupation. Crude and smoking-adjusted SIRs with 95% confidence intervals (CI) for bladder cancer were calculated for each occupation.
Results: The smoking-adjusted SIR for most of the occupations was closer to 1.00 than the unadjusted SIR. The highest statistically significant smoking-adjusted SIRs were observed among chimney sweeps (SIR 1.29, 95% CI 1.05-1.56), waiters (1.22, 1.07-1.38) hairdressers (1.14, 1.02-1.26), cooks and stewards (1.12, 1.01-1.25), printers (1.11, 1.04-1.18) and seamen (1.09, 1.03-1.14).
Conclusions: Smoking is a strong risk factor for bladder cancer but there may also be other factors in some specific occupations in addition to smoking. The occupational variation in risk of bladder cancer is small when adjusted for smoking, but risk increasing factors are indicated in some occupations.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
The aim of this study was to assess the effect of occupational solvent exposure on the risk of adult chronic lymphocytic leukemia (CLL). The current case–control study was nested in the Nordic ...Occupational Cancer Study (NOCCA) cohort. 20,615 CLL cases diagnosed in 1961–2005 in Finland, Iceland, Norway, and Sweden, and 103,075 population‐based controls matched by year of birth, sex, and country were included. Occupational histories for cases and controls were obtained from census records in 1960, 1970, 1980/1981, and 1990. Exposure to selected solvents was estimated by using the NOCCA job‐exposure matrix (NOCCA‐JEM). Odds ratios (OR) and 95% confidence intervals (95% CI) were estimated by using conditional logistic regression models. Overall, nonsignificant CLL risk elevations were observed for methylene chloride, perchloroethylene, and 1,1,1‐trichloroethane. Compared to unexposed, significantly increased risks were observed for cumulative perchloroethylene exposure ≤13.3 ppm‐years (OR = 1.85, 95% CI 1.16–2.96) and average life‐time perchloroethylene exposure ≤2.5 ppm (1.61, 95% CI 1.01–2.56) among women, and cumulative methylene chloride exposure ≤12.5 ppm‐years (OR = 1.19, 95% CI 1.01–1.41) and 12.5–74.8 ppm‐years (OR = 1.23, 95% CI 1.01–1.51) among men in an analysis with 5 years lag‐time, though without dose–response pattern. Decreased CLL risk was observed for aliphatic and alicyclic hydrocarbon solvents and toluene. This study did not support associations for solvent exposure and CLL. Observed weak associations for methylene chloride, perchloroethylene, 1,1,1‐trichloroethane exposures, aliphatic and alicyclic hydrocarbons and toluene were not consistent across sexes, and showed no gradient with amount of exposure.
What's new?
Exposure to organic solvents is associated with various negative health effects, including increased risk of certain blood cancers. Adult chronic lymphocytic leukemia (CLL) is potentially ranked among those malignancies, as causes for CLL remain poorly understood. In this population‐based investigation of CLL patients in the Nordic Occupational Cancer Study cohort, nonsignificant increases in CLL risk were detected for exposure to methylene chloride, perchloroethylene and 1,1,1‐trichloroethane. Relative to unexposed individuals, cumulative perchloroethylene exposure was linked to significantly increased CLL risk. Nonetheless, the absence of a dose–response pattern and inconsistent findings across sexes suggest that solvent exposure is unrelated to CLL.
Early-onset prostate cancer is often more aggressive and may have a different aetiology than later-onset prostate cancer, but has been relatively little studied to date. We evaluated occupation in ...relation to early- and later-onset prostate cancer in a large pooled study.
We used occupational information from census data in five Nordic countries from 1960 to 1990. We identified prostate cancer cases diagnosed from 1961 to 2005 by linkage of census information to national cancer registries and calculated standardised incidence ratios (SIRs) separately for men aged 30–49 and those aged 50 or older. We also conducted separate analyses by period of follow-up, 1961–1985 and 1986–2005, corresponding to pre- and post-prostate-specific antigen (PSA) screening.
For early-onset prostate cancer (n = 1521), we observed the highest SIRs for public safety workers (e.g. firefighters) (SIR = 1.71, 95% confidence interval CI: 1.23–2.31) and military personnel (SIR = 1.97, 95% CI: 1.31–2.85). These SIRs were significantly higher than the SIRs for later-onset disease (for public safety workers, SIR = 1.10, 95% CI: 1.07–1.14 and for military personnel, SIR = 1.09, 95% CI: 1.05–1.13; pheterogeneity = 0.005 and 0.002, respectively). Administrators and technical workers also demonstrated significantly increased risks for early-onset prostate cancer, but the SIRs did not differ from those of later-onset disease (pheterogeneity >0.05). While our early-onset finding for public safety workers was restricted to the post-PSA period, that for military personnel was restricted to the pre-PSA period.
Our results suggest that occupational exposures, particularly for military personnel, may be associated with early-onset prostate cancer. Further evaluation is needed to explain these findings.
•Public safety workers and military personnel had the highest standardised incidence ratios (SIRs) for early-onset prostate cancer (PCa).•Elevated SIR for public safety workers persisted after removing firefighters.•Administrators and technical workers also had elevated SIRs for early-onset PCa.•Military early-onset finding was restricted to the pre-prostate-specific antigen period.•Results provide clues about the aetiology of early-onset PCa, which is poorly understood.
Background Mutations in the BRCA2 gene are associated with an increased risk of prostate cancer, but it is not known whether they are associated with progression of the disease. We compared prostate ...cancer–specific survival, disease stage, and tumor grade between prostate cancer patients carrying the Icelandic BRCA2 999del5 founder mutation and noncarriers. Methods Using population-based registries, we identified all 596 prostate cancer patients who were diagnosed in Iceland during 1955 through 2004 among 29603 male relatives of unselected breast cancer probands. BRCA2 mutation status could be determined for 527 patients (88.4%). Stage and grade were abstracted from original records, blindly with respect to mutation status, for a subgroup of 89 patients that included all mutation carriers and, for each carrier, two control patients without the BRCA2 999del5 mutation who were matched to the carrier on years of diagnosis and birth. Hazard ratios (HRs) and 95% confidence intervals (CIs) for prostate cancer–specific survival were estimated using multivariable regression models. All statistical tests were two-sided. Results The mutation was carried by 30 patients (5.7%). Compared with noncarriers, BRCA2 999del5 mutation carriers had a lower mean age at diagnosis (69.0 years versus 74.0 years; P = .002), more advanced tumor stage (stages 3 or 4, 79.3% versus 38.6%; P<.001), higher tumor grade (grades G3–4, 84.0% versus 52.7%, P = .007), and shorter median survival time (2.1 years, 95% CI = 1.4 to 3.6 years, versus 12.4 years, 95% CI = 9.9 to 19.7 years). Carrying the BRCA2 999del5 mutation was also associated with an increased risk of dying from prostate cancer (adjusting for year of diagnosis and birth, HR = 3.42, 95% CI = 2.12 to 5.51); the association remained after adjustment for stage and grade (HR = 2.35, 95% CI = 1.08 to 5.11). The prognosis of BRCA2 999del5 mutation carriers was not associated with period of diagnosis or with relatedness to breast cancer probands. Conclusions The Icelandic BRCA2 999del5 founder mutation was strongly associated with rapidly progressing lethal prostate cancer.
Since 1980, sunbed use and travel abroad have dramatically increased in Iceland (64°–66°N). The authors assessed temporal trends in melanoma incidence by body site in Iceland in relation to sunbed ...use and travel abroad. Using joinpoint analysis, they calculated estimated annual percent changes (EAPCs) and identified the years during which statistically significant changes in EAPC occurred. Between 1954 and 2006, the largest increase in incidence in men was observed on the trunk (EAPC = 4.6%, 95% confidence interval: 3.2, 6.0). In women, the slow increase in trunk melanoma incidence before 1995 was followed by a significantly sharper increase in incidence, mainly among women aged less than 50 years, resembling an epidemic incidence curve (1995–2002: EAPC = 20.4%, 95% confidence interval: 9.3, 32.8). In 2002, the melanoma incidence on the trunk was higher than the incidence on the lower limbs for women. Sunbed use in Iceland expanded rapidly after 1985, mainly among young women, and in 2000, it was approximately 2 and 3 times the levels recorded in Sweden and in the United Kingdom, respectively. Travels abroad were more prevalent among older Icelanders. The high prevalence of sunbed use probably contributed to the sharp increase in the incidence of melanoma in Iceland.
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