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Sahlgren HAI, Elfgren K, Sparen P, Elfstrom MK. Colposcopic performance in a birth cohort previously eligible for human papillomavirus vaccination. Am J Obstet Gynecol 2022; 226:704.e1-704.e9. [PMID: 34954217 DOI: 10.1016/j.ajog.2021.11.1372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sweden started subsidized quadrivalent human papillomavirus vaccination for girls aged 13 to 17 in 2007. Since 2012, vaccination has been offered to all girls aged 10 to 12 within a school-based vaccination program, with a coverage of 80% or more. In addition, the vaccine has been offered on-demand as catch-up vaccination for girls aged 13 to 18, with a cumulative coverage of 55% to 60%. Since the first women in Sweden eligible for human papillomavirus vaccination entered the cervical screening program, questions on how to evaluate colposcopic findings among vaccinated women have arisen. Evidence is inconsistent on whether colposcopic features for the detection of cervical lesions are influenced by specific human papillomavirus genotypes and what role they can play in the prevention of invasive cervical cancer in vaccinated women. OBJECTIVE The primary objective of the study was to compare colposcopic evaluation in vaccinated and unvaccinated women entering the organized cervical screening program. STUDY DESIGN Women in the 1994 and 1995 birth cohorts who entered the cervical screening program at age 23 in 1 region in Sweden were identified. Colposcopy was performed within 2 to 4 months after a positive screening result in accordance with national guidelines. Colposcopic performance was evaluated according to national guidelines with the Swede score and colposcopic impression. Punch biopsies were taken from colposcopic lesions and as "random biopsies" in the absence of lesions. These biopsies were used as the gold standard for the analysis. An endocervical sample was analyzed for cytologic findings and detection of 14 high-risk human papillomavirus genotypes. All colposcopic imaging was saved digitally for re-review. Vaccination status was obtained through linkage to national vaccination registries. Results were compared between vaccinated and unvaccinated women. RESULTS In 2018 and 2019, 160 out of 165 (98%) women with a positive screening result attended colposcopy, of which 90 (56%) were vaccinated and 70 (44%) were unvaccinated. Only 7 out of 90 (5%) women in the vaccinated group were human papillomavirus 16/18-positive, compared with 23 out of 70 (33%) in the unvaccinated group (P<.001). There was a total of 61 out of 160 (38%) women with high-grade lesions-33 out of 90 (37%) in the vaccinated group and 28 out of 70 (40%) in the unvaccinated group (P=.697). There was 64% (21/33) of vaccinated women and 75% (21/28) of unvaccinated women with high-grade squamous intraepithelial lesions who had a Swede score of 6 to 10 (indicating high-grade squamous intraepithelial lesions) (P=.124). The sensitivity was slightly higher for the detection of high-grade squamous intraepithelial lesions in unvaccinated women using both colposcopic tests (Swede score, 0.67 vs 0.75; colposcopic impression, 0.67 vs 0.68), but the difference was not statistically significant. CONCLUSION We found no statistically significant difference between the colposcopic evaluation of vaccinated and unvaccinated women, although human papillomavirus vaccination reduced the prevalence of human papillomavirus 16/18 infection in human papillomavirus-vaccinated women. Our results indicate that colposcopic examination is still a useful tool in vaccinated women entering the organized cervical screening program.
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Affiliation(s)
- Hanna A I Sahlgren
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; Department of Obstetrics and Gynecology, Falun Hospital, Falun, Sweden; Regional Cancer Center Uppsala, Uppsala, Sweden.
| | - Kristina Elfgren
- Division of Obstetrics and Gynecology, Department of Clinical Science Intervention and Technology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Pär Sparen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Miriam K Elfstrom
- Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden; Regional Cancer Center Stockholm-Gotland, Stockholm, Sweden
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Koenecke A, Powell M, Xiong R, Shen Z, Fischer N, Huq S, Khalafallah AM, Trevisan M, Sparen P, Carrero JJ, Nishimura A, Caffo B, Stuart EA, Bai R, Staedtke V, Thomas DL, Papadopoulos N, Kinzler KW, Vogelstein B, Zhou S, Bettegowda C, Konig MF, Mensh B, Vogelstein JT, Athey S. Alpha-1 adrenergic receptor antagonists to prevent hyperinflammation and death from lower respiratory tract infection. ArXiv 2021:arXiv:2004.10117v8. [PMID: 32550250 PMCID: PMC7280904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Revised: 08/02/2021] [Indexed: 06/11/2023]
Abstract
In severe viral pneumonia, including Coronavirus disease 2019 (COVID-19), the viral replication phase is often followed by hyperinflammation, which can lead to acute respiratory distress syndrome, multi-organ failure, and death. We previously demonstrated that alpha-1 adrenergic receptor ($\alpha_1$-AR) antagonists can prevent hyperinflammation and death in mice. Here, we conducted retrospective analyses in two cohorts of patients with acute respiratory distress (ARD, n=18,547) and three cohorts with pneumonia (n=400,907). Federated across two ARD cohorts, we find that patients exposed to $\alpha_1$-AR antagonists, as compared to unexposed patients, had a 34% relative risk reduction for mechanical ventilation and death (OR=0.70, p=0.021). We replicated these methods on three pneumonia cohorts, all with similar effects on both outcomes. All results were robust to sensitivity analyses. These results highlight the urgent need for prospective trials testing whether prophylactic use of $\alpha_1$-AR antagonists ameliorates lower respiratory tract infection-associated hyperinflammation and death, as observed in COVID-19.
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Koenecke A, Powell M, Xiong R, Shen Z, Fischer N, Huq S, Khalafallah AM, Trevisan M, Sparen P, Carrero JJ, Nishimura A, Caffo B, Stuart EA, Bai R, Staedtke V, Thomas DL, Papadopoulos N, Kinzler KW, Vogelstein B, Zhou S, Bettegowda C, Konig MF, Mensh BD, Vogelstein JT, Athey S. Alpha-1 adrenergic receptor antagonists to prevent hyperinflammation and death from lower respiratory tract infection. eLife 2021; 10:61700. [PMID: 34114951 PMCID: PMC8195605 DOI: 10.7554/elife.61700] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 05/11/2021] [Indexed: 01/16/2023] Open
Abstract
In severe viral pneumonia, including Coronavirus disease 2019 (COVID-19), the viral replication phase is often followed by hyperinflammation, which can lead to acute respiratory distress syndrome, multi-organ failure, and death. We previously demonstrated that alpha-1 adrenergic receptor (⍺1-AR) antagonists can prevent hyperinflammation and death in mice. Here, we conducted retrospective analyses in two cohorts of patients with acute respiratory distress (ARD, n = 18,547) and three cohorts with pneumonia (n = 400,907). Federated across two ARD cohorts, we find that patients exposed to ⍺1-AR antagonists, as compared to unexposed patients, had a 34% relative risk reduction for mechanical ventilation and death (OR = 0.70, p = 0.021). We replicated these methods on three pneumonia cohorts, all with similar effects on both outcomes. All results were robust to sensitivity analyses. These results highlight the urgent need for prospective trials testing whether prophylactic use of ⍺1-AR antagonists ameliorates lower respiratory tract infection-associated hyperinflammation and death, as observed in COVID-19.
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Affiliation(s)
- Allison Koenecke
- Institute for Computational & Mathematical Engineering, Stanford UniversityStanfordUnited States
| | - Michael Powell
- Department of Biomedical Engineering, Institute for Computational Medicine, The Johns Hopkins UniversityBaltimoreUnited States
| | - Ruoxuan Xiong
- Management Science & Engineering, Stanford UniversityStanfordUnited States
| | - Zhu Shen
- Department of Statistics, Stanford UniversityStanfordUnited States
| | - Nicole Fischer
- The Johns Hopkins University School of MedicineBaltimoreUnited States
| | - Sakibul Huq
- Department of Neurosurgery and Neurology, The Johns Hopkins University School of MedicineBaltimoreUnited States
| | - Adham M Khalafallah
- Department of Neurosurgery and Neurology, The Johns Hopkins University School of MedicineBaltimoreUnited States
| | - Marco Trevisan
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, SwedenSolnaSweden
| | - Pär Sparen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, SwedenSolnaSweden
| | - Juan J Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, SwedenSolnaSweden
| | - Akihiko Nishimura
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health at Johns Hopkins UniversityBaltimoreUnited States
| | - Brian Caffo
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health at Johns Hopkins UniversityBaltimoreUnited States
| | - Elizabeth A Stuart
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health at Johns Hopkins UniversityBaltimoreUnited States
| | - Renyuan Bai
- Department of Neurosurgery and Neurology, The Johns Hopkins University School of MedicineBaltimoreUnited States
| | - Verena Staedtke
- Department of Neurosurgery and Neurology, The Johns Hopkins University School of MedicineBaltimoreUnited States
| | - David L Thomas
- The Johns Hopkins University School of MedicineBaltimoreUnited States
| | - Nickolas Papadopoulos
- Ludwig Center, Lustgarten Laboratory, and the Howard Hughes Medical Institute at The Johns Hopkins Kimmel Cancer CenterBaltimoreUnited States
| | - Ken W Kinzler
- Ludwig Center, Lustgarten Laboratory, and the Howard Hughes Medical Institute at The Johns Hopkins Kimmel Cancer CenterBaltimoreUnited States
| | - Bert Vogelstein
- Ludwig Center, Lustgarten Laboratory, and the Howard Hughes Medical Institute at The Johns Hopkins Kimmel Cancer CenterBaltimoreUnited States
| | - Shibin Zhou
- Ludwig Center, Lustgarten Laboratory, and the Howard Hughes Medical Institute at The Johns Hopkins Kimmel Cancer CenterBaltimoreUnited States
| | - Chetan Bettegowda
- The Johns Hopkins University School of MedicineBaltimoreUnited States,Ludwig Center, Lustgarten Laboratory, and the Howard Hughes Medical Institute at The Johns Hopkins Kimmel Cancer CenterBaltimoreUnited States
| | - Maximilian F Konig
- Division of Rheumatology, Department of Medicine, The Johns Hopkins University School of MedicineBaltimoreUnited States
| | - Brett D Mensh
- Janelia Research Campus, Howard Hughes Medical InstituteAshburnUnited States
| | - Joshua T Vogelstein
- Department of Biomedical Engineering, Institute for Computational Medicine, The Johns Hopkins UniversityBaltimoreUnited States,Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health at Johns Hopkins UniversityBaltimoreUnited States
| | - Susan Athey
- Stanford Graduate School of Business, Stanford UniversityStanfordUnited States
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Michalek IM, Kinnunen TI, Kjaerheim K, Lynge E, Martinsen JI, Sparen P, Tryggvadottir L, Weiderpass E, Pukkala E. Smoking-adjusted risk of kidney cancer by occupation: a population-based cohort study of Nordic men. Acta Oncol 2020; 59:582-587. [PMID: 32009517 DOI: 10.1080/0284186x.2020.1714722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 01/08/2020] [Indexed: 12/28/2022]
Abstract
Background: Evidence suggests that among some occupational groups, there is an elevated risk of kidney cancer. This might, however, derive from a difference in smoking habits across occupational groups. The objective of this study was to determine smoking-adjusted occupational variation in the incidence of kidney cancer in Nordic males.Material and Methods: The source population for this study consisted of 7.4 million men from Denmark, Iceland, Finland, Norway, and Sweden. Data on occupation were obtained from national censuses conducted in the years 1960-1990. Data on cancer cases came from national cancer registries. A proxy for the occupation-specific smoking prevalence among all Nordic men was calculated based on the occupation-specific smoking prevalence and lung cancer incidence data for Finnish men. Smoking-adjusted standardized incidence ratio (SIRadj) with 95% confidence intervals (95%CI) were calculated for each occupational group.Results: The highest SIRadj estimates were observed in dentists (1.32, 95%CI 1.06-1.62), journalists (1.20, 95%CI 1.00-1.42), physicians (1.19, 95%CI 1.03-1.36), public safety workers (1.18, 95%CI 1.10-1.26), administrators (1.17, 95%CI 1.13-1.22), military personnel (1.16, 95%CI 1.05-1.28), and religious workers (1.17, 95%CI 1.09-1.26). The lowest SIRadj was observed among forestry workers (0.82, 95%CI 0.76-0.88).Conclusions: Tobacco smoking plays an important role in the occupational variation in the risk of kidney cancer. The smoking-adjusted incidence of kidney cancer was increased in dentists, physicians, journalists, administrators, and public safety workers.
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Affiliation(s)
- Irmina Maria Michalek
- Faculty of Social Sciences, Tampere University, Tampere, Finland
- Women-Mother-Child Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Tarja I Kinnunen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Kristina Kjaerheim
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
| | - Elsebeth Lynge
- Nykøbing Falster Hospital, University of Copenhagen, Denmark
| | - Jan Ivar Martinsen
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
| | - Pär Sparen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Laufey Tryggvadottir
- Icelandic Cancer Registry, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Elisabete Weiderpass
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Eero Pukkala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
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Talibov M, Hansen J, Heikkinen S, Martinsen JI, Sparen P, Tryggvadottir L, Weiderpass E, Pukkala E. RE: "Comment on: "Occupational exposures and male breast cancer: A nested case-control study in the Nordic countries"". Breast 2020; 50:151-152. [PMID: 31704090 PMCID: PMC7375536 DOI: 10.1016/j.breast.2019.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 10/25/2019] [Indexed: 11/26/2022] Open
Affiliation(s)
- Madar Talibov
- Faculty of Social/Health Sciences, University of Tampere, Tampere, Finland.
| | - Johnni Hansen
- The Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Sanna Heikkinen
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | | | - Pär Sparen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Laufey Tryggvadottir
- Icelandic Cancer Registry, Faculty of Medicine, Reykjavik, Iceland; University of Iceland, Reykjavik, Iceland
| | | | - Eero Pukkala
- Faculty of Social/Health Sciences, University of Tampere, Tampere, Finland; Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
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Isendahl J, Giske CG, Hammar U, Sparen P, Tegmark Wisell K, Ternhag A, Nauclér P. Temporal Dynamics and Risk Factors for Bloodstream Infection With Extended-spectrum β-Lactamase-producing Bacteria in Previously-colonized Individuals: National Population-based Cohort Study. Clin Infect Dis 2020; 68:641-649. [PMID: 29961883 DOI: 10.1093/cid/ciy539] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 06/28/2018] [Indexed: 12/11/2022] Open
Abstract
Background Little is known of the long-term risks of bloodstream infection (BSI) with extended spectrum β-lactamase-producing Enterobacteriaceae (EPE) in previously-colonized individuals. We investigated EPE-BSI risks and associated risk factors during 6 years following EPE colonization. Methods We performed a population-based cohort study in Sweden using national health registers. Subjects were followed from their first EPE finding in feces (n = 5513) or urine (n = 17189). The effects of co-morbidity, sociodemography, and outpatient antibiotic dispensation on EPE-BSI risks were assessed. The EPE-BSI risks were compared to those of 45161 matched population-based reference subjects. Results The cumulative 6-year EPE-BSI incidences were 3.8%, 1.6%, and 0.02% in the urine, feces, and reference cohorts, respectively. The incidences decreased exponentially during the first 6-12 months. Among EPE-exposed subjects, urological disorders were associated with the highest adjusted cause-specific hazard ratio (aCSHR) for subsequent EPE-BSIs (3.40, 95% confidence interval 2.47-4.69). The aCSHRs were between 1.62-2.20 for male sex, immunosuppression, diabetes, malignancy, lung disease, baseline urine source, and Klebsiella pneumoniae, compared to the Escherichia coli baseline sample. Antibiotics with selective activity against gram-negative bacilli-but mostly not EPE (trimethoprim-sulfamethoxazole, fluoroquinolones, oral cephalosporins, and penicillins with extended spectrums)-and pivmecillinam were associated with doubled EPE BSI risk during the 3 months after antibiotic dispensation in EPE-colonized subjects. Conclusions EPE in urine or feces is a substantial risk factor for subsequent EPE-BSIs, but the risk declines rapidly during the first year after detection. In EPE-colonized individuals, specific risk factors can be used to identify subgroups for targeted interventions, such as eradication therapy.
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Affiliation(s)
- Joakim Isendahl
- Department of Medicine Solna, Unit for Infectious Diseases, Karolinska University Hospital
| | - Christian G Giske
- Department of Laboratory Medicine, Laboratory Building L2:02, Karolinska University Hospital Laboratory
| | - Ulf Hammar
- Institute of Environmental Medicine, C6, Biostatistics
| | - Pär Sparen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm
| | | | - Anders Ternhag
- Department of Medicine Solna, Unit for Infectious Diseases, Karolinska University Hospital.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Pontus Nauclér
- Department of Medicine Solna, Unit for Infectious Diseases, Karolinska University Hospital.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
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Talibov M, Hansen J, Heikkinen S, Martinsen JI, Sparen P, Tryggvadottir L, Weiderpass E, Pukkala E. Occupational exposures and male breast cancer: A nested case-control study in the Nordic countries. Breast 2019; 48:65-72. [PMID: 31539869 DOI: 10.1016/j.breast.2019.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/14/2019] [Accepted: 09/07/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Male breast cancer (MBC) is a rare and understudied disease. There is limited evidence on association between environmental and occupational agents and MBC. Some similarities in risk factors may be shared with female breast cancer. We evaluated solvents, metals, exhaust gases and other agents in relation to MBC within the large Nordic Occupational Cancer Study (NOCCA). METHODS The study included 1469 MBC cases and 7345 controls from Finland, Iceland and Sweden, matched for the date of birth, sex and country. Cases were identified through national cancer registries. Data on occupation and other demographic indicators were collected from census records and population registries. Overall, 24 occupational exposures were assessed. Exposure estimates were assigned by linking job titles to job-exposure matrices (NOCCA-JEM). Odds ratios (OR) and 95% confidence intervals (95% CI) were estimated by using conditional logistic regression models. RESULTS Significantly decreased overall OR was observed for physical workload (OR = 0.78, 95% CI 0.67-0.91). Protective effect of physical workload was stronger by increasing exposure level with significant dose-response relationship (p-trend<0.01). Non-significantly increased ORs were observed for trichloroethylene, iron, lead, chromium, welding fumes and wood dust, and decreased ORs for asbestos, silica dust and perchloroethylene. However, these results were not consistent across all analyses. CONCLUSIONS The current study showed 20-25% protective effect for physical workload at work, while no strong evidence for other agents was observed.
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Affiliation(s)
- Madar Talibov
- Faculty of Social/Health Sciences, University of Tampere, Tampere, Finland.
| | - Johnni Hansen
- The Danish Cancer Society Research Center, Copenhagen, Denmark.
| | - Sanna Heikkinen
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland.
| | | | - Pär Sparen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Laufey Tryggvadottir
- Icelandic Cancer Registry, Reykjavik, Iceland, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
| | | | - Eero Pukkala
- Faculty of Social/Health Sciences, University of Tampere, Tampere, Finland; Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland.
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Michalek IM, Martinsen JI, Weiderpass E, Hansen J, Sparen P, Tryggvadottir L, Pukkala E. Heavy metals, welding fumes, and other occupational exposures, and the risk of kidney cancer: A population-based nested case-control study in three Nordic countries. Environ Res 2019; 173:117-123. [PMID: 30903816 DOI: 10.1016/j.envres.2019.03.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/22/2019] [Accepted: 03/08/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To determine whether occupational exposure to heavy metals (chromium (VI), iron, nickel, lead) and welding fumes is associated with the risk of kidney cancer and to describe whether other occupational exposures included in the Job Exposure Matrix of the Nordic Occupational Cancer (NOCCA) study are associated with the risk. MATERIALS AND METHODS Nested case-control study among individuals registered in population censuses in Finland, Iceland, and Sweden in 1960-1990. A total of 59,778 kidney cancer cases, and 298,890 controls matched on sex, age, and country. Cumulative occupational exposures to metals (chromium (VI), iron, nickel, lead), welding fumes, and 24 other occupational exposure covariates, lagged 0, 10, and 20 years. RESULTS Overall, there was no or very little association between kidney cancer and exposures studied. The risk was elevated in individuals with high exposure to asbestos (OR 1.19, 95%CI 1.08-1.31). The risk was significantly decreased for individuals characterized with high perceived physical workload (OR 0.86, 95%CI 0.82-0.91), high exposure to ultraviolet radiation (OR 0.85, 95%CI 0.79-0.92), and high exposure to wood dust (OR 0.82, 95%CI 0.71-0.94). The risk of kidney cancer under the age of 59 was elevated in individuals with high exposure to nickel (OR 1.49, 95%CI 1.03-2.17). The risk of kidney cancer in age 59-74 years was elevated for individuals with high exposure to iron (OR 1.41, 95%CI 1.07-1.85), and high exposure to welding fumes (OR 1.43, 95%CI 1.09-1.89). CONCLUSIONS The only markedly elevated risks of kidney cancer were seen for the highest exposures of nickel and iron/welding fumes in specific age strata.
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Affiliation(s)
| | - Jan Ivar Martinsen
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
| | - Elisabete Weiderpass
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway; Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway; Genetic Epidemiology Group, Folkhälsan Research Center and Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Johnni Hansen
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Pär Sparen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Laufey Tryggvadottir
- Icelandic Cancer Registry, Reykjavik, Iceland; Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Eero Pukkala
- Faculty of Social Sciences, University of Tampere, Finland; Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
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Michalek IM, Martinsen JI, Weiderpass E, Kjaerheim K, Lynge E, Sparen P, Tryggvadottir L, Pukkala E. Occupation and risk of cancer of the renal pelvis in Nordic countries. BJU Int 2018; 123:233-238. [DOI: 10.1111/bju.14533] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Jan Ivar Martinsen
- Department of Research; Cancer Registry of Norway; Institute of Population-Based Cancer Research; Oslo Norway
| | - Elisabete Weiderpass
- Department of Research; Cancer Registry of Norway; Institute of Population-Based Cancer Research; Oslo Norway
- Department of Community Medicine; Faculty of Health Sciences; University of Tromsø; Arctic University of Norway; Tromsø Norway
- Genetic Epidemiology Group; Folkhälsan Research Centre and Faculty of Medicine; University of Helsinki; Helsinki Finland
- Department of Medical Epidemiology and Biostatistics; Karolinska Institutet; Stockholm Sweden
| | - Kristina Kjaerheim
- Department of Research; Cancer Registry of Norway; Institute of Population-Based Cancer Research; Oslo Norway
| | - Elsebeth Lynge
- Centre for Epidemiology and Screening; Institute of Public Health; University of Copenhagen; Copenhagen Denmark
| | - Pär Sparen
- Department of Medical Epidemiology and Biostatistics; Karolinska Institutet; Stockholm Sweden
| | | | - Eero Pukkala
- Faculty of Social Sciences; University of Tampere; Tampere Finland
- Finnish Cancer Registry; Institute for Statistical and Epidemiological Cancer Research; Helsinki Finland
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10
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Katuwal S, Martinsen JI, Kjaerheim K, Sparen P, Tryggvadottir L, Lynge E, Weiderpass E, Pukkala E. Occupational variation in the risk of female breast cancer in the Nordic countries. Cancer Causes Control 2018; 29:1027-1038. [DOI: 10.1007/s10552-018-1076-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 08/23/2018] [Indexed: 12/31/2022]
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Plato N, Martinsen JI, Kjaerheim K, Kyyronen P, Sparen P, Weiderpass E. Mesothelioma in Sweden: Dose-Response Analysis for Exposure to 29 Potential Occupational Carcinogenic Agents. Saf Health Work 2018; 9:290-295. [PMID: 30370160 PMCID: PMC6129996 DOI: 10.1016/j.shaw.2018.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 04/10/2018] [Indexed: 11/30/2022] Open
Abstract
Background There is little information on the dose-response relationship between exposure to occupational carcinogenic agents and mesothelioma. This study aimed to investigate this association as well as the existence of agents other than asbestos that might cause mesothelioma. Methods The Swedish component of the Nordic Occupational Cancer (NOCCA) study consists of 6.78 million individuals with detailed information on occupation. Mesothelioma diagnoses recorded in 1961-2009 were identified through linkage to the Swedish Cancer Registry. We determined cumulative exposure, time of first exposure, and maximum exposure intensity by linking data on occupation to the Swedish NOCCA job-exposure matrix, which includes 29 carcinogenic agents and corresponding exposure for 283 occupations. To assess the risk of mesothelioma, we used conditional logistic regression models to estimate hazard ratios and 95% confidence intervals. Results 2,757 mesothelioma cases were identified in males, including 1,416 who were exposed to asbestos. Univariate analyses showed not only a significant excess risk for maximum exposure intensity, with a hazard ratio of 4.81 at exposure levels 1.25-2.0 fb/ml but also a clear dose-response effect for cumulative exposure with a 30-, 40-, and 50-year latency time. No convincing excess risk was revealed for any of the other carcinogenic agents included in the Swedish NOCCA job-exposure matrix. Conclusion When considering asbestos exposure, past exposure, even for short periods, might be enough to cause mesothelioma of the pleura later in life.
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Affiliation(s)
- Nils Plato
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jan I Martinsen
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
| | - Kristina Kjaerheim
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
| | | | - Pär Sparen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Elisabete Weiderpass
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland.,Department of Community Medicine, Faculty of Health Science, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
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Hadkhale K, Martinsen JI, Weiderpass E, Kjaerheim K, Lynge E, Sparen P, Tryggvadottir L, Pukkala E. 144 Smoking adjusted incidence of bladder cancer using proxy smoking from lung cancer in nordic males. Occup Med (Lond) 2018. [DOI: 10.1136/oemed-2018-icohabstracts.1056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Farioli A, Straif K, Brandi G, Curti S, Kjaerheim K, Martinsen JI, Sparen P, Tryggvadottir L, Weiderpass E, Biasco G, Violante FS, Mattioli S, Pukkala E. Occupational exposure to asbestos and risk of cholangiocarcinoma: a population-based case-control study in four Nordic countries. Occup Environ Med 2018; 75:191-198. [PMID: 29133597 PMCID: PMC5869450 DOI: 10.1136/oemed-2017-104603] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 09/01/2017] [Accepted: 09/28/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To assess the association between occupational exposure to asbestos and the risk of cholangiocarcinoma (CC). METHODS We conducted a case-control study nested in the Nordic Occupational Cancer (NOCCA) cohort. We studied 1458 intrahepatic CC (ICC) and 3972 extrahepatic CC (ECC) cases occurring among subjects born in 1920 or later in Finland, Iceland, Norway and Sweden. Each case was individually matched by birth year, gender and country to five population controls. The cumulative exposure to asbestos (measured in fibres (f)/ml × years) was assessed by applying the NOCCA job-exposure matrix to data on occupations collected during national population censuses (conducted in 1960, 1970, 1980/81 and 1990). Odds ratios (OR) and 95% CI were estimated using conditional logistic regression models adjusted by printing industry work. RESULTS We observed an increasing risk of ICC with cumulative exposure to asbestos: never exposed, OR 1.0 (reference category); 0.1-4.9 f/mL × years, OR 1.1 (95% CI 0.9 to 1.3); 5.0-9.9 f/mL × years, OR 1.3 (95% CI 0.9 to 2.1); 10.0-14.9 f/mL × years, OR 1.6 (95% CI 1.0 to 2.5); ≥15.0 f/mL × years, OR 1.7 (95% CI 1.1 to 2.6). We did not observe an association between cumulative asbestos exposure and ECC. CONCLUSIONS Our study provides evidence that exposure to asbestos might be a risk factor for ICC. Our findings also suggest that the association between ECC and asbestos is null or weaker than that observed for ICC. Further studies based on large industrial cohorts of asbestos workers and possibly accounting for personal characteristics and clinical history are needed.
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Affiliation(s)
- Andrea Farioli
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Kurt Straif
- International Agency for Research on Cancer, Lyon, France
| | - Giovanni Brandi
- Department of Experimental, Diagnostic, and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy
- ‘G. Prodi’ Interdepartmental Center for Cancer Research, University of Bologna, Bologna, Italy
| | - Stefania Curti
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Kristina Kjaerheim
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
| | - Jan Ivar Martinsen
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
| | - Pär Sparen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Laufey Tryggvadottir
- Icelandic Cancer Registry, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Elisabete Weiderpass
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
- Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland
| | - Guido Biasco
- Department of Experimental, Diagnostic, and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy
- ‘G. Prodi’ Interdepartmental Center for Cancer Research, University of Bologna, Bologna, Italy
| | | | - Stefano Mattioli
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Eero Pukkala
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
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Hadkhale K, MacLeod J, Demers PA, Martinsen JI, Weiderpass E, Kjaerheim K, Lynge E, Sparen P, Tryggvadottir L, Anne Harris M, Tjepkema M, Peters PA, Pukkala E. Occupational variation in incidence of bladder cancer: a comparison of population-representative cohorts from Nordic countries and Canada. BMJ Open 2017; 7:e016538. [PMID: 28780557 PMCID: PMC5629726 DOI: 10.1136/bmjopen-2017-016538] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES The objective of this study was to compare occupational variation of the risk of bladder cancer in the Nordic countries and Canada. METHODS In the Nordic Occupational Cancer study (NOCCA), 73 653 bladder cancer cases were observed during follow-up of 141.6 million person-years. In the Canadian Census Health and Environment Cohort (CanCHEC), 8170 cases were observed during the follow-up of 36.7 million person-years. Standardised incidence ratios with 95% CI were estimated for 53 occupations in the NOCCA cohort and HR with 95% CIs were estimated for 42 occupations in the CanCHEC. RESULTS Elevated risks of bladder cancer were observed among hairdressers, printers, sales workers, plumbers, painters, miners and laundry workers. Teachers and agricultural workers had reduced risk of bladder cancer in both cohorts. Chimney-sweeps, tobacco workers and waiters had about 1.5-fold risk in the Nordic countries; no risk estimates for these categories were given from the CanCHEC cohort. CONCLUSION We observed different occupational patterns in risk of bladder cancer in Nordic countries and Canada. The only occupation with similarly increased risk was observed among sales workers. Differences in smoking across occupational groups may explain some, but not all, of this variation.
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Affiliation(s)
- Kishor Hadkhale
- Department of Epidemiology, Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Jill MacLeod
- Occupational Cancer Research Centre, Toronto, Canada
| | - Paul A Demers
- Occupational Cancer Research Centre, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- CAREX Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Jan Ivar Martinsen
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
| | - Elisabete Weiderpass
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
- Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Kjaerheim
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
| | - Elsebeth Lynge
- Center for Epidemiology and Screening, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Pär Sparen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Laufey Tryggvadottir
- Icelandic Cancer Registry, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - M Anne Harris
- Occupational Cancer Research Centre, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- School of Occupational and Public Health, Ryerson University, Toronto, Canada
| | - Michael Tjepkema
- Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada
| | - Paul A Peters
- Department of Sociology and Economics, University of New Brunswick Fredericton Campus, New Brunswick, Canada
| | - Eero Pukkala
- Department of Epidemiology, Faculty of Social Sciences, University of Tampere, Tampere, Finland
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
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Hadkhale K, Martinsen JI, Weiderpass E, Kjaerheim K, Sparen P, Tryggvadottir L, Lynge E, Pukkala E. Occupational exposure to solvents and bladder cancer: A population‐based case control study in Nordic countries. Int J Cancer 2017; 140:1736-1746. [DOI: 10.1002/ijc.30593] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 12/14/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Kishor Hadkhale
- Department of EpidemiologyUniversity of TampereTampere Finland
| | - Jan Ivar Martinsen
- Cancer Registry of Norway, Department of Research, Institute of Population‐Based Cancer ResearchOslo Norway
| | - Elisabete Weiderpass
- Cancer Registry of Norway, Department of Research, Institute of Population‐Based Cancer ResearchOslo Norway
- Department of Community Medicine, Faculty of Health SciencesUniversity of Tromsø, The Arctic University of NorwayTromsø Norway
- Genetic Epidemiology Group, Folkhälsan Research CenterHelsinki Finland
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholm Sweden
| | - Kristina Kjaerheim
- Cancer Registry of Norway, Department of Research, Institute of Population‐Based Cancer ResearchOslo Norway
| | - Pär Sparen
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholm Sweden
| | - Laufey Tryggvadottir
- Icelandic Cancer RegistryReykjavik Iceland
- Faculty of MedicineUniversity of IcelandReykjavik Iceland
| | - Elsebeth Lynge
- Center for Epidemiology and Screening, Institute of Public Health, University of CopenhagenCopenhagen Denmark
| | - Eero Pukkala
- Department of EpidemiologyUniversity of TampereTampere Finland
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer ResearchHelsinki Finland
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Siew SSA, Martinsen JI, Weiderpass E, Kjaerheim K, Sparen P, Tryggvadottir L, Pukkala E. P048 Lifetime occupational exposure to wood dust and risk of nasal and nasopharyngeal cancer – a case-control study among men in four nordic countries. Cancer 2016. [DOI: 10.1136/oemed-2016-103951.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hadkhale K, Martinsen JI, Weiderpass E, Kjaerheim K, Lynge E, Sparen P, Tryggvadottir L, Pukkala E. P032 Occupational solvent exposure and risk of bladder cancer in the nordic countries. Cancer 2016. [DOI: 10.1136/oemed-2016-103951.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Malki N, Plone A, Koupil I, Hägg S, Tiikkaja S, Lambert P, Sparen P. Temporal trends in case-fatality of myocardial infarction and stroke by socioeconomic position in Sweden 1987-2010. Eur J Public Health 2013. [DOI: 10.1093/eurpub/ckt126.355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Leval A, Herweijer E, Arnheim-Dahlstrom L, Walum H, Frans E, Sparen P, Simard JF. Incidence of Genital Warts in Sweden Before and After Quadrivalent Human Papillomavirus Vaccine Availability. J Infect Dis 2012; 206:860-6. [DOI: 10.1093/infdis/jis405] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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20
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Riska A, Martinsen JI, Kjaerheim K, Lynge E, Sparen P, Tryggvadottir L, Weiderpass E, Pukkala E. Occupation and risk of primary fallopian tube carcinoma in Nordic countries. Int J Cancer 2011; 131:186-92. [PMID: 21805475 DOI: 10.1002/ijc.26337] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 07/05/2011] [Indexed: 12/27/2022]
Abstract
The aetiology of primary Fallopian tube carcinoma (PFTC) is poorly understood. Occupational exposures may contribute to PFTC risk. We studied incidence of PFTC in occupational categories in the Nordic female population aged 30-64 years during the 1960, 1970, 1980/1981 and/or 1990 censuses in Denmark, Finland, Iceland, Norway and Sweden. Standardized incidence ratios (SIRs) for the years following inclusion in the study up to 2005 were calculated for 53 occupations; the expected numbers of cases were based on PFTC incidence in the national populations. Altogether 2,206 PFTC cases were detected during follow up via data linkages with the Nordic cancer registries. Significantly increased risks of PFTC were observed for smelting workers (SIR 3.99, 95% confidence interval 1.46-8.68, Obs = 6), artistic workers (2.64, 1.44-4.43, Obs = 14), hairdressers (2.18, 1.41-3.22, Obs = 25), packers (1.62, 1.11-2.29, Obs = 32), nurses (1.49, 1.14-1.92, Obs = 60), shop workers (1.25, 1.07-1.46, Obs = 159) and clerical workers (1.20, 1.07-1.35, Obs = 271) and these sustained over times and different Nordic countries. There was a nonsignificant increased risk for PFTC among welders, printers, painters and chemical process workers. The risk was significantly and consistently low for women working in farming (0.68, 0.47-0.95, Obs = 34) and among economically inactive women (0.88, 0.82-0.94, Obs = 833). The possible role of occupational exposures to the PFTC risks found in this study must be further evaluated in studies with a possibility to adjust for possible confounding factors, such as reproductive and life-style factors, which was not possible in our study.
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Affiliation(s)
- A Riska
- Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Helsinki, Finland.
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Kjaerheim K, Martinsen JI, Lynge E, Gunnarsdottir HK, Sparen P, Tryggvadottir L, Weiderpass E, Pukkala E. Effects of occupation on risks of avoidable cancers in the Nordic countries. Eur J Cancer 2011; 46:2545-54. [PMID: 20843484 DOI: 10.1016/j.ejca.2010.07.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Accepted: 07/22/2010] [Indexed: 01/13/2023]
Abstract
Knowledge of cancer risk according to occupational affiliation is an essential part of formatting preventive actions aimed at the adult population. Herein, data on 10 major cancer sites amenable by life style exposures from the Nordic Occupational Cancer Study (NOCCA) are presented. All subjects aged 30-64 years participating in one or more national censuses in Denmark, Finland, Iceland, Norway, or Sweden between 1960 and 1990 were included in the cohort and followed up for cancer from inclusion until 2003/2005 via a linkage with the national cancer registries, and standardised incidence ratios (SIRs) were computed. Variation in risk across occupations was generally larger in men than in women. In men, the most consistent cluster with high risk of numerous cancer types included waiters, cooks and stewards, beverage workers, seamen, and chimney sweeps. Two clusters of occupations with generally low cancer risks were seen in both men and women. The first one comprised farmers, gardeners, and forestry workers, the second one included groups with high education, specifically those in health and pedagogical work. Although cancer risk varies by occupation, only a smaller part of the variation can be attributed to occupational exposures in the strict sense. Preventive measures at the work place are important to avoid established and new occupational health hazards. This study also indicates that the work place in addition should be seen as a useful arena for reaching groups of adults with more or less similar habits and attitudes for general health promotion.
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Melin A, Lundholm C, Malki N, Swahn ML, Sparen P, Bergqvist A. Endometriosis as a prognostic factor for cancer survival. Int J Cancer 2010; 129:948-55. [PMID: 20949560 DOI: 10.1002/ijc.25718] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Accepted: 09/21/2010] [Indexed: 12/24/2022]
Abstract
Studies have shown an increased risk of malignancies in women with endometriosis. Little is known about the impact of endometriosis on cancer survival. We investigated whether the survival after a diagnosis of a malignancy differs in women with a previously diagnosed endometriosis compared to other women. Women with a first time diagnosis of a malignancy in 1969-2005, were identified using the National Swedish Cancer Register (NSCR). By use of the National Swedish Patient Register (NSPR) we identified all women with a diagnosis of endometriosis during the same period and linked these patients with the data from the NSCR. The cohort comprised 4,278 women with endometriosis and a malignancy, and 41,831 randomly selected matched women without endometriosis. Cox regression was used for all calculations to obtain crude and adjusted cause specific mortality rates, measured as hazard ratios (HR) with 95% confidence intervals (CI). A total of 46,109 women entered the study. There was a statistically significant better survival for women with endometriosis for all malignancies combined (HR=0.92) and for breast cancer (HR=0.86) and ovarian cancer (HR=0.81) specifically. For breast cancer the survival enhancing effect in women with endometriosis decreased with increasing parity. There was poorer survival in malignant melanoma for women with endometriosis (HR=1.52). The survival in a malignancy is better in women with a previously diagnosed endometriosis compared to women without endometriosis especially for breast and ovarian cancers. The prognosis of malignant melanoma is poorer in women with endometriosis.
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Affiliation(s)
- A Melin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
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Jiang Y, Zhao J, Hua M, Zhen X, Yan G, Hu Y, Sun H, Selvaggi L, Zannoni GF, Tagliaferri V, De Cicco S, Vellone VG, Romualdi D, Lanzone A, Guido M, Fassbender A, Vodolazkaia AV, Bossuyt XB, Kyama MK, Meuleman CM, Peeraer KP, Tomassetti CT, D'Hooghe TM, Lumini A, Nanni L, Manna C, Pappalardo S, Melin A, Lundholm C, Malki N, Swahn ML, Sparen P, Bergqvist A, Manna C, Crescenzi F, Farrag A, Sallam HN, Zou L, Ding G, Zhang R, Sheng J, Huang H, von Kleinsorgen C, Wilson T, Thiel-Moder U, Ebert AD, Reinfandt M, Papadopolous T, Melo AS, Rodrigues JK, Dib LA, Andrade AZ, Donabela FC, Ferriani RA, Navarro PA, Tocci A, Royo P, Lucchini C, Ramos P, Alcazar JL, Habara T, Terada S, Yoshioka N, Hayashi N, Haouzi D, Assou S, Monzo C, Anahory T, Dechaud H, De Vos J, Hamamah S, Gonzalez-Ramos R, Rojas C, Rocco J, Poch A, Sovino H, Kohen P, Munoz A, Devoto L, Aygen MA, Atakul T, Oner G, Ozgun MT, Sahin Y, Ozturk F, Li R, Qiao J, Zhylkova I, Feskov A, Feskova I, Somova O, Chumakova N, Bontekoe S, Blake D, Heineman MJ, Williams EC, Johnson NP, Motta A, Colaci D, Horton M, Faut M, Bisioli C, Kopcow L, de Zuniga I, Wiener-Megnazi Z, Khaytov M, Lahav - Baratz S, Shiloh H, Koifman M, Oslander R, Dirnfeld M, Sundqvist J, Andersson KL, Scarselli G, Gemzell-Danielsson K, Lalitkumar PGL, Tokushige N, Markham R, Crossett B, Ahn S, Nelaturi V, Khan A, Fraser IS, Van Vaerenbergh I, Fatemi HM, Blockeel C, Van Lommel L, In't Veld P, Schuit F, Kolibianakis EM, Devroey P, Bourgain C, Sugino N, Tamura I, Lee R, Maekawa R, Gelbaya T, Gordts S, D'Hooghe TN, Gergolet M, Nardo LG, Yu H, Wang H, Huang H, Lee C, Soong Y, Kremenska Y, Masliy Y, Goncharova Y, Kremenskoy M, Veselovskyy V, Zukin V, Sudoma I, Delgado-Rosas F, Gomez R, Tamarit S, Abad A, Simon C, Pellicer A, Racicot M, Dean NL, Antaki R, Menard S, Kadoch IJ, Garcia-Guzman R, Cabrera Romero L, Hernandez J, Palumbo A, Marshall E, Lowry J, Maybin JA, Collins F, Critchley HOD, Saunders PTK, Chaudhury K, Jana SK, Banerjee P, Mukherjee S, Chakravarty BN, Allegra A, Marino A, Lama A, Santoro A, Agueli C, Mazzola S, Volpes A, Delvoux B, de Graaff AA, D'Hooghe TM, Kyama CM, Dunselman GAJ, Romano A, Caccavo D, Pellegrino NM, Totaro I, Panzarino M, Nardelli C, Depalo R, Flores R, Montanana V, Monzo A, Polo P, Garcia-Gimeno T, Cabo A, Rubio JM, Pellicer A, de Graaff AA, Dunselman GAJ, Beets GL, van Lankveld JJ, Kim HY, Lee BS, Cho SH, Choi YS, Seo SK, Lee KE, Yang HI, Abubakirov A, Vacheyshvili T, Krechetova L, Ziganshina M, Demura T, Nazarenko T, Fulop I, Rucz A, Herczegh SZ, Ujvari A, Takacs SZ, Szakonyi T, Lopez - Muniz A, Zamora L, Serra O, Guix C, Lopez-Teijon M, Benadiva C, Alvarez JG, Goudakou M, Karkanaki A, Kalogeraki A, Mataliotakis I, Kalogiannidis I, Prapas I, Hosie M, Thomson KJ, Penny CB, Thomson KJ, Penny C, Hosie MJ, McKinnon B, Klaeser B, Bersinger N, Mueller MD, Horcajadas JA, Martinez-Conejero JA, Montesinos M, Morgan M, Fortuno S, Simon C, Pellicer A, Yi KW, Shin JH, Park HT, Kim T, Kim SH, Hur JY, Chan RWS, Chan YY, Ng EHY, Yeung WSB, Santulli P, Borghese B, Chopin N, Marcellin L, de Ziegler D, Chapron C, Elnashar A, Badawy A, Mosbah A, Tzioras S, Polyzos NP, Messini CI, Papanikolaou EG, Valachis A, Patavoukas E, Mauri D, Badawy A, Messinis IE, Acar N, Hirota Y, Tranguch S, Daikoku T, Burnum KE, Xie H, Kodama A, Osuga Y, Ustunel I, Friedman DB, Caprioli RM, Dey SK, Mitra A, Sahu R, Pal M, Bhattachrayya AK, Bhattachrya J, Ferrero S, Remorgida V, Rollandi GA, Biscaldi E, Cho S, Choi YS, Kim HY, Seo SK, Yang HI, Lee KE, Shin JH, Lee BS, Arena E, Morando A, Remorgida V, Ferrero S, Tomazevic T, Ban-Frangez H, Virant-Klun I, Verdenik I, Pozlep B, Vrtacnik-Bokal E, Valenzano Menada M, Biscaldi E, Remorgida V, Morotti M, Venturini PL, Rollandi GA, Ferrero S, Dimitriadis E, Salamonsen LA, Hannan N, O'Connor O, Rombauts L, Stoikos C, Mahmoudi M, Shaikh A, Mousavifar N, Rastin M, Baharara J, Tabasi N, Takemura Y, Fujimoto A, Osuga Y, Tsutsumi R, Ooi N, Yano T, Taketani Y, Karkanaki A, Goudakou M, Kalogiannidis I, Panagiotidis I, Prapas Y, Zhang D, Lv PP, Ding GL, Zhang RJ, Zou LB, Xu GF, Gao HJ, Zhu YM, Sheng JZ, Huang HF, Martinez-Conejero JA, Labarta E, Alama P, Pellicer A, Horcajadas JA, Bosch E. Posters * Endometriosis, Endometrium and Implantation. Hum Reprod 2010. [DOI: 10.1093/humrep/de.25.s1.242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Nnoaham KE, Sivananthan S, Hummelshoj L, Jenkinson C, Webster P, Kennedy SH, Zondervan KT, Vodolazkaia A, Fassbender A, Kyama CM, Bokor A, Clerinx P, Gevaert O, Schols D, Huskens D, Meuleman C, Peeraer K, Tomassetti C, De Moor B, D'Hooghe TM, Opoien HK, Fedorcsak P, Abyholm T, Tanbo TG, Tanbo TG, Kavallaris A, Hornemann A, Bohlmann M, Griesinger G, Chalvatzas N, Diedrich K, Benaglia L, Pasin R, Somigliana E, Vercellini P, Ragni G, Fedele L, Bergqvist A, Lundholm C, Malki N, Swahn ML, Sparen P, Melin A. Session 05: Endometriosis: Impact, Diagnosis and Surgery. Hum Reprod 2010. [DOI: 10.1093/humrep/de.25.s1.5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Osby U, Tiainen A, Backlund L, Edman G, Adler M, Hällgren J, Sennfält K, van Baardewijk M, Sparen P. Psychiatric admissions and hospitalization costs in bipolar disorder in Sweden. J Affect Disord 2009; 115:315-22. [PMID: 18930322 DOI: 10.1016/j.jad.2008.09.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Revised: 09/09/2008] [Accepted: 09/11/2008] [Indexed: 10/21/2022]
Affiliation(s)
- U Osby
- Department of Psychiatry, Danderyd University Hospital, Sweden.
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Villamor E, Sparen P, Cnattingius S. The Authors Reply. Am J Epidemiol 2008. [DOI: 10.1093/aje/kwn245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Andrae B, Kemetli L, Sparen P, Silfverdal L, Strander B, Ryd W, Dillner J, Tornberg S. Screening-Preventable Cervical Cancer Risks: Evidence From a Nationwide Audit in Sweden. J Natl Cancer Inst 2008; 100:622-9. [DOI: 10.1093/jnci/djn099] [Citation(s) in RCA: 269] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Isacsson G, Holmgren A, Osby U, Sparen P, Ahlner J. Forensic toxicology of 16,937 suicides in Sweden 1995-2005 indicates that the increased use of antidepressants caused the decrease in suicide. Eur Psychiatry 2008. [DOI: 10.1016/j.eurpsy.2008.01.1169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Gunnell AS, Ylitalo N, Sandin S, Sparen P, Adami HO, Ripatti S. A Longitudinal Swedish Study on Screening for Squamous Cell Carcinoma and Adenocarcinoma: Evidence of Effectiveness and Overtreatment. Cancer Epidemiol Biomarkers Prev 2007; 16:2641-8. [DOI: 10.1158/1055-9965.epi-07-0278] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Harlow BL, Vitonis AF, Sparen P, Cnattingius S, Joffe H, Hultman CM. 190: Incidence of Postpartum Psychosis in Women with and Without Pre-Pregnancy Psychiatric Hospitalizations. Am J Epidemiol 2005. [DOI: 10.1093/aje/161.supplement_1.s48a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- B L Harlow
- Department of Medical Epidemiology, Karolinska Institute and Ob/Gyn Epidemiology Center, Brigham and Women's Hospital, Boston, MA 02115
| | - A F Vitonis
- Department of Medical Epidemiology, Karolinska Institute and Ob/Gyn Epidemiology Center, Brigham and Women's Hospital, Boston, MA 02115
| | - P Sparen
- Department of Medical Epidemiology, Karolinska Institute and Ob/Gyn Epidemiology Center, Brigham and Women's Hospital, Boston, MA 02115
| | - S Cnattingius
- Department of Medical Epidemiology, Karolinska Institute and Ob/Gyn Epidemiology Center, Brigham and Women's Hospital, Boston, MA 02115
| | - H Joffe
- Department of Medical Epidemiology, Karolinska Institute and Ob/Gyn Epidemiology Center, Brigham and Women's Hospital, Boston, MA 02115
| | - C M Hultman
- Department of Medical Epidemiology, Karolinska Institute and Ob/Gyn Epidemiology Center, Brigham and Women's Hospital, Boston, MA 02115
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Abstract
OBJECTIVE To assess and characterise the risk of bladder cancer, and its relation to cyclophosphamide, in patients with Wegener's granulomatosis. METHODS In the population based, nationwide Swedish Inpatient Register a cohort of 1065 patients with Wegener's granulomatosis, 1969-95, was identified. Through linkage with the Swedish Cancer Register, all subjects in this cohort diagnosed with bladder cancer were identified. Nested within the cohort, a matched case-control study was performed to estimate the association between cyclophosphamide and bladder cancer using odds ratios (ORs) as relative risk. In the cohort the cumulative risk of bladder cancer after Wegener's granulomatosis, and the relative prevalence of a history of bladder cancer at the time of diagnosis of Wegener's granulomatosis, were also estimated. RESULTS The median cumulative doses of cyclophosphamide among cases (n = 11) and controls (n = 25) were 113 g and 25 g, respectively. The risk of bladder cancer doubled for every 10 g increment in cyclophosphamide (OR = 2.0, 95% confidence interval (CI) 0.8 to 4.9). Treatment duration longer than 1 year was associated with an eightfold increased risk (OR = 7.7, 95% CI 0.9 to 69). The absolute risk for bladder cancer in the cohort reached 10% 16 years after diagnosis of Wegener's granulomatosis, and a history of bladder cancer was (non-significantly) twice as common as expected at the time of diagnosis of Wegener's granulomatosis. CONCLUSION The results indicate a dose-response relationship between cyclophosphamide and the risk of bladder cancer, high cumulative risks in the entire cohort, and also the possibility of risk factors operating even before Wegener's granulomatosis.
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Affiliation(s)
- A Knight
- Department of Medicine, Uppsala University Hospital, SE-751 85 Uppsala, Sweden.
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Kleinerman RA, Boice JD, Storm HH, Sparen P, Andersen A, Pukkala E, Lynch CF, Hankey BF, Flannery JT. Second primary cancer after treatment for cervical cancer. An international cancer registries study. Cancer 1995; 76:442-52. [PMID: 8625126 DOI: 10.1002/1097-0142(19950801)76:3<442::aid-cncr2820760315>3.0.co;2-l] [Citation(s) in RCA: 166] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The pattern of second cancers after treatment for cervical cancer provides important information on the risk of radiation-induced malignancies. Large numbers of women survive many years and can be studied for late effects. METHODS Incident second cancers in 86,193 patients with cervical cancer reported to 13 population-based cancer registries in 5 countries were evaluated to estimate the risk of second cancer among very long term survivors. RESULTS Overall, 7543 second cancers were observed versus 6015 cancers expected based on population rates (observed/expected = 1.2). Lung cancer accounted for nearly half of the excess cancers. Among the 49,828 women treated with radiation, 3750 survived 30 or more years and a two-fold risk of cancers of heavily irradiated organs was seen. Most of the excess cancers were of the rectum, vagina, vulva, ovary, and bladder. Patterns of risk over time since treatment were consistent with a radiation etiology. Significant increases of nonchronic lymphocytic leukemia and cancers of the bone and kidney were also linked to radiotherapy. Women treated surgically were also at significant risk of second cancers, in all likelihood related to cigarette smoking and risk factors similar to those of cervical cancer. CONCLUSIONS Curative therapy for cervical cancer results in large numbers of long term survivors who develop second cancers very late in life. Radiation is an important cause of this increase and there is no evidence that risk returns to normal levels.
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Affiliation(s)
- R A Kleinerman
- Radiation Epidemiology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892-7362, USA
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Ljungman C, Adami HO, Bergqvist D, Sparen P, Bergström R. Risk factors for early lower limb loss after embolectomy for acute arterial occlusion: a population-based case-control study. Br J Surg 1991; 78:1482-5. [PMID: 1773332 DOI: 10.1002/bjs.1800781224] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
To identify risk factors for lower limb loss after arterial embolectomy a cohort of 1189 patients was studied. Detailed data were obtained for 165 patients who underwent a major amputation within 30 days of embolectomy and for 165 matched controls. The amputation risk was increased in patients with two or more myocardial infarctions (odds ratio (OR) 3.1, 95 per cent confidence interval (CI) 0.8-11.2), chronic ischaemia (OR 2.1, CI 0.9-4.9), long duration of symptoms (OR 4.3, CI 1.9-9.6, for greater than or equal to 25 h versus less than or equal to 6 h) or postoperative heart failure (OR 3.4, CI 1.8-6.5). Reduced risks were found in association with acute myocardial infarction (OR 0.3, CI 0.1-0.9) and postoperative anticoagulation treatment with warfarin (OR 0.3, CI 0.1-0.9). The independent prognostic value of chronic ischaemia and symptom duration, and the beneficial effect of postoperative anticoagulation gained additional support in multivariate analysis. We conclude that the risk of early amputation after arterial embolectomy or thrombectomy can be predicted by several clinical characteristics.
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Affiliation(s)
- C Ljungman
- Department of Surgery, University Hospital, Uppsala, Sweden
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