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A 25-year follow-up of a population screened with faecal occult blood test in Finland.

https://arctichealth.org/en/permalink/ahliterature161415
Source
Acta Oncol. 2007;46(8):1103-6
Publication Type
Article
Date
2007
Author
Nea Malila
Matti Hakama
Eero Pukkala
Author Affiliation
Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Liisankatu 21 B, FI-001 70 Helsinki, Finland. nea.malila@cancer.fi
Source
Acta Oncol. 2007;46(8):1103-6
Date
2007
Language
English
Publication Type
Article
Keywords
Cohort Studies
Colorectal Neoplasms - diagnosis - epidemiology - mortality
Feasibility Studies
Female
Finland
Follow-Up Studies
Humans
Incidence
Male
Mass Screening - methods
Occult Blood
Patient compliance
Reagent kits, diagnostic
Sensitivity and specificity
Abstract
The aim of the study was to assess the feasibility of and possible selection to attend in colorectal cancer screening.
During the years 1979-1980, 1 785 men and women (born in 1917-1929) were invited to a pilot screening project for colorectal cancer. The screening method used was a guaiac-based faecal occult blood test repeated once if the initial test was positive.
Compliance was 69% and the test was positive in 19% of those attending. In a record linkage with the Finnish Cancer Registry, 47 colorectal cancer cases and 24 deaths from colorectal cancer were observed by the end of 2004. In all, the particular test method was not regarded specific enough for population screening. There was, however, no difference in cancer incidence between those who complied and those who did not when compared to the general population of same age and gender.
Compliance was found high enough to make screening feasible and there was no self selection of persons with low cancer risk to attend screening.
PubMed ID
17851857 View in PubMed
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Adult life after childhood cancer in Scandinavia: diabetes mellitus following treatment for cancer in childhood.

https://arctichealth.org/en/permalink/ahliterature105033
Source
Eur J Cancer. 2014 Apr;50(6):1169-75
Publication Type
Article
Date
Apr-2014
Author
Anna Sällfors Holmqvist
Jørgen H Olsen
Klaus Kaae Andersen
Sofie de Fine Licht
Lars Hjorth
Stanislaw Garwicz
Christian Moëll
Harald Anderson
Finn Wesenberg
Laufey Tryggvadottir
Nea Malila
John D Boice
Henrik Hasle
Jeanette Falck Winther
Author Affiliation
Paediatric Oncology and Haematology, Skåne University Hospital, Department of Clinical Sciences, Lund University, Lund, Sweden. Electronic address: anna.sallfors-holmqvist@med.lu.se.
Source
Eur J Cancer. 2014 Apr;50(6):1169-75
Date
Apr-2014
Language
English
Publication Type
Article
Keywords
Adolescent
Child
Child, Preschool
Cohort Studies
Comorbidity
Diabetes Mellitus, Type 1 - diagnosis - epidemiology
Diabetes Mellitus, Type 2 - diagnosis - epidemiology
Female
Humans
Infant
Infant, Newborn
Male
Middle Aged
Multivariate Analysis
Neoplasms - classification - epidemiology - therapy
Proportional Hazards Models
Registries - statistics & numerical data
Risk Assessment - statistics & numerical data
Risk factors
Scandinavia - epidemiology
Survivors - statistics & numerical data
Young Adult
Abstract
An increased risk for diabetes mellitus (DM) adds significantly to the burden of late complications in childhood cancer survivors. Complications of DM may be prevented by using appropriate screening. It is, therefore, important to better characterise the reported increased risk for DM in a large population-based setting.
From the national cancer registries of the five Nordic countries, a cohort of 32,903 1-year survivors of cancer diagnosed before the age of 20 between start of cancer registration in the 1940s and 1950s through 2008 was identified; 212,393 comparison subjects of the same age, gender and country were selected from national population registers. Study subjects were linked to the national hospital registers. Absolute excess risks (AERs) and standardised hospitalisation rate ratios (SHRRs) were calculated.
DM was diagnosed in 496 childhood cancer survivors, yielding an overall SHRR of 1.6 (95% confidence interval (CI), 1.5-1.8) and an AER of 43 per 100,000 person-years, increasing from approximately 20 extra cases of DM in ages 0-19 to more than 100 extra cases per 100,000 person-years in ages > or =50. The relative risks for DM were significantly increased after Wilms' tumour (SHRR, 2.9), leukaemia (2.0), CNS neoplasms (1.8), germ-cell neoplasms (1.7), malignant bone tumours (1.7) and Hodgkin's lymphoma (1.6). The risk for DM type 2 was slightly higher than that for type 1.
Childhood cancer survivors are at increased risk for DM, with absolute risks increasing throughout life. These findings underscore the need for preventive interventions and prolonged follow-up of childhood cancer survivors.
PubMed ID
24507548 View in PubMed
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Adverse Obstetric Outcomes Among Early-Onset Cancer Survivors in Finland.

https://arctichealth.org/en/permalink/ahliterature269216
Source
Obstet Gynecol. 2015 Oct;126(4):803-10
Publication Type
Article
Date
Oct-2015
Author
Johanna Melin
Sirpa Heinävaara
Nea Malila
Aila Tiitinen
Mika Gissler
Laura Madanat-Harjuoja
Source
Obstet Gynecol. 2015 Oct;126(4):803-10
Date
Oct-2015
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age of Onset
Cesarean Section - statistics & numerical data
Child
Child, Preschool
Female
Finland
Humans
Infant
Labor, Induced - statistics & numerical data
Neoplasms
Pregnancy
Survivors - statistics & numerical data
Young Adult
Abstract
To evaluate risk of adverse obstetric outcomes and operative deliveries in female cancer survivors (diagnosed younger than 35 years of age) compared with female siblings of survivors.
Nationwide cancer and birth registries were merged to identify 1,800 first postdiagnosis deliveries of female cancer survivors and 7,137 first deliveries of female siblings between January 1987 and December 2013. Multiple unconditional logistic regression models were used to estimate the risk for adverse obstetric outcomes and operative deliveries adjusting for maternal age, year of delivery, gestational age, and smoking.
We found a significantly elevated risk for induction of labor, 19.1% in survivors and 15.6% in siblings (odds ratio [OR] 1.17, 95% confidence interval [CI] 1.02-1.35) and cesarean delivery, 23.6% in survivors and 18.6% in siblings (OR 1.15, 95% CI 1.01-1.31) among cancer survivors compared with female siblings. The risks of instrumental vaginal delivery, malpresentation, placental pathologies, and postpartum hemorrhage were not, however, elevated among cancer survivors. The highest risks of adverse obstetric outcomes were seen among women treated in their childhood (aged 0-14 years).
Cancer survivors have a small but statistically increased risk for induction of labor and cesarean delivery compared with siblings without a history of cancer. Our findings indicate that pregnancies in cancer survivors are typically uncomplicated and cancer survivors should not be discouraged to have children after their cancer is cured.
II.
PubMed ID
26348187 View in PubMed
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Age-specific evaluation of primary human papillomavirus screening vs conventional cytology in a randomized setting.

https://arctichealth.org/en/permalink/ahliterature147457
Source
J Natl Cancer Inst. 2009 Dec 2;101(23):1612-23
Publication Type
Article
Date
Dec-2-2009
Author
Maarit Leinonen
Pekka Nieminen
Laura Kotaniemi-Talonen
Nea Malila
Jussi Tarkkanen
Pekka Laurila
Ahti Anttila
Author Affiliation
Mass Screening Registry, Finnish Cancer Registry, Pieni Roobertinkatu 9, FI-00130 Helsinki, Finland. maarit.leinonen@cancer.fi
Source
J Natl Cancer Inst. 2009 Dec 2;101(23):1612-23
Date
Dec-2-2009
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Aging
Alphapapillomavirus - genetics - isolation & purification
Cell Transformation, Neoplastic
Cell Transformation, Viral
Cervical Intraepithelial Neoplasia - diagnosis - prevention & control - virology
Colposcopy
Confounding Factors (Epidemiology)
DNA, Viral - isolation & purification
Early Detection of Cancer
Female
Finland
Humans
Mass Screening - methods
Middle Aged
Odds Ratio
Papillomavirus Infections - complications - diagnosis - virology
Population Surveillance
Predictive value of tests
Referral and Consultation
Reproducibility of Results
Risk assessment
Risk factors
Sensitivity and specificity
Triage
Tumor Virus Infections - complications - diagnosis - virology
Uterine Cervical Neoplasms - diagnosis - prevention & control - virology
Vaginal Smears - methods
Abstract
Human papillomavirus (HPV) DNA testing has shown higher sensitivity than cytology for detecting cervical lesions, but it is uncertain whether the higher sensitivity is dependent on the age of the woman being screened. We compared the age-specific performance of primary HPV DNA screening with that of conventional cytology screening in the setting of an organized population-based cervical cancer screening program in Finland.
From January 1, 2003, to December 31, 2005, randomized invitations were sent to women aged 25-65 years for routine cervical cancer screening by primary high-risk HPV DNA testing (n = 54 207) with a Hybrid Capture 2 assay followed by cytology triage for women who were HPV DNA positive or by conventional cytology screening (n = 54 218). In both screening arms, cytology results of low-grade squamous intraepithelial lesion or worse triggered a referral for colposcopy. Relative rates (RRs) of detection to assess test sensitivity, specificity, and positive predictive values (PPVs) with 95% confidence intervals (CIs) were calculated for the histological endpoints of cervical intraepithelial neoplasia (CIN) grade 1 or higher (CIN 1+), CIN grade 2 or higher (CIN 2+), and CIN grade 3 or higher (CIN 3+). All statistical tests were two-sided.
The overall frequency of colposcopy referrals was 1.2% in both screening arms. Women younger than 35 years were referred more often in the HPV DNA screening vs the conventional screening arm (RR = 1.27, 95% CI = 1.01 to 1.60). The prevalence of histologically confirmed CIN or cancer was 0.59% in the HPV DNA screening arm vs 0.43% in the conventional screening arm. The relative rates of detection for CIN 1, CIN 2, and CIN 3+ for HPV DNA screening with cytology triage vs conventional screening were 1.44 (95% CI = 0.99 to 2.10), 1.39 (95% CI = 1.03 to 1.88), and 1.22 (95% CI = 0.78 to 1.92), respectively. The specificity of the HPV DNA test with cytology triage was equal to that of conventional screening for all age groups (99.2% vs 99.1% for CIN 2+, P = .13). Among women aged 35 years or older, the HPV DNA test with cytology triage tended to have higher specificity than conventional screening. The PPVs for HPV DNA screening with cytology triage were consistently higher than those for conventional screening. In both screening arms, the test specificities increased with increasing age of the women being screening, whereas the highest PPVs were observed among the youngest women being screened. Overall, 7.2% of women in the HPV DNA screening arm vs 6.6% of women in the conventional screening arm were recommended for intensified follow-up, and the percentages were highest among 25- to 29-year-olds (21.9% vs 10.0%, respectively).
Primary HPV DNA screening with cytology triage is more sensitive than conventional screening. Among women aged 35 years or older, primary HPV DNA screening with cytology triage is also more specific than conventional screening and decreases colposcopy referrals and follow-up tests.
Notes
Comment In: J Natl Cancer Inst. 2012 Feb 8;104(3):166-722271766
Comment In: J Natl Cancer Inst. 2010 May 19;102(10):739; author reply 739-4020360534
Comment In: J Natl Cancer Inst. 2009 Dec 2;101(23):1600-119903806
PubMed ID
19903804 View in PubMed
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Association of symptoms and breast cancer in population-based mammography screening in Finland.

https://arctichealth.org/en/permalink/ahliterature262140
Source
Int J Cancer. 2015 Mar 15;136(6):E630-7
Publication Type
Article
Date
Mar-15-2015
Author
Deependra Singh
Nea Malila
Arun Pokhrel
Ahti Anttila
Source
Int J Cancer. 2015 Mar 15;136(6):E630-7
Date
Mar-15-2015
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Breast Neoplasms - epidemiology - pathology - radiography
Early Detection of Cancer
Female
Finland - epidemiology
Humans
Mammography
Middle Aged
Abstract
The study purpose was to assess association of symptoms at screening visits with detection of breast cancer among women aged 50-69 years during the period 2006-2010. Altogether 1.2 million screening visits were made and symptoms (lump, retraction, secretion etc.) were reported either by women or radiographer. Breast cancer risk was calculated for each symptom separately using logistic regression [odds ratio (OR)] and 95% confidence intervals (CIs). Of the 1,198,410 screening visits symptoms were reported in 298,220 (25%) visits. Breast cancer detection rate for women with and without symptoms was 7.8 per 1,000 and 4.7 per 1,000 screening visits, respectively, whereas lump detected 32 cancers per 1,000 screens. Women with lump or retraction had an increased risk of breast cancer, OR?=?6.47, 95% CI 5.89-7.09 and OR?=?2.19, 95% CI 1.92-2.49, respectively. The sensitivity of symptoms in detecting breast carcinoma was 35.5% overall. Individual symptoms sensitivity and specificity ranged from, 0.66 to 14.8% and 87.4 to 99.7%, respectively. Of 5,541 invasive breast cancers, 1,993 (36%) reported symptoms at screen. Breast cancer risk among women with lump or retraction was higher in large size tumors (OR?=?9.20, 95% CI 8.08-10.5) with poorly differentiated grades (OR?=?5.91, 95% CI 5.03-6.94) and regional lymph nodes involvement (OR?=?6.47, 95% CI 5.67-7.38). This study was done in a setting where breast tumors size is generally small, and symptoms sensitivity and specificity in diagnosing breast tumors were limited. Importance of breast cancer symptoms in the cancer prevention and control strategy needs to be evaluated also in other settings.
Notes
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PubMed ID
25160029 View in PubMed
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Cancer incidence in a cohort of Finnish male smokers.

https://arctichealth.org/en/permalink/ahliterature170359
Source
Eur J Cancer Prev. 2006 Apr;15(2):103-7
Publication Type
Article
Date
Apr-2006
Author
Nea Malila
Mikko J Virtanen
Jarmo Virtamo
Demetrius Albanes
Eero Pukkala
Author Affiliation
Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland. nea.malila@cancer.fi
Source
Eur J Cancer Prev. 2006 Apr;15(2):103-7
Date
Apr-2006
Language
English
Publication Type
Article
Keywords
Aged
Cohort Studies
Finland - epidemiology
Follow-Up Studies
Humans
Incidence
Male
Middle Aged
Neoplasms - epidemiology
Registries
Risk factors
Smoking - epidemiology
Abstract
A total of 29,133 male smokers, aged 50-69 years, were recruited into the Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) Study in 1984-1988. The nationwide Finnish Cancer Registry (FCR) recorded 5944 incident cases of cancer in this cohort through the end of 1999. Compared with the FCR data of the entire Finnish male population of same age the standardized incidence ratio (SIR) of total cancer in the ATBC cohort was 1.55 [95% confidence interval (CI) 1.51-1.59]. There was a significant excess of established smoking-related malignancies, such as lung cancer (SIR 2.45, 95% CI 2.35-2.56), and cancers of the tongue, mouth, pharynx, larynx, oesophagus, pancreas, stomach, liver, urinary bladder and kidney. In addition to these sites, cancers of the prostate and colon were slightly more common in the ATBC cohort than in the total Finnish male population (SIR 1.10, 95% CI 1.04-1.18 and SIR 1.14, 95% CI 1.00-1.30, respectively). In conclusion, the risk of many cancers was significantly higher in the ATBC Study cohort compared with the total Finnish male population of same age. In addition to the well known smoking-related cancers, cigarette smoking may increase slightly the risk of colon and prostate cancer, too.
PubMed ID
16523006 View in PubMed
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Cervical cancer patterns with automation-assisted and conventional cytological screening: a randomized study.

https://arctichealth.org/en/permalink/ahliterature140726
Source
Int J Cancer. 2011 Mar 1;128(5):1204-12
Publication Type
Article
Date
Mar-1-2011
Author
Ahti Anttila
Arun Pokhrel
Laura Kotaniemi-Talonen
Matti Hakama
Nea Malila
Pekka Nieminen
Author Affiliation
Mass Screening Registry, Finnish Cancer Registry, Helsinki, Finland. ahti.anttila@cancer.fi
Source
Int J Cancer. 2011 Mar 1;128(5):1204-12
Date
Mar-1-2011
Language
English
Publication Type
Article
Keywords
Adult
Aged
Automation
Female
Finland - epidemiology
Humans
Mass Screening - methods
Middle Aged
Uterine Cervical Neoplasms - diagnosis - epidemiology - pathology
Vaginal Smears
Abstract
The purpose was to evaluate alternative cytological screening methods in population-based screening for cervical cancer up to cancer incidence and mortality outcome. Automation-assisted screening was compared to conventional cytological screening in a randomized design. The study was based on follow-up of 503,391 women invited in the Finnish cervical cancer screening program during 1999-2003. The endpoints were incident cervical cancer, severe intraepithelial neoplasia and deaths from cervical cancer. One third of the women had been randomly allocated to automation-assisted screening and two thirds to conventional cytology. Information on cervical cancer and severe neoplasia were obtained through 1999-2007 from a linkage between screening and cancer registry files. There were altogether 3.2 million woman-years at risk, and the average follow-up time was 6.3 years. There was no difference in the risk of cervical cancer between the automation-assisted and conventional screening methods; the relative risk (RR) of cervical cancer between the study and control arm was 1.00 (95% confidence interval [CI] = 0.76-1.29) among all invited and 1.08 (95% CI = 0.76-1.51) among women who were test negative at entry. Comparing women who were test negative with nonscreened, RR of cervical cancer incidence was 0.26, 95% CI = 0.19-0.36 and of mortality 0.24 (0.13-0.43). Both methods were valid for screening. Because cervical cancer is rare in our country, we cannot rule out small differences between methods. Evidence on alternative methods for cervical cancer screening is increasing and it is thus feasible to evaluate new methods in large-scale population-based screening programs up to cancer outcome.
PubMed ID
20848590 View in PubMed
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Childhood cancer mortality and survival in immigrants: A population-based registry study in Finland.

https://arctichealth.org/en/permalink/ahliterature310102
Source
Int J Cancer. 2020 05 15; 146(10):2746-2755
Publication Type
Journal Article
Date
05-15-2020
Author
Anniina Kyrönlahti
Laura Madanat-Harjuoja
Janne Pitkäniemi
Matti Rantanen
Nea Malila
Mervi Taskinen
Author Affiliation
Finnish Cancer Registry, Helsinki, Finland.
Source
Int J Cancer. 2020 05 15; 146(10):2746-2755
Date
05-15-2020
Language
English
Publication Type
Journal Article
Keywords
Adolescent
Cancer survivors
Child
Child, Preschool
Emigrants and Immigrants - statistics & numerical data
Female
Finland - epidemiology
Humans
Incidence
Infant
Infant, Newborn
Male
Neoplasms - ethnology - mortality
Registries
Young Adult
Abstract
Immigration in Europe has increased considerably over the past decades with the immigrant population similarly expanding in Finland. Our aim was to study childhood cancer mortality and survival in immigrants. In all, 4,437 patients diagnosed with cancer under the age of 20?years between 1990 and 2009 were identified from the Finnish Cancer Registry and their parents from the Population Register Center. Information on demographic factors was obtained from Statistics Finland. Poisson regression modeling was used to estimate hazard ratios (HRs) for cancer deaths. The life table method and the log rank test were used in survival analysis. Patients or parents of foreign background and born abroad had higher 5-year mortality (patient HR 2.03, 95% CI 1.18-3.49; maternal HR 2.11, 95% CI 1.46-3.04; paternal HR 1.85, 95% CI 1.29-2.66) compared to those of Finnish background and born in Finland. Childhood cancer survival in 5-year follow-up was higher if the mother (83% vs. 68%) or the father (83% vs. 70%) were of Finnish background and born in Finland. Despite equal access to public health care, we observed significant differences in childhood cancer mortality and survival by background. Cultural differences, linguistic obstacles and difficulties in navigating the health care system may contribute, along with genetic and biologic factors. Offering tailored information and taking cultural and linguistic aspects into account is necessary when diagnosing and treating patients from different ethnic backgrounds who have not yet integrated into the local culture and health care system.
PubMed ID
31407318 View in PubMed
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Colorectal cancer screening in Finland: details of the national screening programme implemented in Autumn 2004.

https://arctichealth.org/en/permalink/ahliterature175397
Source
J Med Screen. 2005;12(1):28-32
Publication Type
Article
Date
2005
Author
Nea Malila
Ahti Anttila
Matti Hakama
Author Affiliation
Finnish Cancer Registry, Helsinki, Finland. nea_malila@cancer.fi
Source
J Med Screen. 2005;12(1):28-32
Date
2005
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Colonoscopy
Colorectal Neoplasms - diagnosis - mortality - prevention & control
Female
Finland - epidemiology
Humans
Male
Mass Screening - methods
Middle Aged
National Health Programs
Occult Blood
Abstract
Colorectal cancer mortality can be reduced by repeated faecal occult blood (FOB) testing followed by colonoscopy for test positives. The object of this report is to describe how to launch a new screening programme in such a way that its effectiveness can be reliably evaluated. The programme is based on gradual expansion over time with individual-level randomization into screening or control arms among a target population aged 60-69 years in Finland. The target population will be sampled from the population register for invitees and controls by municipality and by birth cohort. The non-invited controls will gradually be screened only after the six-year implementation period. After 10 years, the programme covers the entire target population. The effects of screening will be evaluated, comparing the incidence of and mortality from colorectal cancer in those invited to screening with controls. The primary screening test is a biannual guaiac-based FOB test with three test cards for consecutive samples. In September-December 2004, around 5000 test-kits were sent to 22 piloting municipalities. In 2005, the programme expands both among municipalities and the target population, resulting in nearly 20,000 individual requests. The implementation of colorectal cancer screening in Finland in this way meets the criteria for a randomized controlled trial and the requirements for a public health programme. It allows unbiased research data to be collected while introducing the programme and may set an example for the introduction of all national screening programmes.
PubMed ID
15814016 View in PubMed
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Coverage and accuracy of myeloproliferative and myelodysplastic neoplasms in the Finnish Cancer Registry.

https://arctichealth.org/en/permalink/ahliterature280079
Source
Acta Oncol. 2016 Jun;55(6):782-6
Publication Type
Article
Date
Jun-2016
Author
Maarit K Leinonen
Matti Rantanen
Janne Pitkäniemi
Nea Malila
Source
Acta Oncol. 2016 Jun;55(6):782-6
Date
Jun-2016
Language
English
Publication Type
Article
Keywords
Finland - epidemiology
Hematologic Neoplasms - diagnosis - epidemiology
Hospitals - statistics & numerical data
Humans
Myelodysplastic Syndromes - diagnosis - epidemiology
Myelodysplastic-Myeloproliferative Diseases - diagnosis - epidemiology
Myeloproliferative Disorders - diagnosis - epidemiology
Patient Discharge - statistics & numerical data
Registries
Abstract
Background Registration of haematological malignancies presents specific challenges, and a wide range of data is required to ensure case ascertainment and proper classification of these diseases. We studied the data quality of myeloproliferative and myelodysplastic neoplasms in the Finnish Cancer Registry (FCR), comparing information with hospital discharges. Material and methods Hospital discharges (HILMO) in 2007-2013 including diagnostic codes of myeloproliferative and myelodysplastic neoplasms were extracted. Patients were individually linked to the FCR database for all haematological malignancies registered in 1953-2013. Coverage and accuracy of the FCR and agreement between registers was estimated. Results In total 5289 individuals were retrieved from two registers. Of these, 1406 were common, 1080 only found in the FCR and 2803 only in the HILMO. Coverage of myeloproliferative and myelodysplastic neoplasms in the FCR was 47.0% (95% CI 45.7-48.4%). Almost one quarter of the registrations in the FCR was based on a death certificate only. The accuracy of diagnosis was 51.4% (95% CI 49.4-53.3%), but it varied substantially by disease category. Kappa statistic for agreement between registers was excellent (0.83, 95% CI 0.80-0.85) for common cases. 7.6% of cases in the HILMO was registered as leukaemias in the FCR. Conclusions More than half of the patients found in the HILMO were entirely missing from the FCR. However, some of the diagnoses in HILMO may be preliminary and this represents the maximal number of missing cases. Cancer registers benefit from supplementary data sources, such as hospital discharges, to increase coverage and accuracy of register data on haematological malignancies.
PubMed ID
26767306 View in PubMed
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61 records – page 1 of 7.