A cohort of 4 475 Finnish men was followed up during 1964-80 in order to study regional differences in mortality from cardiovascular diseases, especially ischaemic heart disease (IHD). The west/east gradient in cardiovascular mortality recorded in several previous studies was greatly age-dependent. The excess eastern risk was a feature of younger age groups; with increasing age the risk pattern was reversed. The risk factors in IHD in eastern Finland have an element which somehow accelerates the process of this disease.
This report based on the data available from the Finnish Cancer Registry and from virus isolations gives further support to the association (P=0.04) between maternal influenza of the 1957 "Asian" type and subsequent later leukaemia in the infants. No such association was found from other influenza epidemics.
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Random error in the numbers of avoidable deaths among cancer patients has not been considered in earlier studies.
Methods to obtain valid confidence intervals (CIs) for numbers of avoidable deaths were developed. The excess mortality rates were estimated for patients diagnosed with colon cancer in five cancer control regions in Finland during 2000-2007 using a relative survival regression model. Numbers of avoidable deaths due to colon cancer and other causes, respectively, were estimated in different scenarios.
Altogether, 4139 and 1335 out of 10 772 patients under 90 years at diagnosis were estimated to have died due to colon cancer and other causes, respectively, during the first 5 years after diagnosis. If all the patients had shared the relative survival of the largest cancer control region to which the country capital belongs, the estimated number of avoidable deaths would have been 146 (95% CI 3-290).
Random error in numbers of avoidable deaths, often substantial, can be quantified by realistic error margins, based on appropriate statistical methods.
A high level of available tissue iron may increase the risk of cancer through its contribution to the production of free oxygen radicals. Serum iron, total iron-binding capacity (TIBC) and transferrin saturation levels were studied for their prediction of different cancers in a cohort of 41,276 men and women aged 20-74 years and initially free from cancer. During a mean follow-up of 14 years, 2,469 primary cancer cases were diagnosed. Excess risks of colorectal and lung cancers were found in subjects with transferrin saturation level exceeding 60%. The relative risks, adjusted for age, sex and smoking, were 3.04 for colorectal cancer and 1.51 for lung cancer, in comparison with subjects having lower levels. The risk of lung cancer was inversely related to serum TIBC, with a relative risk between the highest and lowest quartiles of 0.69 for men and 0.19 for women. For the risk of stomach cancer, we detected inverse relationships with serum iron and with transferrin saturation and a positive relationship with TIBC, but these associations weakened when the cancer cases occurring during the 5 first years of follow-up were excluded. High iron stores may increase the risk of colorectal cancer, whereas low iron stores may be an early sign of occult stomach cancer.
Between 1920 and 1959, 9675 women were irradiated in infancy for skin hemangioma at Radiumhemmet, Stockholm. They were exposed to low to moderate doses of ionizing radiation. The mean age at first exposure was 6 months and the mean absorbed dose to the breast anlage was 0.39 Gy (range or = 50 years after exposure the ERR at 1 Gy was 2.25 (95% CI 0.59-5.62). The fitted excess absolute risk (EAR) was 22.9 per 10(4) breast-year gray. The breast absorbed dose and time after exposure were important risk determinants for breast cancer excess risk. Forty to 50 years of follow-up was necessary for the excess risk to be expressed. The study confirms previous findings that the breast anlage of female infants is sensitive to ionizing radiation.
Two nationwide registers, the Finnish Cancer Registry and a register of persons entitled to free drugs for hypertension, were linked in a case-control study of the association of breast cancer and use of rauwolfia. Cases were all hypertensive patients in whom breast cancer was diagnosed in 1973. To test the association specifically with rauwolfia, controls were hypertensive women matched with the cases for age and geographic area and approximately matched for duration of treatment for hypertension. There were 109 case-control pairs. Use of any physician-prescribed drugs during the year prior to diagnosis of breast cancer was ascertained from original prescriptions. In the first set of analyses the patients were classified according to the drug used during most days of the year ("main antihypertensive agent"). In the second set a person qualified as a user of the respective drug regardless of the amount taken. The relative risks in the use of rauwolfia, methyldopa, another synthetic antihypertensive or a diuretic as main antihypertensive agent all ranged between 0.90 and 1.11. The results based on use of a drug in any amount were similar. Next, pairs in which duration of treatment for hypertension was different for cases and controls were excluded. The relative risk associated with use of rauwolfia as main antihypertensive agent then increased from 1.00 to 1.30 and the risk associated with use of any amount of rauwolfia from 1.16 to 2.14. Simultaneously, the relative risk in the use of digitalis was raised from 1.33 to 2.67 and of nitroglycerin from 1.00 to 1.71. Cases also used more types of antihypertensive agents simultaneously than controls. There was no association between rauwolfia-use and breast cancer in analyses limited to pairs in which neither case nor control used digitalis. Thus, there was not a consistent drug-specific association between rauwolfia-use and breast cancer in hypertensive patients. An underlying association of hypertension, heart disease or its treatment (digitalis) and breast cancer may have confounded some of the results of this and earlier studies. In conclusion, it is unlikely that use of rauwolfia increases the risk of breast cancer.
BACKGROUND - Screening for ovarian cancer is based on ultrasound, colour Doppler, and tumour markers. There is only limited evidence on their discriminatory performance and no evidence on their effectiveness in reducing mortality. OBJECTIVE - To investigate the discriminatory performance of CA 125 as a screening test for ovarian cancer. METHODS - A registry of 15 093 serum samples drawn in 1968-72 was linked to the cancer registry. During follow up between 1968 and 1980 24 ovarian cancers were identified. One or two matched case-control design nested within the sample bank was applied and the concentrations of CA 125 were assessed. RESULTS - Case-control differences (relative risk 4-0, 95% confidence interval 1.0 to 15.5 at 20 kU/1) were found. Detection rate of the CA 125 test was 21-33% and the true negative rate was 75-98% depending on the cut off level and interval between drawing of the blood sample and diagnosis of the cancer. CONCLUSION - CA 125 is not a valid screening test if used alone. Case-control differences of borderline significance were found in CA 125 before diagnosis of ovarian cancer, but they were not large enough to provide a sufficient detection rate.
Chlorophenols have contaminated the drinking water system and the local lake in the village of Järvelä in southern Finland. Local geology, ground water streams, and chemical analyses incriminated a local sawmill as the only plausible source of exposure. Cancer incidence in the municipality of Kärkölä (half of the population lives in Järvelä), compared with the rest of the local health-care district and with the greater cancer control region, indicated an excess of soft-tissue sarcomas and non-Hodgkin's lymphomas. A case-control study, which focused on cancers of the colon, bladder and soft tissues, lymphomas, and leukemia, demonstrated a significantly elevated risk ratio for non-Hodgkin's lymphomas among persons who consumed fish from the local lake, which was contaminated with chlorophenols. Probable exposure to chlorophenol-contaminated drinking water played a role in the increased incidence of non-Hodgkin's lymphomas and possibly was a factor in the development of soft-tissue sarcoma.