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Age-specific trends of survival in metastatic breast cancer: 26 years longitudinal data from a population-based cancer registry in Stockholm, Sweden.

https://arctichealth.org/en/permalink/ahliterature101025
Source
Breast Cancer Res Treat. 2011 May 27;
Publication Type
Article
Date
May-27-2011
Author
Theodoros Foukakis
Tommy Fornander
Tobias Lekberg
Henrik Hellborg
Jan Adolfsson
Jonas Bergh
Author Affiliation
Department of Oncology-Pathology, Radiumhemmet, Karolinska Institutet, Karolinska University Hospital, 17176, Stockholm, Sweden, theodoros.foukakis@ki.se.
Source
Breast Cancer Res Treat. 2011 May 27;
Date
May-27-2011
Language
English
Publication Type
Article
Abstract
Treatment of metastatic breast cancer (MBC) has evolved during the last decades but it is largely unknown whether this has led to improved survival in the general MBC population. Based on the regional, population-based breast cancer registry, we identified 5,463 patients diagnosed with MBC in Stockholm County during 1979-2004. Patients were divided into five cohorts based on the year of first MBC diagnosis and observed and relative survival were compared across the cohorts after adjustment for potential confounders. A significant trend of better survival over time was demonstrated for patients 60 years or younger (P 
PubMed ID
21617918 View in PubMed
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Bilateral prophylactic mastectomy in Swedish women at high risk of breast cancer: a national survey.

https://arctichealth.org/en/permalink/ahliterature134424
Source
Ann Surg. 2011 Jun;253(6):1147-54
Publication Type
Article
Date
Jun-2011
Author
Brita Arver
Karin Isaksson
Hans Atterhem
Annika Baan
Leif Bergkvist
Yvonne Brandberg
Hans Ehrencrona
Monica Emanuelsson
Henrik Hellborg
Karin Henriksson
Per Karlsson
Niklas Loman
Jonas Lundberg
Anita Ringberg
Marie Stenmark Askmalm
Marie Wickman
Kerstin Sandelin
Author Affiliation
Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden.
Source
Ann Surg. 2011 Jun;253(6):1147-54
Date
Jun-2011
Language
English
Publication Type
Article
Keywords
Adult
Aged
Breast Neoplasms - epidemiology - genetics - pathology - surgery
Female
Genes, BRCA1
Genes, BRCA2
Genetic Predisposition to Disease
Health Care Surveys
Humans
Incidence
Mastectomy
Middle Aged
Reoperation
Risk assessment
Risk factors
Sweden - epidemiology
Abstract
This study attempted a national inventory of all bilateral prophylactic mastectomies performed in Sweden between 1995 and 2005 in high-risk women without a previous breast malignancy. The primary aim was to investigate the breast cancer incidence after surgery. Secondary aims were to describe the preoperative risk assessment, operation techniques, complications, histopathological findings, and regional differences.
Geneticists, oncologists and surgeons performing prophylactic breast surgery were asked to identify all women eligible for inclusion in their region. The medical records were reviewed in each region and the data were analyzed centrally. The BOADICEA risk assessment model was used to calculate the number of expected/prevented breast cancers during the follow-up period.
A total of 223 women operated on in 8 hospitals were identified. During a mean follow-up of 6.6 years, no primary breast cancer was observed compared with 12 expected cases. However, 1 woman succumbed 9 years post mastectomy to widespread adenocarcinoma of uncertain origin. Median age at operation was 40 years. A total of 58% were BRCA1/2 mutation carriers. All but 3 women underwent breast reconstruction, 208 with implants and 12 with autologous tissue. Four small, unifocal, invasive cancers and 4 ductal carcinoma in situ were found in the mastectomy specimens. The incidence of nonbreast related complications was low (3%). Implant loss due to infection/necrosis occurred in 21 women (10%) but a majority received a new implant later. In total, 64% of the women underwent at least 1unanticipated secondary operation.
Bilateral prophylactic mastectomy is safe and efficacious in reducing future breast cancer in asymptomatic women at high risk. Unanticipated reoperations are common. Given the small number of patients centralization seems justified.
PubMed ID
21587115 View in PubMed
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Incidence of fractures causing hospitalisation in prostate cancer patients: results from the population-based PCBaSe Sweden.

https://arctichealth.org/en/permalink/ahliterature126471
Source
Eur J Cancer. 2012 Jul;48(11):1672-81
Publication Type
Article
Date
Jul-2012
Author
Andreas Thorstenson
Ola Bratt
Olof Akre
Henrik Hellborg
Lars Holmberg
Mats Lambe
Anna Bill-Axelson
Pär Stattin
Jan Adolfsson
Author Affiliation
Regional Cancer Centre, Karolinska University Hospital, Stockholm, Sweden. andreas.thorstenson@capio.se
Source
Eur J Cancer. 2012 Jul;48(11):1672-81
Date
Jul-2012
Language
English
Publication Type
Article
Keywords
Aged
Androgen Antagonists - adverse effects
Antineoplastic Agents, Hormonal - adverse effects
Fractures, Bone - epidemiology
Hospitalization
Humans
Incidence
Male
Orchiectomy - adverse effects
Osteoporosis - chemically induced
Prostatic Neoplasms - complications - drug therapy - surgery
Risk factors
Sweden - epidemiology
Abstract
Prostate cancer patients have an increased risk of fractures as a consequence of skeletal metastases and osteoporosis induced by endocrine treatment. Data on incidence of fractures and risks in subgroups of men with prostate cancer are sparse. Our aim with this study is to report the risk of fractures among men with prostate cancer in a nationwide population-based study.
We identified 76,600 Swedish men diagnosed with prostate cancer 1997-2006 in the Prostate Cancer Data Base (PCBaSe) Sweden and compared the occurrence of fractures requiring hospitalisation with the Swedish male population.
Only men treated with gonadotropin releasing-hormone (GnRH) agonists or orchiectomy had increased incidence and increased relative risk of fractures requiring hospitalisation. Men treated with GnRH agonists had 9.8 and 6.3/1000 person-years higher incidence of any fracture and hip fracture requiring hospitalisation than the general population. The corresponding increases in incidence for men treated with orchiectomy were 16 and 12/1000 person-years, respectively. Men treated with orchiectomy, GnRH agonists, and antiandrogen monotherapy, had SIR for hip fracture of 2.0 (95% Confidence Interval 1.8-2.2), 1.6 (95% CI 1.5-1.8) and 0.9 (95% CI 0.7-1.1), respectively. Men treated with a curative intent (radical prostatectomy or radiotherapy) or managed with surveillance had no increased risk of fractures. Older men had the highest incidence of fractures while younger men had the highest relative risk.
Prostate cancer patients treated with GnRH agonists or orchiectomy have significantly increased risk of fractures requiring hospitalisation while patients treated with antiandrogen monotherapy had no increase in such fractures. In absolute terms the excess risk in men treated with GnRH agonists corresponded to almost 10 extra fractures leading to hospitalisation per 1000 patient-years. Effects on bone density should be considered for men on long-term endocrine treatment. Unwarranted use of orchiectomy and GnRH agonists should be avoided.
PubMed ID
22386317 View in PubMed
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Interobserver variability of histopathological prognostic parameters in cutaneous malignant melanoma: impact on patient management.

https://arctichealth.org/en/permalink/ahliterature117343
Source
Acta Derm Venereol. 2013 Jul 6;93(4):411-6
Publication Type
Article
Date
Jul-6-2013
Author
Hanna Eriksson
Margareta Frohm-Nilsson
Mari-Anne Hedblad
Henrik Hellborg
Lena Kanter-Lewensohn
Kamilla Krawiec
Barbro Lundh Rozell
Eva Månsson-Brahme
Johan Hansson
Author Affiliation
Department of Medicine, Unit of Dermatology, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden. hanna.eriksson.4@ki.se
Source
Acta Derm Venereol. 2013 Jul 6;93(4):411-6
Date
Jul-6-2013
Language
English
Publication Type
Article
Keywords
Clinical Competence
Humans
Melanoma - pathology - surgery
Neoplasm Invasiveness
Neoplasm Staging
Observer Variation
Pathology - methods
Predictive value of tests
Prognosis
Registries
Reproducibility of Results
Sentinel Lymph Node Biopsy
Skin Neoplasms - pathology - surgery
Skin Ulcer - pathology
Sweden
Tumor Burden
Abstract
Clinical management of primary cutaneous melanomas is based on histopathological staging of the tumour. The aim of this study was to investigate, in a non-selected population in clinical practice, the agreement rate between general pathologists and pathologists experienced in melanoma in terms of the evaluation of histopathological prognostic parameters in cutaneous malignant melanomas, and to what extent the putative variability affected clinical management. A total of 234 cases of invasive cutaneous malignant melanoma were included in the study from the Stockholm-Gotland Healthcare Region in Sweden. Overall interobserver variability between a general pathologist and an expert review was 68.8-84.8%. Approximately 15.5% of melanomas =1 mm were re-classified either as melanoma in situ or melanomas >1 mm after review. In conclusion, review by a pathologist experienced in melanoma resulted in a change in recommendations about surgical excision margins and/or sentinel node biopsy in subgroups of T1 melanomas.
PubMed ID
23306667 View in PubMed
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Metastatic potential in renal cell carcinomas =7 cm: Swedish Kidney Cancer Quality Register data.

https://arctichealth.org/en/permalink/ahliterature133103
Source
Eur Urol. 2011 Nov;60(5):975-82
Publication Type
Article
Date
Nov-2011
Author
Eirikur Guðmundsson
Henrik Hellborg
Sven Lundstam
Stina Erikson
Börje Ljungberg
Author Affiliation
Department of Urology, Uppsala University Hospital, Uppsala, Sweden.
Source
Eur Urol. 2011 Nov;60(5):975-82
Date
Nov-2011
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Carcinoma, Renal Cell - epidemiology - secondary
Chi-Square Distribution
Female
Humans
Incidence
Incidental Findings
Kidney Neoplasms - epidemiology - pathology
Lymphatic Metastasis
Male
Middle Aged
Neoplasm Grading
Neoplasm Invasiveness
Neoplasm Staging
Prognosis
Registries
Retrospective Studies
Risk assessment
Risk factors
Sweden - epidemiology
Time Factors
Tumor Burden
Young Adult
Abstract
Renal cell carcinoma (RCC) represents 2-3% of all malignancies and accounts for approximately 90% of all kidney malignancies. An increasing proportion of RCCs are discovered incidentally, and the average tumor diameter at diagnosis has decreased over the last few decades. Small RCCs have often been regarded by many as relatively harmless.
The objective was to evaluate the incidence of local T-category distribution and lymph node and distant metastases in relation to tumor size in RCCs =7 cm in a nationally based patient population.
Data were extracted from the National Swedish Kidney Cancer Register containing 3489 RCCs diagnosed between 2005 and 2008. This is a population-based registry including 99% of all RCCs diagnosed nationwide. The study included 2033 patients having a tumor =7 cm in diameter.
The size of the tumors was compared with sex, age, cause of diagnosis, Fuhrman grade, RCC type, and TNM category.
Most RCCs were discovered incidentally and incidence correlated inversely to tumor size. There were 887 (43%) patients with category T1a tumors, 836 (40%) with category T1b, 174 (8%) with T3a, 131 (6%) with T3b/c, and 12 (1%) patients had invasion of adjacent organs (T4). A total of 309 (15%) patients had lymph node and/or distant metastases. Of the 177 1- to 2-cm RCCs, category T3 tumors were identified in three patients and lymph node and/or distant metastases were identified in 8 (5%). Only for tumors =1 cm was there neither advanced stage nor metastasis. The occurrence of locally advanced growth, lymph node and distant metastases, and high tumor grade correlated to tumor size. Patients with Fuhrman grade III or IV had a four-fold greater risk of metastases than grades I or II.
Lymph node and distant metastases occur even in small RCCs. Risk of metastases increases with tumor size. The data clearly show that small RCCs also have a malignant potential and should be properly evaluated and adequately treated.
Notes
Comment In: Eur Urol. 2011 Nov;60(5):983-5; discussion 985-621783319
Comment In: J Urol. 2012 Mar;187(3):87322325491
PubMed ID
21741160 View in PubMed
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Prognosis of patients with breast cancer: causes of death and effects of time since diagnosis, age, and tumor characteristics.

https://arctichealth.org/en/permalink/ahliterature131384
Source
J Clin Oncol. 2011 Oct 20;29(30):4014-21
Publication Type
Article
Date
Oct-20-2011
Author
Edoardo Colzani
Annelie Liljegren
Anna L V Johansson
Jan Adolfsson
Henrik Hellborg
Per F L Hall
Kamila Czene
Author Affiliation
Department of Medical Epidemiology and Biostatistics (MEB), Karolinska Institutet, Stockholm, Sweden. edoardo.colzani@ki.se
Source
J Clin Oncol. 2011 Oct 20;29(30):4014-21
Date
Oct-20-2011
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Breast Neoplasms - diagnosis - mortality - pathology
Cause of Death
Female
Humans
Middle Aged
Neoplasm Staging
Prognosis
Proportional Hazards Models
Sweden - epidemiology
Abstract
The proportion of women living with a diagnosis of breast cancer in developed countries is increasing. Because breast cancer-specific deaths decrease with time since diagnosis, it is important to assess the burden of other causes of death in women diagnosed with breast cancer.
Different causes of death within 10 years from diagnosis were assessed in 12,850 women younger than 75 years of age with stage 1 to 3 breast cancer diagnosed in Stockholm and Gotland regions 1990 to 2006. Flexible parametric survival models were used to estimate hazard ratios over time since diagnosis by tumor characteristics and age at diagnosis.
The proportion of deaths attributed to breast cancer ranged from 95.0% among women younger than age 45 years at diagnosis to 44.5% among women age 65 to 74 years. The proportions of circulatory system-specific deaths and deaths resulting from other causes increased with older age at diagnosis. Patients with one to three positive lymph nodes were more likely to die as a result of breast cancer during the first 10 years of follow-up compared with women without positive lymph nodes. Women with estrogen receptor (ER) -positive tumors had the same risk of dying as a result of breast cancer 5 years after diagnosis compared with women with ER-negative tumors.
Lymph node negativity is an important long-term predictor of more favorable prognosis. The nature of the relationship between ER status and risk of dying as a result of breast cancer after 5 years of follow-up requires further investigation. Circulatory system diseases are an important cause of death, especially in women diagnosed with breast cancer at an older age.
PubMed ID
21911717 View in PubMed
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When does my treatment start?--The continuum of care for patients with head and neck cancer.

https://arctichealth.org/en/permalink/ahliterature18978
Source
Radiother Oncol. 2002 Jun;63(3):293-7
Publication Type
Article
Date
Jun-2002
Author
Lena Sharp
Freddi Lewin
Henrik Hellborg
Jan Lundgren
Erik Hemmingsson
Lars Erik Rutqvist
Author Affiliation
Department of Oncology/Radiotherapy, Huddinge University Hospital/SöS, S-118 83 Stockholm, Sweden.
Source
Radiother Oncol. 2002 Jun;63(3):293-7
Date
Jun-2002
Language
English
Publication Type
Article
Keywords
Adult
Combined Modality Therapy
Continuity of Patient Care - statistics & numerical data
Female
Head and Neck Neoplasms - epidemiology - therapy
Humans
Male
Middle Aged
Sweden - epidemiology
Time Factors
Abstract
BACKGROUND AND PURPOSE: The clinical workup of patients with head and neck (H&N) cancer is often time-consuming. The overall time involved is obviously important to the treatment results, since delays in time can increase the risk for clinical upstaging resulting in a worse outcome. Although for ethical considerations, time delay is impossible to study in randomised trials. Major reorganisations for this group of patients have taken place in Stockholm during the 1990s. In this study, we measured the duration of the overall continuum of care experienced by the patients, in different time periods during the 1990s. MATERIALS AND METHODS: Two hundred and two patients from the population base of southern Stockholm were identified during different time periods. The continuum of care was identified as the period between the first presentation of the patient to the health care system to the first date of the patient's treatment for his/her cancer. This period was divided into several intervals reflecting the patient's perspective of his or her continuum of care. These intervals were then compared. RESULTS: Median time from first consultation to start of treatment increased between 1994 and 1999 from 67 to 89 days (P = 0.018). The increase of time occurred from referral from first care provider to ENT-specialist, from first visit to ENT-specialist to date of diagnosis. CONCLUSIONS: Different parameters such as duration of the continuum of care must be monitored before and after reorganisations.
PubMed ID
12142093 View in PubMed
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7 records – page 1 of 1.