BACKGROUND: Self-selection may compromise cost-effectiveness of screening programs. We hypothesized that nonparticipants have generally higher morbidity and mortality than participants. METHODS: A Swedish population-based random sample of 1,986 subjects ages 59 to 61 years was invited to sigmoidoscopy screening and followed up for 9 years by means of multiple record linkages to health and population registers. Gender-adjusted cancer incidence rate ratio (IRR) and overall and disease group-specific and mortality rate ratio (MRR) with 95% confidence intervals (95% CI) were estimated for nonparticipants relative to participants. Cancer and mortality rates were also estimated relative to the age-matched, gender-matched, and calendar period-matched Swedish population using standardized incidence ratios and standardized mortality ratios. RESULTS: Thirty-nine percent participated. The incidence of colorectal cancer (IRR, 2.2; 95% CI, 0.8-5.9), other gastrointestinal cancer (IRR, 2.7; 95% CI, 0.6-12.8), lung cancer (IRR, 2.2; 95% CI, 0.8-5.9), and smoking-related cancer overall (IRR, 1.4; 95% CI, 0.7-2.5) tended to be increased among nonparticipants relative to participants. Standardized incidence ratios for most of the studied cancers tended to be >1.0 among nonparticipants and
PURPOSE: Evaluate the effects of radiotherapy after sector resection for ductal carcinoma in situ of the breast (DCIS) in patient groups as defined by age, size of the lesion, focality, completeness of excision and mode of detection. PATIENTS AND METHODS: A total of 1,067 women in Sweden were randomly assigned to either postoperative radiotherapy (RT) or control from 1987 to 1999, and 1,046 were followed for a mean of 8 years. The main outcome was new ipsilateral breast cancer events and distant metastasis-free survival analyzed according to intention to treat. RESULTS: There were 64 ipsilateral events in the RT arm and 141 in the control group corresponding to a risk reduction of 16.0 percentage points at 10 years (95% CI, 10.3% to 21.6%) and a relative risk of 0.40 (95% CI, 0.30 to 0.54). There was no statistically significant difference in distant metastasis-free survival. There was an effect modification by age, yielding a low effect of RT in women younger than 50, but substantial protection in women older than 60 years. The age effect was not confounded by focality, lesion size, completeness of excision, or detection mode. There was no group as defined by our stratification variables that had a low risk without radiotherapy. CONCLUSION: Our results indicate that younger women have a low protective effect of conventional RT after sector resection. Older women benefit substantially. We caution that the age effect was seen in a subgroup analysis. Further search with conventional clinical variables for a low risk group that does not need RT does not seem fruitful.
AIM: To compare different areas of adolescent behaviors and self-perceived health with the aim of identify'ing age and gender differences to facilitate planning of public health preventive measures. METHODS: A cross-sectional survey in ten Swedish schools covering all students between 13 and 18 years of age. A validated instrument, Q90, created for use in teenagers, was distributed in the classrooms to 3,216 teenagers. RESULTS: In all age groups, girls had significantly more problems regarding self-perceived health, i.e., general health, abdominal pain, headache, feeling depressed, and suicidal thoughts, than boys. Ingirls, proportion feelingdepressed increased from 28% inthe youngest group (11% in boys) to 51% in the oldest (20% in boys). Similar results were found for all health-related problems. Significant differences were found between both gender and age groups in experiences of being bullied. A significantly higher frequency of boys than girls admitted to committing vandalism (35% vs. 11% in the oldest age group). The frequency of girls feeling overweight increased moderately with age, from 35% at age 13 y to 50% at age 18 y. The proportion of boys feeling underweight increased more distinctly, from 8% at age 13 y to 29% at age 18 y. Tobacco use and alcohol habits were similar in gender comparisons. CONCLUSION: The study demonstrates areas of normative development from early to late adolescence. The striking differences in health perception between girls and boys must be stressed. The results might form a basis for teachers, school health workers, and other health authorities working with adolescents.
AIM: To study the associations between self-perceived sleeping problems and wide areas of adolescent life. METHODS: All eligible adolescents 13-18 years old (3216 pupils) in a medium-sized town in Sweden completed a validated in-depth questionnaire (Q90), with 165 questions. RESULTS: Nine hundred and thirty-two (29.3%) adolescents (36.3% among girls; 21.9% among boys) reported having poor sleep, combined with daytime tiredness in the vast majority. Significant independent associations in specific age and gender groups were found for 'feeling depressed', breakfast habits, 'I do well in school' (inverse), physical training (inverse), no adult to talk to, having bullied someone, shop-lifting, physical fighting, not feeling healthy, abdominal pain, headache, tobacco use, and sexual experience. CONCLUSIONS: Many of these adolescents feel very poorly, as is evident from the magnitude of the problems. Poor sleepers form an easily recognized group, but it seems unlikely that therapy for sleeping problems alone would be successful in a large proportion of these adolescents.
BACKGROUND: Data on birth outcome and offspring health after the appearance of breast cancer are limited. The aim of this study was to assess the risk of adverse birth outcomes in women previously treated for invasive breast cancer compared with the general population of mothers. METHODS AND FINDINGS: Of all 2,870,932 singleton births registered in the Swedish Medical Birth Registry during 1973-2002, 331 first births following breast cancer surgery--with a mean time to pregnancy of 37 mo (range 7-163)--were identified using linkage with the Swedish Cancer Registry.Logistic regression analysis was used. The estimates were adjusted for maternal age, parity, and year of delivery. Odds ratios (ORs) and 95% confidence intervals (CIs) were used to estimate infant health and mortality, delivery complications, the risk of preterm birth, and the rates of instrumental delivery and cesarean section.The large majority of births from women previously treated for breast cancer had no adverse events. However, births by women exposed to breast cancer were associated with an increased risk of delivery complications (OR 1.5, 95% CI 1.2-1.9), cesarean section (OR 1.3, 95% CI 1.0-1.7), very preterm birth (
Our objective was to compare sociodemographic conditions and risky/health behaviors affecting Turkish or Middle Eastern versus ethnic Swedes and Finnish immigrant adolescents, respectively. All eligible adolescents 13-18 years old (3,216 pupils) in a medium-sized town in Sweden completed a validated in-depth questionnaire (Q90), with 165 questions. One hundred and one adolescents were Turkish or Middle Eastern immigrants, while 73 were immigrants from Finland, a neighboring country to Sweden. Turkish/Middle Eastern immigrants were more likely to attend a theoretical program in school, were rarely bullied, as compared to ethnic Swedes and Finns. Turkish/Middle Eastern girls used alcohol at a lower frequency, and reported less depression and sexual experiences than ethnic Swedish girls and Finns. A higher frequency of Finnish adolescents had been bullied and had vandalized, and Finnish adolescents were also determined to have used tobacco and cannabis and to be heavy drinkers more frequently than boys from Turkey/the Middle East. We concluded that adolescent immigrants from Turkey and the Middle East seem to be well adapted to Sweden and also have ambitions for a higher education. Differences in risky behaviors were particularly pronounced in comparisons with immigrants from Finland for both boys and girls.
A deficit in colorectal cancer survival in Denmark and in the UK compared to Sweden, Norway and Finland was found in the EUROCARE studies. We set out to explore if these differences still exist. Patients diagnosed with colorectal cancer as their first invasive cancer at age 15-89 in the period 1994-2000 were identified using data from 11 cancer registries in the UK and from four Nordic countries. Five-year relative period survival using deaths in 1999-2000 following cancers diagnosed in 1994-2000 was analysed with excess mortality risk modelling. Follow-up time since diagnosis with age as an effect-modifier in the first half year was the most important factor with the highest excess risk of death immediately after diagnosis and with higher age and decreasing with length of follow-up. Variations between countries were bigger in the first half year following diagnosis than in the interval 0.5-5 years with about 30% higher risk in UK and Denmark. The differences between countries are still substantial and the order has not changed, even if the five year relative survival has improved since the EUROCARE studies. Patient management, diagnostics, and comorbidity likely explain the excess deaths in UK and Denmark during the first 6 months. The effect of stage and quality of management and treatment should be examined in population based studies with detailed patient information. Use of more detailed age-intervals than conventionally applied in survival studies proved to be important in statistical modelling and is recommended for future studies. (c) 2007 Wiley-Liss, Inc.
INTRODUCTION: The Swedish Cancer Register (SCR) is used extensively for monitoring cancer incidence and survival and for research purposes. Completeness and reliability of cancer registration are thus of great importance for all types of use of the cancer register. The aim of the study was to estimate the overall coverage of malignant cancer cases in 1998 and to reveal possible reasons behind non-reporting. METHODS: We selected all malignant cancer cases in the Hospital Discharge Register (HDR) from 1998 and compared these records to those reported to the SCR. There were 43,761 discharges for 42,010 individuals of whom 3,429 individuals were not recorded in the SCR. From these 3 429 records we randomly selected 202 patients for review of their medical records to determine whether they should have been registered on the SCR as incident cases in 1998. RESULTS: About half of the 202 cases (93 malignant and 8 benign) should have been reported, which translates into an additional 1 579 malignant cases (95% CI 1 349-1 808), or 3.7% of the cases reported in 1998. The crude incidence rate for males and females combined would increase from 493 per 100,000 to 511 (95% CI 508-514) if these cases were taken into account. CONCLUSION: The overall completeness of the SCR is high and comparable to other high quality registers in Northern Europe. For most uses in epidemiological or public health surveillance, the underreporting will be without major impact. However, for specific research questions our findings have implications, as the degree of underreporting is site specific, increases with age, and does not seem to be random, as diagnoses without histology or cytology verification are overrepresented. An annual comparison of the SCR against the HDR could point to hospitals, geographic areas or specific diagnoses where organizational and administrative changes should be introduced to improve reporting.
OBJECTIVE: Recruitment of both patients and clinicians to randomized trials is difficult. Low participation carries the risk of terminating studies early and making them invalid owing to insufficient statistical power. This study investigated patients' and clinicians' experiences of randomization with the aim of facilitating trial participation in the future. MATERIAL AND METHODS: This was a qualitative study using content analysis. Patients offered to participate in a randomized trial and randomizing clinicians were interviewed. Five participants, four non-participants and five randomizing clinicians were interviewed, 2-8 years from randomization. RESULTS: Clinicians used strategies in interaction with the patients to facilitate decision making. Patients' attitudes differed and experiences of relatives or friends were often stated as reasons for treatment preferences. Patients described that letting chance decide treatment was a difficult barrier to overcome for randomization. The clinicians used a number of different strategies perceived to make randomization more acceptable to their patients. The clinicians' own motivation for randomizing patients for trials depended on the medical relevance of the study question and the clinicians' major obstacle was to maintain equipoise over time. Regular meetings with the study group helped to maintain equipoise and motivation. CONCLUSIONS: To establish a good platform for randomization the clinician needs to know about the patient's treatment preferences and the patient's attitude concerning the role of the clinician to facilitate decision making. The strategies used by the clinicians were perceived as helpful and could be tested in an intervention study.