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Adjuvant chemotherapy in early breast cancer and incidence of new primary malignancies.

https://arctichealth.org/en/permalink/ahliterature24760
Source
Lancet. 1991 Aug 31;338(8766):535-8
Publication Type
Article
Date
Aug-31-1991
Author
R. Arriagada
L E Rutqvist
Author Affiliation
Institut Gustave-Roussy, Villejuif, France.
Source
Lancet. 1991 Aug 31;338(8766):535-8
Date
Aug-31-1991
Language
English
Publication Type
Article
Keywords
Adult
Aged
Analysis of Variance
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Breast Neoplasms - drug therapy - epidemiology - radiotherapy
Combined Modality Therapy
Comparative Study
Cyclophosphamide - therapeutic use
Drug Administration Schedule
Drug Evaluation
Female
Fluorouracil - therapeutic use
Humans
Incidence
Methotrexate - therapeutic use
Middle Aged
Neoplasms, Multiple Primary - prevention & control
Radiotherapy Dosage
Registries
Research Support, Non-U.S. Gov't
Sweden - epidemiology
Tamoxifen - administration & dosage - therapeutic use
Time Factors
Abstract
Adjuvant chemotherapy is increasingly being given to patients with early breast cancer. Long-term follow-up studies suggest a higher frequency of secondary tumours, especially leukaemias, among women receiving such cytotoxic drugs. We studied the frequency of new primary malignancies in 1113 patients with early breast cancer who had been included in a randomised trial to compare chemotherapy as an adjunct to primary surgery with adjuvant locoregional radiotherapy. The estimated rate of new primary malignancies at ten years was significantly lower (p less than 0.0003) in the chemotherapy group (1%) than in the radiotherapy group (6%). The corresponding rate among 1986 patients treated with surgery alone was 5%. Our findings suggest that adjuvant chemotherapy in early breast cancer may protect against the development of new primary tumours in the first ten years of follow-up.
Notes
Comment In: Lancet. 1991 Oct 5;338(8771):885-61681236
PubMed ID
1678800 View in PubMed
Less detail

Adjuvant tamoxifen therapy for early stage breast cancer and second primary malignancies. Stockholm Breast Cancer Study Group.

https://arctichealth.org/en/permalink/ahliterature23222
Source
J Natl Cancer Inst. 1995 May 3;87(9):645-51
Publication Type
Article
Date
May-3-1995
Author
L E Rutqvist
H. Johansson
T. Signomklao
U. Johansson
T. Fornander
N. Wilking
Author Affiliation
Oncologic Center, Karolinska Hospital, Stockholm, Sweden.
Source
J Natl Cancer Inst. 1995 May 3;87(9):645-51
Date
May-3-1995
Language
English
Publication Type
Article
Keywords
Aged
Breast Neoplasms - drug therapy
Colorectal Neoplasms - chemically induced
Denmark
Endometrial Neoplasms - chemically induced
Female
Gastrointestinal Neoplasms - chemically induced
Humans
Middle Aged
Neoplasms, Second Primary - chemically induced
Research Support, Non-U.S. Gov't
Statistics
Stomach Neoplasms - chemically induced
Sweden
Tamoxifen - antagonists & inhibitors
Abstract
BACKGROUND: Tamoxifen is being increasingly used for the treatment of breast cancer and is undergoing study for the primary prevention of breast cancer. However, concerns have been raised that the drug may increase the incidence of new primary malignancies, such as endometrial, liver, and colorectal cancers. PURPOSE: Our goal was to assess the carcinogenic risks associated with long-term use of tamoxifen in women with early stage breast cancer. METHODS: The incidence of new primary cancers among 2729 women participants of the Stockholm Trial was determined at a median follow-up of 9 years. In this trial, after primary surgery, postmenopausal patients aged less than 71 years with unilateral invasive breast cancer were randomly allocated to receive either 2 years of adjuvant tamoxifen (40 mg daily) or no adjuvant endocrine therapy. Information on second cancers was obtained by retrospective linkage to the Swedish Cancer Registry. To increase statistical power, a joint analysis of the incidence of endometrial and gastrointestinal cancers was performed in the following three major studies in Scandinavia evaluating adjuvant tamoxifen therapy: the Stockholm Trial, the Danish Breast Cancer Group Trial, and the South-Swedish Trial. These studies included a total of 4914 patients with a median follow-up of 8-9 years. All P values were calculated from two-tailed tests of statistical significance. RESULTS: In the Stockholm Trial, there was a statistically significant (P = .008) reduction in the incidence of second primary cancers in the contralateral breast among the tamoxifen-treated patients. However, there was a nearly sixfold increase in endometrial cancers (P
Notes
Comment In: J Natl Cancer Inst. 1995 May 3;87(9):623-67752262
Comment In: J Natl Cancer Inst. 1995 May 3;87(9):627-97752263
PubMed ID
7752269 View in PubMed
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Analogues of LHRH versus orchidectomy: comparison of economic costs for castration in advanced prostate cancer.

https://arctichealth.org/en/permalink/ahliterature24429
Source
Br J Cancer. 1992 Jun;65(6):927-9
Publication Type
Article
Date
Jun-1992
Author
L E Rutqvist
N. Wilking
Author Affiliation
Radiumhemmet, Karolinska Hospital, Stockholm, Sweden.
Source
Br J Cancer. 1992 Jun;65(6):927-9
Date
Jun-1992
Language
English
Publication Type
Article
Keywords
Antineoplastic Agents - economics
Combined Modality Therapy
Costs and Cost Analysis
Gonadorelin - analogs & derivatives - therapeutic use
Humans
Male
Orchiectomy - economics
Prostatic Neoplasms - drug therapy - surgery - therapy
Abstract
Analogues of luteinising hormone releasing hormone (LHRH) have recently been introduced as an alternative to surgical orchidectomy in prostate cancer, but there has been concern about the economic costs of long-term treatment. The paper presents a comparison of costs for LHRH analogues versus orchidectomy in patients with advanced prostate cancer. The cost for the surgical procedure was estimated using data on patients treated with orchidectomy in Stockholm County, Sweden, during 1981-86. Estimates of costs for treatment with a depot LHRH analogue was based on observed treatment times among patients with symptomatic prostate cancer in a British randomised clinical trial of medical castration versus surgical orchidectomy. The average cost for orchidectomy was estimated at 2,580 pounds i.e. 7-31% less than for treatment with a depot LHRH analogue (2,760 pounds-3,380 pounds) assuming a mean treatment time in the range 19-23 months. The most cost-effective policy for castration was found to be initial treatment with an LHRH analogue followed by deferred orchidectomy after about 2 years among long-term responders. This policy would obviate the need for surgery in about 85% of the patients and the average cost (1,900 pounds) would be about 26% lower compared to that of a policy of primary orchidectomy in all patients.
PubMed ID
1616866 View in PubMed
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An overview of the Swedish randomised mammography trials: total mortality pattern and the representivity of the study cohorts.

https://arctichealth.org/en/permalink/ahliterature22910
Source
J Med Screen. 1996;3(2):85-7
Publication Type
Article
Date
1996
Author
L. Nystrom
L G Larsson
S. Wall
L E Rutqvist
I. Andersson
N. Bjurstam
G. Fagerberg
J. Frisell
L. Tabar
Author Affiliation
Department of Epidemiology and Public Health, Umeå University, Sweden.
Source
J Med Screen. 1996;3(2):85-7
Date
1996
Language
English
Publication Type
Article
Keywords
Adult
Aged
Breast Neoplasms - mortality - prevention & control - radiography
Cohort Studies
Female
Humans
Mammography
Mass Screening - methods
Middle Aged
Randomized Controlled Trials
Research Support, Non-U.S. Gov't
Sweden - epidemiology
Abstract
OBJECTIVES: To analyse the cause of death pattern in the cohorts of women included in the Swedish randomised mammography screening trials by comparing the groups of invited and control women both with each other and with the general population of Swedish women. SETTING: Since 1977 four randomised trials of mammography screening have been performed in Sweden: Malmö, Kopparberg and Ostergötland (the two county trial), Stockholm, and Gothenburg. DESIGN: Overview of four randomised mammography screening trials. RESULTS: The total numbers of deaths in the invited and control groups respectively were 15 695 and 11 887 corresponding to a relative risk (RR) of 1.00. There were no significant differences between the invited and control groups for cause-specific mortality, except for breast cancer. When the total mortality in the invited and the control groups was compared with that for Swedish women in general the standardised mortality ratio was close to 100. CONCLUSIONS: The cause of death pattern in the invited group was, except for breast cancer, very similar to that in the control group, showing that the groups were comparable. Similarly, the total mortality including breast cancer mortality in the control group was almost identical to that in Swedish women in general. The same was true, with the exception of breast cancer, for the invited group. These observations confirm that the trial cohorts are representative of Swedish women and indicate that the quantitative results from these trials may safely be generalised to the Swedish populations.
PubMed ID
8849766 View in PubMed
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Breast cancer screening with mammography: overview of Swedish randomised trials.

https://arctichealth.org/en/permalink/ahliterature24070
Source
Lancet. 1993 Apr 17;341(8851):973-8
Publication Type
Article
Date
Apr-17-1993
Author
L. Nyström
L E Rutqvist
S. Wall
A. Lindgren
M. Lindqvist
S. Rydén
I. Andersson
N. Bjurstam
G. Fagerberg
J. Frisell
Author Affiliation
Department of Epidemiology and Public Health, Umeå University, Sweden.
Source
Lancet. 1993 Apr 17;341(8851):973-8
Date
Apr-17-1993
Language
English
Publication Type
Article
Keywords
Adult
Aged
Breast Neoplasms - epidemiology - mortality - radiography
Cause of Death
Female
Follow-Up Studies
Humans
Mammography - utilization
Mass Screening
Middle Aged
Models, Theoretical
Outcome Assessment (Health Care)
Program Evaluation
Registries
Research Support, Non-U.S. Gov't
Sweden - epidemiology
Abstract
Despite encouraging results from screening trials the efficacy of mammography in reducing mortality remains somewhat controversial. Five studies have been done in Sweden. This overview, based on 282,777 women followed for 5-13 years in randomised trials in Malmö, Kopparberg, Ostergötland, Stockholm, and Gothenburg, reveals a 24% (95% confidence interval 13-34%) significant reduction of breast cancer mortality among those invited to mammography screening compared with those not invited. To avoid the potential risk of differential misclassification causes of death were assessed by an independent end-point committee after a blinded review of all fatal breast cancer cases. The mortality reduction was similar, irrespective of the end-point used for evaluation ("breast cancer as underlying cause of death" or "breast cancer present at death"). There was a consistent risk reduction associated with screening in all studies, although the point estimate of the relative risk for all ages varied non-significantly between 0.68 and 0.84. The cumulative breast cancer mortality by time since randomisation was estimated at 1.3 per 1000 within 6 years in the invited group compared with 1.6 in the control group. The corresponding figures after 9 years are 2.6 and 3.3 and after 12 years 3.9 and 5.1. The largest reduction of breast cancer mortality (29%) was observed among women aged 50-69 at randomisation. Among women 40-49 there was a non-significant 13% reduction. In this younger age group cumulative breast cancer mortality was similar in the invited and control group during the first 8 years of follow-up. After 8 years there was a difference in favour of the invited women. There was no evidence of any detrimental effect of screening in terms of breast cancer mortality in any age group. Among women aged 70-74 years screening seems to have had only a marginal impact.
Notes
Comment In: Lancet. 1993 Aug 28;342(8870):549-508102679
Comment In: Lancet. 1993 Jun 12;341(8859):1531; author reply 1531-28099397
Comment In: Lancet. 1993 Jun 12;341(8859):1531; author reply 1531-28099398
Comment In: Lancet. 1993 Jun 12;341(8859):1531; author reply 1531-28099399
Erratum In: Lancet 1993 Nov 27;342(8883):1372
PubMed ID
8096941 View in PubMed
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Breast conserving surgery for invasive breast cancer: risk factors for ipsilateral breast tumor recurrences.

https://arctichealth.org/en/permalink/ahliterature22180
Source
Breast Cancer Res Treat. 1997 Mar;43(1):73-86
Publication Type
Article
Date
Mar-1997
Author
K. Dalberg
A. Mattsson
L E Rutqvist
U. Johansson
L. Riddez
K. Sandelin
Author Affiliation
Department of Surgery, Karolinska Hospital, Södersjukhuset, Stockholm, Sweden.
Source
Breast Cancer Res Treat. 1997 Mar;43(1):73-86
Date
Mar-1997
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Breast Neoplasms - pathology - radiotherapy - surgery
Cohort Studies
Comparative Study
Disease-Free Survival
Female
Humans
Mastectomy
Middle Aged
Neoplasm Invasiveness
Neoplasm Recurrence, Local - epidemiology - pathology
Prognosis
Research Support, Non-U.S. Gov't
Risk factors
Sweden - epidemiology
Abstract
To identify risk factors associated with an increased risk for ipsilateral breast tumor recurrence following breast-conserving surgery, a cohort of 759 women with T1-T2 tumors were studied. The majority of the patients (88%) had received postoperative radiation therapy to the breast. Median follow-up time was 10 (range: 6-17) years. There was a 1-1.5% yearly increase in ipsilateral breast tumor recurrences. For women or = 50 ys, 9%. Node positive women had a cumulative breast recurrence rate of 25% versus 10% for node negative women. Ten years postoperatively, irradiated patients had a cumulative recurrence rate of 11% versus 26% when no irradiation was given. The beneficial effect of radiotherapy was substantial during the first four postoperative years. The relative risk for an ipsilateral breast tumor recurrence during this period was 4.5 times higher than for non-irradiated patients. However, the protective effect of radiotherapy decreased with time. After ten years the relative risk of ipsilateral breast tumor recurrence was the same among irradiated and non-irradiated patients although the number of events during this period was low. Univariate analysis showed that seven factors were significantly associated with an increased risk of ipsilateral breast tumor recurrence, namely age or = 50 were a low risk-group for ipsilateral breast tumor recurrence, with a cumulative risk at 10 years of 9% without radiation therapy and 5% with breast irradiation.
PubMed ID
9065601 View in PubMed
Less detail

Cancer mortality trends in Sweden 1960-1986.

https://arctichealth.org/en/permalink/ahliterature25688
Source
Acta Oncol. 1989;28(6):771-5
Publication Type
Article
Date
1989
Author
L E Rutqvist
B. Mattsson
T. Signomklao
Author Affiliation
Department of Oncology, Radiumhemmet, Karolinska Hospital, Stockholm, Sweden.
Source
Acta Oncol. 1989;28(6):771-5
Date
1989
Language
English
Publication Type
Article
Keywords
Adult
Female
Humans
Male
Middle Aged
Neoplasms - mortality
Research Support, Non-U.S. Gov't
Survival Analysis
Sweden - epidemiology
Time Factors
Abstract
Time-related trends in age-standardized cancer mortality have been suggested to be the best single measure of the progress--or lack of progress--in cancer control measures. The paper presents data on trends in Sweden during 1960-1986. From the middle of the 1970s, total cancer mortality decreased significantly among both males and females. The estimated annual decrease between 1975 and 1986 was 0.5-1.2%. Current Swedish trends are thus in keeping with the goal stated in the European Community's action programme 'Europe against cancer': a 10-15% decrease in total age-standardized cancer mortality by the year 2000. This goal might even be too conservative, because most of the cancer control measures in 'Europe against cancer' will not be able to enhance the current downward trends until the early 1990s.
PubMed ID
2611029 View in PubMed
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Comparison between diagnoses in the Stockholm Regional Cancer Register and certified underlying causes of death.

https://arctichealth.org/en/permalink/ahliterature26609
Source
Acta Radiol Oncol. 1985 May-Jun;24(3):219-26
Publication Type
Article
Author
B. Mattsson
L E Rutqvist
A. Wallgren
Source
Acta Radiol Oncol. 1985 May-Jun;24(3):219-26
Language
English
Publication Type
Article
Keywords
Biliary Tract Neoplasms - diagnosis - mortality
Comparative Study
Death Certificates
Female
Genital Neoplasms, Female - diagnosis - mortality
Humans
Leukemia - diagnosis - mortality
Liver Neoplasms - diagnosis - mortality
Lymphoma - diagnosis - mortality
Male
Neoplasms - diagnosis - mortality
Registries
Research Support, Non-U.S. Gov't
Respiratory Tract Neoplasms - diagnosis - mortality
Sweden
Abstract
Data in the Stockholm Regional Cancer Register were compared with death certificates for persons who died of carcinoma in 1978 and were domiciled in Stockholm County. Concordance between cancer register diagnosis and certified underlying cause of death was 87 per cent. Many malignant tumours in organs which often show metastases were unspecified by one of the registers. In many other cases of discordance, differing site codes denoted anatomically close-lying organs. Age distribution did not differ between concordant and discordant diagnostic groups. Coordination of the cancer register and the mortality statistics as regards coding routines and disease classification presumably would enhance inter-register comparability.
PubMed ID
2994370 View in PubMed
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62 records – page 1 of 7.