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Oko-Oboh GA, Auvinen A, Obaseki DE, Pitkäniemi J. Improving cancer incidence evaluation through local government area matching: a study of the Edo-Benin cancer registry in Nigeria. BMC Public Health 2024; 24:514. [PMID: 38373974 PMCID: PMC10875802 DOI: 10.1186/s12889-024-17972-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 02/03/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Cancer registries in Nigeria, as well as in other sub-Saharan African countries, face challenges in adhering to international cancer registration standards. We aimed to improve cancer incidence estimation by identifying under-reporting of new cancers through matching patient-reported local government areas (LGAs) in Edo state, Nigeria, to their respective catchment populations. METHODS Information on cancers was obtained from records of hospitals, medical clinics, pathology laboratories, and death certificates according to IARC guidelines. We utilized normalized scores to establish consistency in the number of cancers by calendar time, and standardized incidence ratios (SIR) to assess the variation in cancer incidence across LGAs compared to Edo state average. Subsequently, we estimated sex- and site-specific annual incidence using the average number of cancers from 2016 to 2018 and the predicted mid-year population in three LGAs. Age-standardization was performed using the direct method with the World Standard Population of 1966. RESULTS The number of incident cancers consistent between 2016-2018 in Egor, Oredo, and Uhunmwonde showed a significantly increased SIR. From 2016 to 2018 in these three LGAs, 1,045 new cancers were reported, with 453 (42.4%) in males and 592 (57.6%) in females. The average annual age-standardized incidence rate (ASR) was 50.6 (95% CI: 45.2 - 56.6) per 105. In men, the highest incidence was prostate cancer (ASR: 22.4 per 105), and in women, it was breast cancer (ASR: 16.5 per 105), and cervical cancer (ASR: 12.0 per 105). Microscopically verified cancers accounted for 98.1%. CONCLUSIONS We found lower age-standardized incidence rates than those reported earlier for the Edo state population. Collecting information on the local government areas of the cancers allows better matching with the respective target population. We recommend using LGA information to improve the evaluation of population-based cancer incidence in sub-Saharan countries.
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Affiliation(s)
- Gregrey A Oko-Oboh
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, Arvo Ylpön Katu 34, 33520, Tampere, Finland.
| | - Anssi Auvinen
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, Arvo Ylpön Katu 34, 33520, Tampere, Finland
| | | | - Janne Pitkäniemi
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, Arvo Ylpön Katu 34, 33520, Tampere, Finland
- Finnish Cancer Registry, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
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Roos E, Heikkinen S, Seppä K, Pietiläinen O, Ryynänen H, Laaksonen M, Roos T, Knekt P, Männistö S, Härkänen T, Jousilahti P, Koskinen S, Eriksson JG, Malila N, Rahkonen O, Pitkäniemi J. Pairwise association of key lifestyle factors and risk of solid cancers - A prospective pooled multi-cohort register study. Prev Med Rep 2024; 38:102607. [PMID: 38298822 PMCID: PMC10828451 DOI: 10.1016/j.pmedr.2024.102607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 02/02/2024] Open
Abstract
Smoking, alcohol consumption, obesity, and physical inactivity are key lifestyle risk factors for cancer. Previously these have been mostly examined singly or combined as an index, assuming independent and equivalent effects to cancer risk. The aim of our study was to systematically examine the joint pairwise and interactive effects of these lifestyle factors on the risk of a first solid primary cancer in a multi-cohort prospective setting. We used pooled data from seven Finnish health survey studies during 1972-2015, with 197,551 participants diagnosed with 16,373 solid malignant primary tumors during follow-up. Incidence of any cancer was analyzed separately without and with lung cancers using Poisson regression with main and interaction effects of key lifestyle factors. When excluding lung cancer, the highest risk of any cancer in men was observed for smokers with a BMI of ≥25 kg/m2 (HR 1.36, 95 % CI 1.25-1.48) and in women for smokers consuming alcohol (HR 1.22, 1.14-1.30). No statistically significant interactions between any studied risk factor pairs were observed. When including lung cancer, the highest HRs among men were observed for smokers who consume alcohol (HR 1.72, 1.57-1.89) and among women for smokers who were physically inactive (HR 1.38, 1.27-1.49). Smoking combined with other lifestyle factors at any exposure level resulted in highest pairwise risks, both in men and women. These results highlight the importance of smoking prevention, but also the importance of preventing obesity and reducing alcohol consumption.
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Affiliation(s)
- Eira Roos
- Department of Public Health, University of Helsinki, Finland
| | - Sanna Heikkinen
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Karri Seppä
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | | | - Heidi Ryynänen
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Maarit Laaksonen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
- School of Mathematics and Statistics, University of New South Wales, Sydney, Australia
| | - Teemu Roos
- Department of Computer Science, University of Helsinki, Finland
| | - Paul Knekt
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Satu Männistö
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Tommi Härkänen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Pekka Jousilahti
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Seppo Koskinen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Johan G. Eriksson
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - Nea Malila
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, Finland
| | - Janne Pitkäniemi
- Department of Public Health, University of Helsinki, Finland
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Finland
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Seppä K, Heikkinen S, Ryynänen H, Albanes D, Eriksson JG, Härkänen T, Jousilahti P, Knekt P, Koskinen S, Männistö S, Rahkonen O, Rissanen H, Malila N, Laaksonen M, Pitkäniemi J. Every tenth malignant solid tumor attributed to overweight and alcohol consumption: A population-based cohort study. Eur J Cancer 2024; 198:113502. [PMID: 38181631 DOI: 10.1016/j.ejca.2023.113502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/06/2023] [Accepted: 12/14/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Recent studies have shown that some four in ten cancers are attributable to a few key risk factors. The aim of this study was to estimate cohort-based population attributable fractions (PAFs) in Finland for potentially modifiable cancer risk factors. METHODS Data from eight health studies including 253,953 subjects with 29,802 incident malignant solid tumors were analysed using Bayesian multivariate regression model with multiplicative risk factor effects. We estimated the effects of smoking, excess body weight, alcohol consumption, physical activity, parity and education on cancer incidence and related PAFs by cancer site, accounting for competing mortality. RESULTS PAF for all cancer sites and exposures combined was 34% (95% credible interval 29%-39%) in men and 24% (19%-28%) in women. In men, 23% (21%-27%) and in women 8% (6%-9%) of all cancers were attributed to smoking. PAF related to excess body weight was 4% (2%-6%) in men and 5% (2%-7%) in women, to alcohol 7% (3%-10%) in men and 4% (0%-7%) in women, and to excess body weight and alcohol combined 10% (6%-15%) in men and 9% (4%-13%) in women. CONCLUSION Smoking was the most important factor contributing to cancer burden in Finnish men and women over the last 40 years. The contribution of excess body weight and alcohol consumption together outweighed the role of smoking in women. As the prevalence of overweight is expected to increase, more efficient public health measures supporting adherence to healthy weight are essential to reduce cancer burden.
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Affiliation(s)
- Karri Seppä
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland.
| | - Sanna Heikkinen
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Heidi Ryynänen
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Demetrius Albanes
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Department of Health and Human Services, Bethesda, MD, USA
| | - Johan G Eriksson
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland; Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Folkhälsan Research Center, Helsinki, Finland; Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore; Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tommi Härkänen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Pekka Jousilahti
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Paul Knekt
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Seppo Koskinen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Satu Männistö
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, Finland
| | - Harri Rissanen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Nea Malila
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Maarit Laaksonen
- School of Mathematics and Statistics, Faculty of Science, University of New South Wales, Sydney, Australia
| | - Janne Pitkäniemi
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland; Department of Public Health, University of Helsinki, Finland; Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Finland
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Tammi R, Kaartinen NE, Harald K, Maukonen M, Tapanainen H, Smith-Warner SA, Albanes D, Eriksson JG, Jousilahti P, Koskinen S, Laaksonen MA, Heikkinen S, Pitkäniemi J, Pajari AM, Männistö S. Partial substitution of red meat or processed meat with plant-based foods and the risk of colorectal cancer. Eur J Epidemiol 2024:10.1007/s10654-024-01096-7. [PMID: 38253935 DOI: 10.1007/s10654-024-01096-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/02/2024] [Indexed: 01/24/2024]
Abstract
OBJECTIVES Shifting from animal-based to plant-based diets could reduce colorectal cancer (CRC) incidence. Currently, the impacts of these dietary shifts on CRC risk are ill-defined. Therefore, we examined partial substitutions of red or processed meat with whole grains, vegetables, fruits or a combination of these in relation to CRC risk in Finnish adults. METHODS We pooled five Finnish cohorts, resulting in 43 788 participants aged ≥ 25 years (79% men). Diet was assessed by validated food frequency questionnaires at study enrolment. We modelled partial substitutions of red (100 g/week) or processed meat (50 g/week) with corresponding amounts of plant-based foods. Cohort-specific hazard ratios (HR) for CRC were calculated using Cox proportional hazards models and pooled together using random-effects models. Adjustments included age, sex, energy intake and other relevant confounders. RESULTS During the median follow-up of 28.8 years, 1124 CRCs were diagnosed. We observed small risk reductions when red meat was substituted with vegetables (HR 0.97, 95% CI 0.95 - 0.99), fruits (0.97, 0.94 - 0.99), or whole grains, vegetables and fruits combined (0.97, 0.95 - 0.99). For processed meat, these substitutions yielded 1% risk reductions. Substituting red or processed meat with whole grains was associated with a decreased CRC risk only in participants with < median whole grain intake (0.92, 0.86 - 0.98; 0.96, 0.93 - 0.99, respectively; pinteraction=0.001). CONCLUSIONS Even small, easily implemented substitutions of red or processed meat with whole grains, vegetables or fruits could lower CRC risk in a population with high meat consumption. These findings broaden our insight into dietary modifications that could foster CRC primary prevention.
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Affiliation(s)
- Rilla Tammi
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), P.O. Box 30, Helsinki, 00271, Finland.
| | - Niina E Kaartinen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), P.O. Box 30, Helsinki, 00271, Finland
| | - Kennet Harald
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), P.O. Box 30, Helsinki, 00271, Finland
| | - Mirkka Maukonen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), P.O. Box 30, Helsinki, 00271, Finland
| | - Heli Tapanainen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), P.O. Box 30, Helsinki, 00271, Finland
| | - Stephanie A Smith-Warner
- Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Demetrius Albanes
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Johan G Eriksson
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Center, University of Helsinki, Helsinki, Finland
- Department of Obstetrics and Gynaecology and Human Potential Translational Research programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Agency for Science, Technology and Research, Singapore Institute for Clinical Sciences (SICS), A*STAR, Singapore, Singapore
| | - Pekka Jousilahti
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), P.O. Box 30, Helsinki, 00271, Finland
| | - Seppo Koskinen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), P.O. Box 30, Helsinki, 00271, Finland
| | - Maarit A Laaksonen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), P.O. Box 30, Helsinki, 00271, Finland
- School of Public Health, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Sanna Heikkinen
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Janne Pitkäniemi
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, Tampere, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Anne-Maria Pajari
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Satu Männistö
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), P.O. Box 30, Helsinki, 00271, Finland
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Seppä K, Pitkäniemi J. Utilising cancer registry data to monitor cancer burden. Lancet Oncol 2024; 25:6-7. [PMID: 38096891 DOI: 10.1016/s1470-2045(23)00596-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/16/2023] [Indexed: 01/07/2024]
Affiliation(s)
- Karri Seppä
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, FI-00130 Helsinki, Finland; Faculty of Social Sciences, Tampere University, Tampere, Finland.
| | - Janne Pitkäniemi
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, FI-00130 Helsinki, Finland; Faculty of Social Sciences, Tampere University, Tampere, Finland; Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Nikkilä R, Hirvonen E, Haapaniemi A, Tapiovaara L, Pitkäniemi J, Malila N, Mäkitie A. Significant risk of second primary cancer among laryngeal squamous cell carcinoma patients even after 20 years. Acta Oncol 2023; 62:1322-1330. [PMID: 37672344 DOI: 10.1080/0284186x.2023.2254482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/28/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Evidence on the risk of second primary cancer (SPC) following primary laryngeal squamous cell carcinoma (LSCC) is limited, especially in Europe. METHODS Patients diagnosed with primary LSCC from 1953-2018 were retrieved from the Finnish Cancer Registry. A total of 6241 LSCC patients were identified adding to 49,393 person-years (PY) of follow-up until the end of 2019. Only one patient emigrated and was lost to follow-up. Both standardized incidence ratios (SIR) and excess absolute risk (EAR) per 1000 person-years at risk (PYR) of second primary cancer (SPC) were calculated relative to the general population. Only non-laryngeal SPCs diagnosed six months after diagnosis of primary LSCC were included. RESULTS A SPC was diagnosed in 1244 LSCC patients (20% of all LSCC patients) over the 65-year period, predominantly in men (92%, n = 1170). Out of all SPCs, 34% were diagnosed within 0.5 to 5 years and 66% after 5 years from primary LSCC. Among male patients, the overall SIR for SPC at any location was 1.61 (95% CI: 1.52-1.71), corresponding to 9.49 excess SPCs per 1000 PYR (95% CI: 8.19-11). The corresponding SIR for women was 1.47 (95% CI: 1.15-1.84), yielding 4.82 excess SPCs per 1000 PYR (95% CI: 2.36-9.84). The risk remained significant even after 20 years of follow-up (SIR for all 1.73, 95% CI: 1.49-2.01 and EAR 16.8 per 1000 PY, 11.88-23.75). The risk for SPC was also significantly elevated in all age groups, except <40. The highest SIRs were for SPCs arising in the mouth/pharynx (SIR for all 3.08, 95% CI: 2.36-3.95 and EAR 0.80 per 1000 PY, 0.55-1.15) and lungs (3.02, 2.75-3.30 and 5.90 per 1000, 5.13-6.78). CONCLUSION Patients with LSCC as primary cancer have a 60% excess risk for an SPC, especially for tobacco-associated cancers, remaining significantly elevated even decades after treatment.
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Affiliation(s)
- Rayan Nikkilä
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Elli Hirvonen
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Aaro Haapaniemi
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Laura Tapiovaara
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Janne Pitkäniemi
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Nea Malila
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden
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Kyrönlahti A, Erdmann F, Feychting M, Frederiksen LE, Hirvonen E, Korhonen LM, Krøyer A, Mader L, Malila N, Mogensen H, Pedersen C, Talbäck M, Taskinen M, Winther JF, Madanat‐Harjuoja L, Pitkäniemi J. Income disparities between adult childhood cancer survivors and their peers-A register-based cohort study from the SALiCCS research programme. Cancer Med 2023; 12:16455-16468. [PMID: 37305982 PMCID: PMC10469706 DOI: 10.1002/cam4.6218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/20/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND Childhood cancer survivors face various adverse consequences. This Nordic register-based cohort study aimed to assess whether survivors of childhood cancer are more likely to have low income than their peers. METHODS We identified 17,392 childhood cancer survivors diagnosed at ages 0 to 19 between 1971 and 2009 with 83,221 age-, sex-, and country-matched population comparisons. Annual disposable income at ages 20 to 50 years was retrieved from statistical offices (for 1990-2017) and categorized into low income and middle/high income. The number of transitions between income categories were assessed using binomial regression analyses. RESULTS The prevalence of annual low income among childhood cancer survivors was 18.1% and 15.6% among population comparisons (risk ratio [RR] 1.17; 95% confidence interval [CI] 1.16-1.18). Compared to population comparisons, childhood cancer survivors were 10% (95% CI 8%-11%) less likely to transition from low to middle/high income and 12% (10%-15%) more likely to transition from middle/high to low income during follow-up. Among those initially in the low income category, survivors were 7% (95% CI 3%-11%) more likely to remain in the low income category. If the initial category was middle/high income, childhood cancer survivors were 10% (95% CI 8%-11%) less likely to remain in the middle/high income and 45% (37%-53%) more likely to transition to the low income category permanently. CONCLUSIONS Childhood cancer survivors are at higher risk for low income in adulthood than their peers. These disparities might be reduced by continued career counseling along with support in managing within the social security system.
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Affiliation(s)
- Anniina Kyrönlahti
- Finnish Cancer RegistryHelsinkiFinland
- Children and AdolescentsHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Friederike Erdmann
- Childhood Cancer Research GroupDanish Cancer Society Research CenterCopenhagenDenmark
- Division of Childhood Cancer EpidemiologyInstitute of Medical Biostatistics, Epidemiology, and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University MainzGermany
- Department of Prevention and EvaluationLeibniz Institute for Prevention Research and Epidemiology – BIPSBremenGermany
| | - Maria Feychting
- Unit of EpidemiologyInstitute of Environmental Medicine, Karolinska InstitutetStockholmSweden
| | | | | | - Liisa Maria Korhonen
- Finnish Cancer RegistryHelsinkiFinland
- Children and AdolescentsHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Anja Krøyer
- Childhood Cancer Research GroupDanish Cancer Society Research CenterCopenhagenDenmark
| | - Luzius Mader
- Childhood Cancer Research GroupDanish Cancer Society Research CenterCopenhagenDenmark
- Childhood Cancer Research GroupInstitute of Social and Preventive Medicine, University of BernBernSwitzerland
- Cancer Registry Bern‐SolothurnUniversity of BernBernSwitzerland
| | | | - Hanna Mogensen
- Unit of EpidemiologyInstitute of Environmental Medicine, Karolinska InstitutetStockholmSweden
| | - Camilla Pedersen
- Childhood Cancer Research GroupDanish Cancer Society Research CenterCopenhagenDenmark
| | - Mats Talbäck
- Unit of EpidemiologyInstitute of Environmental Medicine, Karolinska InstitutetStockholmSweden
| | - Mervi Taskinen
- Children and AdolescentsHelsinki University Hospital and University of HelsinkiHelsinkiFinland
- Division of Pediatric Hematology, Oncology, and Stem Cell TransplantationHelsinki University HospitalHelsinkiFinland
| | | | - Laura Madanat‐Harjuoja
- Finnish Cancer RegistryHelsinkiFinland
- Dana Farber/Boston Children's Cancer and Blood Disorders ClinicBostonMassachusettsUSA
| | - Janne Pitkäniemi
- Finnish Cancer RegistryHelsinkiFinland
- Health Sciences Unit, Faculty of Social SciencesTampere UniversityTampereFinland
- Department of Public Health, Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
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Mroueh R, Hirvonen E, Pitkäniemi J, Malila N, Hagström J, Mäkitie A, Virtanen A. Incidence of head and neck cancer among first-generation immigrants and their children in Finland. Acta Oncol 2023; 62:223-230. [PMID: 36976657 DOI: 10.1080/0284186x.2023.2192876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Limited data exist regarding head and neck cancer (HNC) burden among immigrants who may have distinct characteristics, and hence different incidence rates from the general population. Variations in behavioral habits, cultural lifestyle, or diet may cause variations across different subgroups. METHODS The whole immigrant population of Finnish residents born abroad, and their children were retrieved for the years 1970-2017. First-generation immigrants are defined as individuals born abroad, excluding their children (even if born abroad). The study comprised 0.5 million first-generation immigrants and 0.3 million children, contributing to 6 million and 5 million person-years of follow-up, respectively. Standardized incidence ratios (SIR) and excess absolute risk (EAR) per 100,000 person-years at risk were calculated to quantify the risk of HNC among immigrants relative to the general Finnish population. RESULTS The overall risk of any HNC was not increased among first-generation male immigrants (SIR 1.00, 95% CI: 0.88-1.15), but significantly elevated for cancer of the pharynx (SIR 1.56, 95% CI: 1.22-1.95), and larynx (SIR 1.38, 95% CI: 1.02-1.83) and decreased for lip (SIR 0.38, 95% CI: 0.20-0.67). The increased risk of pharyngeal cancer was highest among male immigrants from Asia Pacific (SIR 4.21, 95% CI: 2.02-7.75). First-generation immigrant women had a significantly reduced risk of any HNC (SIR 0.45, 95% CI: 0.37-0.55), which remained even after stratification by site. We observed no increased risk of any HNC among the children of first-generation immigrants. CONCLUSION Healthcare professionals need to recognize the groups at higher HNC risk. Efforts to address the main etiological risk factors, such as smoking, are needed among the selected immigrant populations, that haven't yet reached similar decreasing trends, as in for example smoking, as the main population.NOVELTY AND IMPACTCurrently, globally, over 280 million people live outside their country of birth. Limited data exist regarding head and neck cancer (HNC) burden among immigrants who may have distinct characteristics and hence different incidence rates from the general population. Immigrant studies can provide novel data by shedding light on risk alterations and the pace of acculturation of different populations.
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Affiliation(s)
- Rayan Mroueh
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland
| | - Elli Hirvonen
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Janne Pitkäniemi
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Nea Malila
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Jaana Hagström
- Department of Oral Pathology and Radiology, University of Turku, Turku, Finland
- Department of Pathology, University of Helsinki and HUS Diagnostic Center, Helsinki University Hospital, Helsinki, Finland
- Translational Cancer Research Program Unit, University of Helsinki, Helsinki, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden
| | - Anni Virtanen
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
- Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland
- Department of Pathology, University of Helsinki and HUS Diagnostic Center, Helsinki University Hospital, Helsinki, Finland
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9
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Hermiö E, Seppä K, Ryynänen H, Hirvonen E, Pylkkänen L, Järvelin J, Malila N, Pitkäniemi J. Use of health services one year before primary colorectal cancer. BMC Health Serv Res 2023; 23:279. [PMID: 36959641 PMCID: PMC10035279 DOI: 10.1186/s12913-023-09298-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 03/16/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) patient pathways focus typically on periods after confirmed diagnosis and only limited data are available on pathways prior to cancer diagnosis. The aim of the study was to describe the use of health services (HS) one year before diagnosis among CRC patients in Finland. We also studied the role of sex, age, stage, and university hospital district in relation to the use of HS during the pre-diagnostic phase. This information is expected to bring light on the question why CRC is often not found in its early stages. METHODS Incident CRC cases (N = 3115) concerning year 2015 were retrieved from the Finnish Cancer Registry and linked with data from the Finnish Institute for Health and Welfare on primary or specialised care outpatient visits or inpatient episodes over one year prior to CRC diagnosis. We modelled the average number of HS events per patient using Poisson regression model with log-link. Change points for monthly HS event rates and 95% CIs one year before diagnosis were evaluated using Poisson broken line regression models. RESULTS Around 10% of patients diagnosed in 2015 had no events prior to cancer leaving 2816 CRCs in the study. Of all pre-diagnostic events (N = 23268), 86% were outpatient events and 14% inpatient episodes. More than half of the inpatient episodes (65%) started as urgent admissions. The use of HS started to increase 3-4 months before diagnosis. The average number of pre-diagnostic HS events per patient varied by sex, age, stage and university hospital district. Overall, men had more events per patient than women and older patients had more events than younger patients. CONCLUSIONS The amount of inpatient episodes starting as urgent admissions indicate potential bottlenecks in the access to health services. An increase in service use only 3-4 months prior to diagnosis reflects a need for advice both for health care professionals and the general population in recognising symptoms of CRC.
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Affiliation(s)
- Elina Hermiö
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, 33014, Finland.
- Cancer Society of Finland, Unioninkatu 22, 00130, Helsinki, Finland.
| | - Karri Seppä
- Cancer Society of Finland, Unioninkatu 22, 00130, Helsinki, Finland
| | - Heidi Ryynänen
- Cancer Society of Finland, Unioninkatu 22, 00130, Helsinki, Finland
| | - Elli Hirvonen
- Cancer Society of Finland, Unioninkatu 22, 00130, Helsinki, Finland
| | | | - Jutta Järvelin
- Finnish Institute for Health and Welfare, PL 30, 00271, Helsinki, Finland
| | - Nea Malila
- Cancer Society of Finland, Unioninkatu 22, 00130, Helsinki, Finland
| | - Janne Pitkäniemi
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, 33014, Finland
- Cancer Society of Finland, Unioninkatu 22, 00130, Helsinki, Finland
- University of Helsinki, Yliopistonkatu 4, 00100, Helsinki, Finland
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10
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Heikkinen S, Demers PA, Hansen J, Jakobsen J, Kjaerheim K, Lynge E, Martinsen JI, Mehlum IS, Pitkäniemi J, Selander J, Torfadóttir J, Weiderpass E, Pukkala E. Incidence of cancer among Nordic police officers. Int J Cancer 2023; 152:1124-1136. [PMID: 36196485 DOI: 10.1002/ijc.34311] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/25/2022] [Accepted: 09/02/2022] [Indexed: 01/21/2023]
Abstract
Police work may expose officers to various circumstances that have potential for increasing their risk of cancer, including traffic-related air pollution, night shift work and radiation from radars. In this study, we examined the incidence of cancer among Nordic male and female police officers. We utilize data from the Nordic Occupational Cancer (NOCCA) project, which linked census data on occupations from Finland, Iceland, Norway and Sweden to national cancer registries for the period 1961 to 2005. We report standardized incidence ratios (SIR) and 95% confidence intervals (CI) of selected cancers for each country by sex, age and calendar period. The cohort included 38 523 male and 1998 female police officers. As compared with the general population, male police officers had a 7% (95% CI: 4-9%) excess cancer risk, with elevated SIRs for various cancer sites, including prostate (SIR 1.19, 1.14-1.25), breast (SIR 1.77, 1.05-2.80), colon (SIR 1.22, 1.12-1.32) and skin melanoma (SIR 1.44, 1.28-1.60). Conversely, male police officers had a lower risk of lung cancer than the general population (SIR 0.72, 0.66-0.77). In female police officers, the SIR for cancer overall was 1.15 (0.98-1.34), and there was a slight excess of cancers of the breast (SIR 1.25, 0.97-1.59) and colon (SIR 1.21, 0.55-2.30). In conclusion, cancer incidence among the police officers was slightly higher than in the general population. Notably, SIRs were elevated for cancer sites potentially related to night shift work, namely colon, breast and prostate cancer.
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Affiliation(s)
- Sanna Heikkinen
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Paul A Demers
- Occupational Cancer Research Center, Ontario Health, Ontario, Canada
| | - Johnni Hansen
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Jarle Jakobsen
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | | | | | | | | | - Janne Pitkäniemi
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
- Tampere University, Tampere, Finland
| | | | - Jóhanna Torfadóttir
- Icelandic Cancer Registry, Reykjavik, Iceland
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Elisabete Weiderpass
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Eero Pukkala
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
- Tampere University, Tampere, Finland
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11
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Alanen E, Heikkinen S, Nurminen R, Nykter M, Haapasalo H, Hirvonen E, Pitkäniemi J, Rautajoki KJ. Early-onset grade 2-3 diffuse gliomas and schwannomas increase the risk of central nervous system tumors among the patients' relatives. Neurooncol Adv 2023; 5:vdad008. [PMID: 36950216 PMCID: PMC10025807 DOI: 10.1093/noajnl/vdad008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background Central nervous system (CNS) tumors are a heterogeneous group of tumors that include several aggressive malignancies with a high mortality rate. This study aimed to evaluate the familial relative risk of CNS tumors in family members of early-onset index cases (probands) in and between diffuse glioma, non-diffuse glioma, meningioma, and other CNS tumors. Methods We retrieved tumor data from the Finnish cancer registry and familial relationships data from the population information system. We ascertained 5408 probands diagnosed with primary CNS tumors (age ≤40 years) between 1970 and 2012 in Finland. We report the standardized incidence ratios as a measure of familial aggregation using Poisson regression. Results The risk of early-onset diffuse glioma increased among siblings of probands with the same tumor [SIR 3.85, 95% confidence interval (CI): 1.66-7.59], with association mainly returning to grade 2-3 diffuse gliomas. Early-onset other CNS tumors were associated with an increased risk of other CNS tumors, early-onset meningioma, and late-onset diffuse glioma in 1st-degree relatives. The elevated risk of other CNS tumors was largely caused by schwannomas (SIR 59.44, 95% CI: 27.18-112.84 for 1st-degree relatives) and associated with neurofibromatosis. No tumor syndrome was associated with an increased risk of diffuse gliomas. Conclusions The early onset of grade 2-3 diffuse gliomas is associated with an increased risk of similar tumor entities. Early-onset schwannomas dramatically increase CNS tumor risk with a broader tumor-type profile. In future studies, it would be important to identify the underlying shared hereditary factors that contribute to the development of familial diffuse gliomas.
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Affiliation(s)
| | | | - Riikka Nurminen
- Prostate Cancer Research Center, Faculty of Medicine and Health Technology, Tampere University and Tays Cancer Center, Tampere University Hospital, Tampere, Finland
| | - Matti Nykter
- Prostate Cancer Research Center, Faculty of Medicine and Health Technology, Tampere University and Tays Cancer Center, Tampere University Hospital, Tampere, Finland
- Foundation for the Finnish Cancer Institute, Helsinki, Finland
| | - Hannu Haapasalo
- Faculty of Medicine and Health Technology, Tampere University and Tays Cancer Center, Tampere University Hospital, Tampere, Finland
- Fimlab Laboratories ltd., Tampere University Hospital, Tampere, Finland
| | - Elli Hirvonen
- Finnish Cancer Registry, Cancer Society of Finland, Helsinki, Finland
| | - Janne Pitkäniemi
- Janne Pitkäniemi, PhD, Finnish Cancer Registry, Unioninkatu 22, 00130, Helsinki, Finland ()
| | - Kirsi J Rautajoki
- Corresponding Authors: Kirsi J. Rautajoki, PhD, BioMediTech Unit, Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, 33520 Tampere, Finland, ()
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12
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Korhonen L, Madanat-Harjuoja L, Hirvonen E, Pitkäniemi J, Malila N, Taskinen M. Sexually transmitted diseases in cancer patients diagnosed under the age of 20 years – a national registry-based cohort study from Finland. Acta Oncol 2022; 61:1309-1316. [DOI: 10.1080/0284186x.2022.2150092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Liisa Korhonen
- Finnish Cancer Registry, Helsinki, Finland
- New Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Laura Madanat-Harjuoja
- Finnish Cancer Registry, Helsinki, Finland
- Boston Children’s Cancer and Blood Disorders Center, Dana Farber Cancer Institute, Boston, MA, USA
| | | | - Janne Pitkäniemi
- Finnish Cancer Registry, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Nea Malila
- Finnish Cancer Registry, Helsinki, Finland
| | - Mervi Taskinen
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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13
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Botta L, Gatta G, Capocaccia R, Stiller C, Cañete A, Dal Maso L, Innos K, Mihor A, Erdmann F, Spix C, Lacour B, Marcos-Gragera R, Murray D, Rossi S, Hackl M, Van Eycken E, Van Damme N, Valerianova Z, Sekerija M, Scoutellas V, Demetriou A, Dušek L, Krejci D, Storm H, Mägi M, Innos K, Paapsi K, Malila N, Pitkäniemi J, Jooste V, Clavel J, Poulalhon C, Lacour B, Desandes E, Monnereau A, Erdmann F, Spix C, Katalinic A, Petridou E, Markozannes G, Garami M, Birgisson H, Murray D, Walsh PM, Mazzoleni G, Vittadello F, Cuccaro F, Galasso R, Sampietro G, Rosso S, Gasparotto C, Maifredi G, Ferrante M, Torrisi A, Sutera Sardo A, Gambino ML, Lanzoni M, Ballotari P, Giacomazzi E, Ferretti S, Caldarella A, Manneschi G, Gatta G, Sant M, Baili P, Berrino F, Botta L, Trama A, Lillini R, Bernasconi A, Bonfarnuzzo S, Vener C, Didonè F, Lasalvia P, Del Monego G, Buratti L, Serraino D, Taborelli M, Capocaccia R, De Angelis R, Demuru E, Di Benedetto C, Rossi S, Santaquilani M, Venanzi S, Tallon M, Boni L, Iacovacci S, Russo AG, Gervasi F, Spagnoli G, Cavalieri d'Oro L, Fusco M, Vitale MF, Usala M, Vitale F, Michiara M, Chiranda G, Sacerdote C, Maule M, Cascone G, Spata E, Mangone L, Falcini F, Cavallo R, Piras D, Dinaro Y, Castaing M, Fanetti AC, Minerba S, Candela G, Scuderi T, Rizzello RV, Stracci F, Tagliabue G, Rugge M, Brustolin A, Pildava S, Smailyte G, Azzopardi M, Johannesen TB, Didkowska J, Wojciechowska U, Bielska-Lasota M, Pais A, Ferreira AM, Bento MJ, Miranda A, Safaei Diba C, Zadnik V, Zagar T, Sánchez-Contador Escudero C, Franch Sureda P, Lopez de Munain A, De-La-Cruz M, Rojas MD, Aleman A, Vizcaino A, Almela F, Marcos-Gragera R, Sanvisens A, Sanchez MJ, Chirlaque MD, Sanchez-Gil A, Guevara M, Ardanaz E, Cañete-Nieto A, Peris-Bonet R, Galceran J, Carulla M, Kuehni C, Redmond S, Visser O, Karim-Kos H, Stevens S, Stiller C, Gavin A, Morrison D, Huws DW. Long-term survival and cure fraction estimates for childhood cancer in Europe (EUROCARE-6): results from a population-based study. Lancet Oncol 2022; 23:1525-1536. [DOI: 10.1016/s1470-2045(22)00637-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 11/17/2022]
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14
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Sipilä LJ, Seppä K, Aavikko M, Ravantti J, Heikkinen S, Aaltonen LA, Pitkäniemi J. Sex-specific familial aggregation of cancers in Finland. Sci Rep 2022; 12:15126. [PMID: 36068325 PMCID: PMC9448814 DOI: 10.1038/s41598-022-19039-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/23/2022] [Indexed: 12/24/2022] Open
Abstract
Despite the fact that the effect of sex on the occurrence of cancers has been studied extensively, it remains unclear whether sex modifies familial aggregation of cancers. We explored sex-specific familial aggregation of cancers in a large population-based historical cohort study. We combined cancer and population registry data, inferring familial relationships from birth municipality-surname-sex (MNS) combinations. Our data consisted of 391,529 incident primary cancers in 377,210 individuals with 319,872 different MNS combinations. Cumulative sex-specific numbers of cancers were compared to expected cumulative incidence. Familial cancer risks were similar between the sexes in our population-wide analysis. Families with concordant cancer in both sexes exhibited similar sex-specific cancer risks. However, some families had exceptionally high sex-specific cumulative cancer incidence. We identified six families with exceptionally strong aggregation in males: three families with thyroid cancer (ratio between observed and expected incidence 184.6; 95% credible interval (95% CI) 33.1–1012.7, 173.4 (95% CI 65.4–374.3), and 161.4 (95% CI 29.6–785.7), one with stomach (ratio 14.4 (95% CI 6.9–37.2)), colon (ratio 15.5 (95% CI 5.7–56.3)) cancers and one with chronic lymphocytic leukaemia (ratio 33.5 (95% CI 17.2–207.6)). Our results imply that familial aggregation of cancers shows no sex-specific preference. However, the atypical sex-specific aggregation of stomach cancer, colon cancer, thyroid cancer and chronic lymphocytic leukaemia in certain families is difficult to fully explain with present knowledge of possible causes, and could yield useful knowledge if explored further.
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Affiliation(s)
- Lauri J Sipilä
- Department of Medical and Clinical Genetics, Biomedicum Helsinki, University of Helsinki, Haartmaninkatu 8, PO Box 63, 00014, Helsinki, Finland.,Applied Tumor Genomics Research Program, Research Programs Unit, Biomedicum Helsinki, University of Helsinki, Haartmaninkatu 8, PO Box 63, 00014, Helsinki, Finland.,Finnish Cancer Registry, Unioninkatu 22, 00130, Helsinki, Finland
| | - Karri Seppä
- Finnish Cancer Registry, Unioninkatu 22, 00130, Helsinki, Finland
| | - Mervi Aavikko
- Department of Medical and Clinical Genetics, Biomedicum Helsinki, University of Helsinki, Haartmaninkatu 8, PO Box 63, 00014, Helsinki, Finland.,Applied Tumor Genomics Research Program, Research Programs Unit, Biomedicum Helsinki, University of Helsinki, Haartmaninkatu 8, PO Box 63, 00014, Helsinki, Finland.,Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Janne Ravantti
- Department of Medical and Clinical Genetics, Biomedicum Helsinki, University of Helsinki, Haartmaninkatu 8, PO Box 63, 00014, Helsinki, Finland.,Applied Tumor Genomics Research Program, Research Programs Unit, Biomedicum Helsinki, University of Helsinki, Haartmaninkatu 8, PO Box 63, 00014, Helsinki, Finland.,Molecular and Integrative Biosciences Research Programme, Faculty of Biological and Environmental Sciences, University of Helsinki, 00014, Helsinki, Finland
| | - Sanna Heikkinen
- Finnish Cancer Registry, Unioninkatu 22, 00130, Helsinki, Finland
| | - Lauri A Aaltonen
- Department of Medical and Clinical Genetics, Biomedicum Helsinki, University of Helsinki, Haartmaninkatu 8, PO Box 63, 00014, Helsinki, Finland.,Applied Tumor Genomics Research Program, Research Programs Unit, Biomedicum Helsinki, University of Helsinki, Haartmaninkatu 8, PO Box 63, 00014, Helsinki, Finland
| | - Janne Pitkäniemi
- Finnish Cancer Registry, Unioninkatu 22, 00130, Helsinki, Finland. .,Health Sciences Unit, Faculty of Social Sciences (Health Sciences), Tampere University, Tampere, Finland. .,Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland. .,Institute for Statistical and Epidemiological Cancer Research, Finnish Cancer Registry, Unioninkatu 22, 00130, Helsinki, Finland.
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15
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Seikkula H, Kaipia A, Boström PJ, Malila N, Pitkäniemi J, Seppä K. Periodic trends in geographical variation of prostate cancer incidence and mortality in Finland between 1985 and 2019. Acta Oncol 2022; 61:1209-1215. [PMID: 36008888 DOI: 10.1080/0284186x.2022.2112971] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Evaluation of regional variation of prostate cancer (PCa) incidence and PCa-specific mortality is essential in the assessment of equity in a national healthcare system. We evaluated PCa incidence and PCa-specific mortality between different municipalities and hospital districts in Finland over 1985-2019. MATERIAL AND METHODS Men diagnosed with PCa in Finland from 1985 through 2019 were retrieved from Finnish Cancer Registry. Age-standardized PCa incidence and mortality rates were estimated by municipality and hospital district as well as municipality urbanization, education, and income level using hierarchical Bayesian modeling. Standard deviations (SD) of the regional rates were compared between periods from 1985-1989 to 2015-2019. RESULTS We identified 123,185 men diagnosed with any stage PCa between 1985 and 2019. SD of PCa incidence rate (per 100,000 person-years) showed that the total variation of PCa incidence between different municipalities was substantial and varied over time: from 22.2 (95% CI, 17.1-27.8) in 1985-1989 to 56.5 (95% CI, 49.8-64.5) in 2000-2004. The SD of PCa mortality rate between all municipalities was from 9.0 (95% CI, 6.6-11.8) in 2005-2009 to 2.4 (95% CI, 0.9-4.8) in 2015-2019. There was a trend toward a lower PCa-specific mortality rate in municipalities with higher education level. DISCUSSION Regional variation in the incidence rate of PCa became more evident after initiation of PSA testing in Finland, which indicates that early diagnostic practice (PSA testing) of PCa has been different in different parts of the country. Variation in the national PCa mortality rate was indeed recognizable, however, this variation diminished at the same time as the mortality rate declined in Finland. It seems that after the initiation period of PSA testing, PSA has equalized PCa mortality outcomes in Finland.
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Affiliation(s)
- Heikki Seikkula
- Department of Surgery, Hospital Nova of Central Finland, Jyväskylä, Finland
| | - Antti Kaipia
- Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Peter J Boström
- Department of Urology, Turku University Hospital, Turku, Finland.,Department of Urology, University of Turku, Turku, Finland
| | - Nea Malila
- Mass Screening Registry, Finnish Cancer Registry, Helsinki, Finland
| | - Janne Pitkäniemi
- Mass Screening Registry, Finnish Cancer Registry, Helsinki, Finland.,School of Health Sciences, University of Tampere, Tampere, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Karri Seppä
- Mass Screening Registry, Finnish Cancer Registry, Helsinki, Finland
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16
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Abuhamed J, Nikkilä A, Raitanen J, Alimam W, Lohi O, Pitkäniemi J, Haapasalo H, Auvinen A. Incidence trends of childhood central nervous system tumors in Finland 1990-2017. BMC Cancer 2022; 22:784. [PMID: 35850678 PMCID: PMC9290294 DOI: 10.1186/s12885-022-09862-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/04/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Central nervous system (CNS) tumors are a leading cause of cancer-related morbidity and mortality in children. Our aim is to characterize incidence trends of pediatric CNS tumors in Finland over the last three decades. Methods Data on all benign and malignant incident CNS tumors diagnosed in children aged 0–14 years in 1990–2017 were extracted from the Finnish Cancer Registry and classified according to the 2016 WHO classification of CNS tumors. We analyzed age-standardized incidence rates (ASR) for pediatric CNS tumors overall and by sex, age, tumor histology, grade, and location using Poisson regression. We used joinpoint regression to evaluate changes in trends. Results Overall, 1117 pediatric CNS tumor cases were registered in Finland with a 1.2:1 male to female ratio. The average annual ASR was 4.3 per 100,000 person-years (95% CI 4.26, 4.34). The most common tumor type was pilocytic astrocytoma (30% of tumors), followed by medulloblastoma (10%) with incidence rates of 1.30 and 0.45 per 100,000 person-years, respectively. The overall incidence of pediatric CNS tumors increased by an annual percentage change (APC) of 0.8% (95% CI 0.2, 1.4). We observed no major changes in incidence trends of tumor histology groups or tumor location groups. The ASR of benign tumors increased by an APC of 1.0 (95% CI 0.1, 2.0). Conclusions Utilizing the high-quality and completeness of data in the Finnish Cancer registry, we found that the incidence of pediatric CNS tumors in Finland has increased slightly from 1990 until 2017. Although variations in diagnostic and registration practices over time might have affected the rates, the trend may also reflect a true increase in incidence.
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Affiliation(s)
- Jad Abuhamed
- The Health Sciences Unit, Faculty of Social Sciences, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland.
| | - Atte Nikkilä
- TamCAM - Tampere Center for Child, Adolescent and Maternal Health Research, Tampere University, Tampere, Finland
| | - Jani Raitanen
- The Health Sciences Unit, Faculty of Social Sciences, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland.,UKK Institute for Health Promotion Research, Tampere, Finland
| | - Wafa Alimam
- The Health Sciences Unit, Faculty of Social Sciences, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland
| | - Olli Lohi
- Department of Pediatrics and Tays Cancer Center, Tampere University Hospital, Tampere, Finland
| | - Janne Pitkäniemi
- The Health Sciences Unit, Faculty of Social Sciences, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland.,Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland.,Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | | | - Anssi Auvinen
- The Health Sciences Unit, Faculty of Social Sciences, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland.,STUK - Radiation and Nuclear Safety Authority, Helsinki, Finland.,Tampere University Hospital, Tampere, Finland
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17
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Heikkinen S, Tanskanen T, Sipilä L, Pitkäniemi J. Abstract 29: Autoimmune diseases and the risk of cancer. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Many autoimmune diseases (AD) are known to be associated with comorbidities, and certain ADs have been suggested to influence cancer risk. Immunosuppression and dysregulation of the immune system promote the development of certain cancers, particularly hematological malignancies. There is also evidence on an increased risk of several types of solid tumors among individuals with an AD. The aim of this population-based cohort study was to evaluate the risk of any cancer, except non-melanoma skin cancer, in 31 different ADs. We explored associations between both common (such as rheumatoid arthritis) and rare (such as Behcet’s disease) ADs and cancer.
Material and methods: The data consists of a population-based random sample of 2.5 million individuals who lived in Finland on January 1, 2000. It includes information on hospital diagnoses between 1970 and 2017 for each individual, with a total of 92 million hospital care records. There were 70 694 individuals with prevalent AD and 68 002 individuals with prevalent cancer. Those with prevalent cancer were removed from the analyses. Participants were followed up for subsequent occurrence of cancer, based on data from the nationwide cancer registry. We estimated relative risks (RRs) with 95% confidence intervals (CIs) using piecewise constant hazard regression models, adjusting for age, sex, and calendar period. Time since AD diagnosis was treated as a time-varying covariate.
Results: During the follow-up, 222 211 primary cancers were diagnosed, 18 409 with and 203 802 without a pre-existing AD. Overall, the risk of cancer was 2.02 (95% CI 1.93-2.12) for <1 year since any AD diagnosis and 1.05 (1.03-1.07) for ≥10 years since diagnosis. The largest increase in cancer risk was observed for individuals with autoimmune hemolytic anemia, and there was evidence of a persisting risk even after 10 years since diagnosis (RR 8.53 (6.76-10.77) for <1 year since diagnosis and 1.62 (1.18-2.24) for ≥10 years since diagnosis). Long-term impact on cancer risk was also observed for autoimmune vasculitis, Crohn's disease, discoid lupus erythematosus, pemphigus, psoriasis, systemic lupus erythematosus and ulcerative colitis. For individuals with these ADs, cancer risk was still elevated after 10 or more years after AD diagnosis.
Discussion: Cancer incidence was greatly dependent on AD duration. Cancer risk was increased soon (<1 year) after AD diagnosis in 24 different ADs and elevated risks were still observed after ≥10 years in 8 ADs.
Cancer and comorbid diseases may have partly shared etiologies. Many lifestyle factors such as smoking, alcohol consumption, and obesity are established causes of many common diseases. Also, AD treatments may in some cases be tumorigenic. In conclusion, many ADs were associated with a significantly increased risk of cancer long after diagnosis, and this should be considered in patient counseling and monitoring. The findings also encourage search for shared risk factors underlying both diseases.
Citation Format: Sanna Heikkinen, Tomas Tanskanen, Lauri Sipilä, Janne Pitkäniemi. Autoimmune diseases and the risk of cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 29.
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18
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Johansson AL, Larønningen S, Skovlund CW, Kristiansen MF, Mørch LS, Friis S, Johannesen TB, Myklebust TÅ, Skog A, Pettersson D, Birgisson H, Virtanen A, Malila N, Pitkäniemi J, Tanskanen T, Tryggvadóttir L, Ursin G, Lambe M. The impact of the COVID-19 pandemic on cancer diagnosis based on pathology notifications: A comparison across the Nordic countries during 2020. Int J Cancer 2022; 151:381-395. [PMID: 35419824 PMCID: PMC9087674 DOI: 10.1002/ijc.34029] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 11/06/2022]
Abstract
The severity of the COVID-19 pandemic and subsequent mitigation strategies have varied across the Nordic countries. In a joint Nordic population-based effort, we compared patterns of new cancer cases and notifications between the Nordic countries during 2020. We used pathology notifications to cancer registries in Denmark, the Faroe Islands, Finland, Iceland, Norway and Sweden to determine monthly numbers of pathology notifications of malignant and in-situ tumors from January to December 2020 compared to 2019 (2017-2019 for Iceland and the Faroe Islands). We compared new cancer cases per month based on unique individuals with pathology notifications. In April and May 2020, the numbers of new malignant cases declined in all Nordic countries, except the Faroe Islands, compared to previous year(s). The largest reduction was observed in Sweden (May: -31.2%, 95% CI -33.9, -28.3), followed by significant declines in Finland, Denmark and Norway, and a non-significant decline in Iceland. In Denmark, Norway, Sweden and Finland the reporting rates during the second half of 2020 rose to almost the same level as in 2019. However, in Sweden and Finland, the increase did not compensate for the spring decline (annual reduction -6.2% and -3.6%, respectively). Overall, similar patterns were observed for in-situ tumors. The COVID-19 pandemic led to a decline in rates of new cancer cases in Sweden, Finland, Denmark and Norway, with the most pronounced reduction in Sweden. Possible explanations include the severity of the pandemic, temporary halting of screening activities and changes in healthcare seeking behaviour.
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Affiliation(s)
- Anna Lv Johansson
- Cancer Registry of Norway, Oslo, Norway.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Marnar Fríðheim Kristiansen
- Center of Health Science, Faculty of Health Sciences, Tórshavn, Faroe Islands.,National Hospital of the Faroe Islands, Tórshavn, Faroe Islands
| | - Lina Steinrud Mørch
- Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | - Søren Friis
- Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | | | - Tor Åge Myklebust
- Cancer Registry of Norway, Oslo, Norway.,Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Anna Skog
- Cancer Registry of Norway, Oslo, Norway
| | | | - Helgi Birgisson
- Cancer Registry of Iceland, Icelandic Cancer Society, Reykjavik, Iceland
| | - Anni Virtanen
- Finnish Cancer Registry, Cancer Society of Finland, Helsinki, Finland
| | - Nea Malila
- Finnish Cancer Registry, Cancer Society of Finland, Helsinki, Finland
| | - Janne Pitkäniemi
- Finnish Cancer Registry, Cancer Society of Finland, Helsinki, Finland.,Health Sciences Unit, Faculty of Social Sciences, Tampere University, Tampere, Finland.,Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Tomas Tanskanen
- Finnish Cancer Registry, Cancer Society of Finland, Helsinki, Finland
| | - Laufey Tryggvadóttir
- Cancer Registry of Iceland, Icelandic Cancer Society, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Giske Ursin
- Cancer Registry of Norway, Oslo, Norway.,Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mats Lambe
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Regional Cancer Center Central Sweden, Uppsala, Sweden
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19
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Roos E, Seppä K, Pietiläinen O, Ryynänen H, Heikkinen S, Eriksson JG, Härkänen T, Jousilahti P, Knekt P, Koskinen S, Laaksonen M, Männistö S, Roos T, Rahkonen O, Malila N, Pitkäniemi J. Pairwise association of key lifestyle factors and risk of colorectal cancer: a prospective pooled multicohort study. Cancer Rep (Hoboken) 2022; 5:e1612. [PMID: 35243812 PMCID: PMC9675367 DOI: 10.1002/cnr2.1612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/03/2021] [Accepted: 02/16/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Several lifestyle factors are associated with an increased risk of colorectal cancer (CRC). Although lifestyle factors co-occur, in most previous studies these factors have been studied focusing upon a single risk factor or assuming independent effects between risk factors. AIM To examine the pairwise effects and interactions of smoking, alcohol consumption, physical inactivity, and body mass index (BMI) with risk of subsequent colorectal cancer (CRC). METHODS AND RESULTS We used METCA cohort data (pooled data from seven population-based Finnish health behavior survey studies during years 1972-2015) consisting of 171 063 women and men. Participants' smoking, alcohol consumption, physical inactivity and BMI measures were gathered, and participants were categorized into those exposed and those not exposed. The incidence of CRC was modeled by Poisson regression with main and interaction effects of key lifestyle factors. The cohort members were followed-up through register linkage to the Finnish Cancer Registry for first primary CRC case until the end of 2015. Follow-up time was 1715, 690 person years. The highest pairwise CRC risk was among male smokers who had overweight (BMI ≥ 25 kg/m2 ) (HR 1.75, 95% CI 1.36-2.26) and women who had overweight and consumed alcohol (HR 1.45, 95% CI 1.14-1.85). Overall, among men the association of lifestyle factors and CRC risk was stronger than among women. In men, both having overweight and being a smoker combined with any other adverse lifestyle factor increased CRC risk. Among women, elevated CRC risks were observed for those who were physically inactive and who consumed alcohol or had overweight. No statistically significant interactions were detected between pairs of lifestyle factors. CONCLUSIONS This study strengthens the evidence of overweight, smoking, and alcohol consumption as CRC risk factors. Substantial protective benefits in CRC risk can be achieved by preventing smoking, maintaining BMI to <25 kg/m2 and not consuming alcohol.
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Affiliation(s)
- Eira Roos
- Department of Public HealthUniversity of HelsinkiHelsinkiFinland
| | - Karri Seppä
- Finnish Cancer RegistryInstitute for Statistical and Epidemiological Cancer ResearchHelsinkiFinland
| | - Olli Pietiläinen
- Department of Public HealthUniversity of HelsinkiHelsinkiFinland
| | - Heidi Ryynänen
- Finnish Cancer RegistryInstitute for Statistical and Epidemiological Cancer ResearchHelsinkiFinland
| | - Sanna Heikkinen
- Finnish Cancer RegistryInstitute for Statistical and Epidemiological Cancer ResearchHelsinkiFinland
| | | | - Tommi Härkänen
- The Finnish Institute for Health and Welfare (THL)HelsinkiFinland
| | - Pekka Jousilahti
- The Finnish Institute for Health and Welfare (THL)HelsinkiFinland
| | - Paul Knekt
- The Finnish Institute for Health and Welfare (THL)HelsinkiFinland
| | - Seppo Koskinen
- The Finnish Institute for Health and Welfare (THL)HelsinkiFinland
| | - Maarit Laaksonen
- The Finnish Institute for Health and Welfare (THL)HelsinkiFinland,School of Mathematics and StatisticsUniversity of New South WalesSydneyAustralia
| | - Satu Männistö
- The Finnish Institute for Health and Welfare (THL)HelsinkiFinland
| | - Teemu Roos
- Department of Computer ScienceUniversity of HelsinkiHelsinkiFinland
| | - Ossi Rahkonen
- Department of Public HealthUniversity of HelsinkiHelsinkiFinland
| | - Nea Malila
- Finnish Cancer RegistryInstitute for Statistical and Epidemiological Cancer ResearchHelsinkiFinland
| | - Janne Pitkäniemi
- Finnish Cancer RegistryInstitute for Statistical and Epidemiological Cancer ResearchHelsinkiFinland,School of Health SciencesUniversity of TampereTampereFinland
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Kuisma H, Bramante S, Rajamäki K, Sipilä LJ, Kaasinen E, Kaukomaa J, Palin K, Mäkinen N, Sjöberg J, Sarvilinna N, Taipale J, Kauppi L, Tumiati M, Hassinen A, Pitkäniemi J, Jalkanen J, Heikkinen S, Pasanen A, Heikinheimo O, Bützow R, Välimäki N, Aaltonen LA. Parity associates with chromosomal damage in uterine leiomyomas. Nat Commun 2021; 12:5448. [PMID: 34521855 PMCID: PMC8440576 DOI: 10.1038/s41467-021-25806-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 08/30/2021] [Indexed: 12/16/2022] Open
Abstract
Mechanical forces in a constrained cellular environment were recently established as a facilitator of chromosomal damage. Whether this could contribute to tumorigenesis is not known. Uterine leiomyomas are common neoplasms that display relatively few chromosomal aberrations. We hypothesized that if mechanical forces contribute to chromosomal damage, signs of this could be seen in uterine leiomyomas from parous women. We examined the karyotypes of 1946 tumors, and found a striking overrepresentation of chromosomal damage associated with parity. We then subjected myometrial cells to physiological forces similar to those encountered during pregnancy, and found this to cause DNA breaks and a DNA repair response. While mechanical forces acting in constrained cellular environments may thus contribute to neoplastic degeneration, and genesis of uterine leiomyoma, further studies are needed to prove possible causality of the observed association. No evidence for progression to malignancy was found.
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Affiliation(s)
- Heli Kuisma
- Department of Medical and Clinical Genetics and Applied Tumor Genomics Research Program University of Helsinki, Helsinki, Finland
| | - Simona Bramante
- Department of Medical and Clinical Genetics and Applied Tumor Genomics Research Program University of Helsinki, Helsinki, Finland
| | - Kristiina Rajamäki
- Department of Medical and Clinical Genetics and Applied Tumor Genomics Research Program University of Helsinki, Helsinki, Finland
| | - Lauri J Sipilä
- Department of Medical and Clinical Genetics and Applied Tumor Genomics Research Program University of Helsinki, Helsinki, Finland
| | - Eevi Kaasinen
- Department of Medical and Clinical Genetics and Applied Tumor Genomics Research Program University of Helsinki, Helsinki, Finland
| | - Jaana Kaukomaa
- Department of Medical and Clinical Genetics and Applied Tumor Genomics Research Program University of Helsinki, Helsinki, Finland
| | - Kimmo Palin
- Department of Medical and Clinical Genetics and Applied Tumor Genomics Research Program University of Helsinki, Helsinki, Finland
| | - Netta Mäkinen
- Department of Medical and Clinical Genetics and Applied Tumor Genomics Research Program University of Helsinki, Helsinki, Finland
| | - Jari Sjöberg
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Nanna Sarvilinna
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Systems Oncology Research Program, University of Helsinki, Helsinki, Finland
| | - Jussi Taipale
- Department of Medical and Clinical Genetics and Applied Tumor Genomics Research Program University of Helsinki, Helsinki, Finland
| | - Liisa Kauppi
- Systems Oncology Research Program, University of Helsinki, Helsinki, Finland
| | - Manuela Tumiati
- Systems Oncology Research Program, University of Helsinki, Helsinki, Finland
| | - Antti Hassinen
- FIMM-HCA, Institute for Molecular Medicine Finland (FIMM), Helsinki, Finland
| | - Janne Pitkäniemi
- Institute for Statistical and Epidemiological Cancer Research, Finnish Cancer Registry, Helsinki, Finland
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Jyrki Jalkanen
- Department of Obstetrics and Gynecology, Central Finland Central Hospital, Jyväskylä, Finland
| | - Sanna Heikkinen
- Institute for Statistical and Epidemiological Cancer Research, Finnish Cancer Registry, Helsinki, Finland
| | - Annukka Pasanen
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Oskari Heikinheimo
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ralf Bützow
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Niko Välimäki
- Department of Medical and Clinical Genetics and Applied Tumor Genomics Research Program University of Helsinki, Helsinki, Finland
| | - Lauri A Aaltonen
- Department of Medical and Clinical Genetics and Applied Tumor Genomics Research Program University of Helsinki, Helsinki, Finland.
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21
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Melin J, Tiitinen A, Hirvonen E, Malila N, Pitkäniemi J, Gissler M, Madanat-Harjuoja L. Probability of live birth after IVF/ICSI treatments in female early onset cancer survivors: a Finnish population-based registry study. Hum Reprod 2021; 36:3131-3140. [PMID: 34491339 DOI: 10.1093/humrep/deab202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/09/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Does the probability of a live birth after fresh IVF/ICSI cycles with autologous oocytes differ in early onset female cancer survivors compared to their siblings? SUMMARY ANSWER The probability of a live birth was similar in female cancer survivors and siblings after four fresh IVF/ICSI cycles. WHAT IS KNOWN ALREADY Fertility preservation strategies are rapidly being developed to help female cancer patients who wish to have children later. However, there are only a few studies available on fertility treatments and following live births in female cancer survivors before fertility preservation strategies became available. In one of them, the probability of a live birth was reduced after assisted reproductive technology with autologous oocytes in cancer survivors compared to siblings. STUDY DESIGN, SIZE, DURATION In this retrospective, register-based study, data from Finnish registers on cancer, birth and prescribed medications were merged to identify 8944 female cancer survivors (diagnosed with cancer between 1953 and 2012 at the age of 0-40 years) and 9848 female siblings of survivors eligible for IVF/ICSI treatments between January 1993 and December 2012. PARTICIPANTS/MATERIALS, SETTING, METHODS Fresh IVF/ICSI cycles and following live birth rates (LBRs) within 22-48 weeks in cancer survivors and siblings at the age of 20-41 years were identified. A binomial regression model with log-link function was used to calculate risk ratio (RR) for live births after fresh IVF/ICSI cycles in survivors compared to siblings, adjusting for attained age and calendar time. A Poisson regression model was used to estimate incidence rate ratios (IRRs) for an IVF/ICSI treatment, as well as overall live births, including both pregnancies after fertility treatments and spontaneous pregnancies, in survivors compared to siblings. MAIN RESULTS AND THE ROLE OF CHANCE We observed an overall decreased LBR, irrespective of IVF/ICSI treatments, in cancer survivors compared to siblings (IRR 0.68, 95% CI 0.64-0.71). All in all, 179 (2.0%) survivors and 230 (2.3%) siblings were prescribed fertility drugs for IVF/ICSI treatments (IRR 0.72, 95% CI 0.62-0.84). For the first fresh IVF/ICSI cycle, the LBR was 17.2% among survivors and 15.7% among siblings (RR 1.13, 95% CI 0.72-1.87). The mean LBR after four fresh IVF/ICSI cycles was not statistically different in survivors compared to siblings. LIMITATIONS, REASONS FOR CAUTION In this study, only IVF/ICSI treatments with autologous oocytes were included. The probability of a live birth after a frozen embryo transfer or oocyte donation could not be evaluated in this study. Information on miscarriages, extrauterine pregnancies or termination of pregnancies was not available. WIDER IMPLICATIONS OF THE FINDINGS For those early onset cancer survivors, who received IVF/ICSI treatments, the probability of live birth was not different from siblings who received IVF/ICSI treatments. However, an overall decreased LBR, irrespective of IVF/ICSI treatments, was observed in cancer survivors compared to siblings, indicating that cancer survivors receiving IVF/ICSI treatments in our study consisted of a selected group with at least a moderate ovarian reserve. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by a grant from the Cancer Foundation (Finland) (grant number 130079) and by a grant from LähiTapiola. The authors have no potential conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- J Melin
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland.,Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - A Tiitinen
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - E Hirvonen
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - N Malila
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - J Pitkäniemi
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland.,Faculty of Social Science, University of Tampere, Tampere, Finland.,Department of Public Health, School of Medicine, University of Helsinki, Helsinki, Finland
| | - M Gissler
- Information Services Department, Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Neurobiology, Care Science and Society, Karolinska Institute, Stockholm, Sweden
| | - L Madanat-Harjuoja
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland.,Dana Farber Cancer Institute/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA.,Department of Pediatrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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22
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Rissanen E, Heikkinen S, Seppä K, Ryynänen H, Eriksson JG, Härkänen T, Jousilahti P, Knekt P, Koskinen S, Männistö S, Rahkonen O, Rissanen H, Malila N, Laaksonen MA, Pitkäniemi J. Incidence trends and risk factors of lung cancer in never smokers: Pooled analyses of seven cohorts. Int J Cancer 2021; 149:2010-2019. [PMID: 34398974 DOI: 10.1002/ijc.33765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/23/2021] [Accepted: 07/07/2021] [Indexed: 12/24/2022]
Abstract
The trends in incidence of lung cancer in never smokers are unclear as well as the significance of risk factors. We studied time trends in the incidence and risk factors of lung cancer in never smokers in Finland in a large, pooled cohort. We pooled data from seven Finnish health cohorts from the period between 1972 and 2015 with 106 193 never smokers. The harmonised risk factors included education, alcohol consumption, physical activity, height and BMI. We retrieved incident lung cancers from the nation-wide Finnish Cancer Registry. We estimated average annual percent change (AAPC) and the effects of risk factors on cause-specific hazard ratios (HRs) of lung cancer using Poisson regression. We detected 47 lung cancers in never smoking men (n = 31 859) and 155 in never smoking women (n = 74 334). The AAPC of lung cancer incidence was -3.30% (95% confidence interval [CI]: -5.68% to -0.88%, P = .009) in never smoking men and 0.00% (95% CI: -1.57% to 1.60%, P = .996) in never smoking women. Of the five studied risk factors only greater height in women had a statistically significant increased risk of lung cancer (multivariate HR = 1.84, 95%CI: 1.08 to 3.12). It is plausible that tobacco control measures focused on working places have reduced passive smoking among men more than among women, which could explain the declining trend in lung cancer incidence in never smoker men but not in never smoker women. As tobacco control measures have not been targeted to domestic environments, it is likely that women's exposure to passive smoking has continued longer.
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Affiliation(s)
- Emilia Rissanen
- Institute for Statistical and Epidemiological Cancer Research, Finnish Cancer Registry, Helsinki, Finland
| | - Sanna Heikkinen
- Institute for Statistical and Epidemiological Cancer Research, Finnish Cancer Registry, Helsinki, Finland
| | - Karri Seppä
- Institute for Statistical and Epidemiological Cancer Research, Finnish Cancer Registry, Helsinki, Finland
| | - Heidi Ryynänen
- Institute for Statistical and Epidemiological Cancer Research, Finnish Cancer Registry, Helsinki, Finland
| | - Johan G Eriksson
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland.,Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Folkhälsan Research Center, Helsinki, Finland.,Singapore Institute for Clinical Science, Agency for Science, Technology and Research, Singapore, Singapore.,Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tommi Härkänen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Pekka Jousilahti
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Paul Knekt
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Seppo Koskinen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Satu Männistö
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Harri Rissanen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Nea Malila
- Institute for Statistical and Epidemiological Cancer Research, Finnish Cancer Registry, Helsinki, Finland
| | - Maarit A Laaksonen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland.,School of Mathematics and Statistics, Faculty of Science, University of New South Wales, Sydney, Australia
| | - Janne Pitkäniemi
- Institute for Statistical and Epidemiological Cancer Research, Finnish Cancer Registry, Helsinki, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland.,Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland
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23
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Rönkkö R, Hirvonen E, Malila N, Kilpivaara O, Wartiovaara-Kautto U, Pitkäniemi J. Familial aggregation of early-onset haematological malignancies. Br J Haematol 2021; 193:1134-1141. [PMID: 34002362 DOI: 10.1111/bjh.17477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/22/2021] [Indexed: 02/04/2023]
Abstract
Population-based studies on familial aggregation of haematological malignancies (HM) have rarely focused specifically on early-onset HMs. We estimated standardized incidence ratios (SIR) and cumulative risks of relatives with Hodgkin lymphoma (HL), non-Hodgkin lymphomas (NHL), acute lymphoblastic leukaemia/lymphoma (ALL/LBL) and acute myeloid leukaemia (AML) when index persons and relatives were diagnosed with early-onset HM. A total of 8791 patients aged ≤40 years and diagnosed with primary HM in Finland from 1970 to 2012 were identified from the Finnish Cancer Registry and their 75 774 family members were retrieved from the population registry. SIRs for concordant HMs were elevated among first-degree relatives in all of the most common HMs of children and adolescents and young adults (AYA). The risk was highest among siblings with HL (SIR 9·09, 95% confidence interval 5·55-14·04) and AML (8·29, 1·00-29·96). HL also had the highest cumulative risk for siblings at ≤40 years of age (0·92% vs. 0·11% in the population). In conclusion, significantly elevated SIRs indicate a role of shared aetiological factors in some families, which should be noted in the clinical setting when caring for patients with early-onset HMs.
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Affiliation(s)
- Rosa Rönkkö
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland.,Department of Internal Medicine, Helsinki University Hospital, Helsinki, Finland.,Department of Hematology, University of Helsinki, Helsinki, Finland
| | - Elli Hirvonen
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Nea Malila
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Outi Kilpivaara
- Applied Tumor Genomics, Research Programs Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Medical and Clinical Genetics, Medicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,HUSLAB Laboratory of Genetics, HUS Diagnostic Center (Helsinki University Hospital), Helsinki, Finland
| | - Ulla Wartiovaara-Kautto
- Department of Hematology, University of Helsinki, Helsinki, Finland.,Applied Tumor Genomics, Research Programs Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Hematology, Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
| | - Janne Pitkäniemi
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland.,Faculty of Social Sciences, Tampere University, Tampere, Finland.,Department of Public Health, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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24
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Hakkarainen J, Nevala A, Tomás E, Nieminen K, Malila N, Pitkäniemi J, Auranen A. Decreasing trend and changing indications of hysterectomy in Finland. Acta Obstet Gynecol Scand 2021; 100:1722-1729. [PMID: 33797081 DOI: 10.1111/aogs.14159] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 02/25/2021] [Accepted: 03/28/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Hysterectomy has been one of the most common surgical procedures in women in Finland. We studied the population-based trends of hysterectomy and its indications from 1986 to 2017. MATERIAL AND METHODS A retrospective population-based cohort was created from the Care Register for Health Care by identifying women who had a hysterectomy from 1986 to 2017 and calculating the number of women from the Digital and Population Data Services Agency. We estimated the number and incidence of hysterectomy by period and age as well as by indication. We considered the primary diagnosis at the time of surgery as the indication of hysterectomy. RESULTS The number of hysterectomies increased from 7492 procedures in 1986 to 12 404 procedures in 1998, and reduced substantially after that to 5971 procedures in 2017, the turning point being in 1999. The incidence rate of hysterectomy has decreased on average by 2.5% annually from 432.6 per 100 000 women in 1998-2001 to 224.5 per 100 000 women in 2014-2017. The median age at the time of hysterectomy has increased from 51 years in 1998-2001 to 55 years in 2014-2017. The cumulative burden of hysterectomy by age of 60 years has nearly halved from the first 4-year period (23%) to the last (12%). After 2010, the most common indication has been genital prolapse and incontinence, whereas earlier it was uterine fibroids. CONCLUSIONS The number and incidence of hysterectomies have fluctuated during the observation period 1986-2017 and decreased considerably during the past 17 years in Finland. This is probably a result of the availability of hormonal and other conservative treatment options for bleeding disorders and uterine fibroids. As hysterectomy practically removes the risk for endometrial cancer, the change in hysterectomy incidence over time emphasizes the importance of correcting endometrial cancer incidence according to hysterectomy incidence.
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Affiliation(s)
- Jenni Hakkarainen
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland.,Faculty of Medicine and Health Technology (MET), Tampere University, Tampere, Finland.,Department of Obstetrics and Gynecology, Central Finland Central Hospital, Jyväskylä, Finland
| | - Aapeli Nevala
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Eija Tomás
- Faculty of Medicine and Health Technology (MET), Tampere University, Tampere, Finland.,Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland.,Tays Cancer center, Tampere University Hospital, Tampere, Finland
| | - Kari Nieminen
- Faculty of Medicine and Health Technology (MET), Tampere University, Tampere, Finland.,Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland.,Tays Cancer center, Tampere University Hospital, Tampere, Finland
| | - Nea Malila
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Janne Pitkäniemi
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland.,Department of Public Health, School of Medicine, University of Helsinki, Helsinki, Finland.,Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Annika Auranen
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland.,Tays Cancer center, Tampere University Hospital, Tampere, Finland
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Pitkäniemi J, Heikkinen S, Seppä K, Ryynänen H, Ylöstalo T, Eriksson JG, Härkänen T, Jousilahti P, Knekt P, Koskinen S, Männistö S, Albanes D, Rissanen H, Malila N, Laaksonen MA. Pooling of Finnish population-based health studies: lifestyle risk factors of colorectal and lung cancer. Acta Oncol 2020; 59:1338-1342. [PMID: 32657191 DOI: 10.1080/0284186x.2020.1789214] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Janne Pitkäniemi
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Sanna Heikkinen
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Karri Seppä
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Heidi Ryynänen
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Tiina Ylöstalo
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Johan G. Eriksson
- Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tommi Härkänen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Pekka Jousilahti
- Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Paul Knekt
- Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Seppo Koskinen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Satu Männistö
- Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Demetrius Albanes
- Department of Health and Human Services, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Harri Rissanen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Nea Malila
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Maarit A. Laaksonen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
- School of Mathematics and Statistics, Faculty of Science, University of New South Wales, Sydney, Australia
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Abstract
BACKGROUND Monitoring regional variation in population-based cancer survival is useful for assessing equity in national health-care system. This study quantifies variation in survival between municipalities and hospital districts responsible for primary care and for specialised care, respectively, in Finland. MATERIAL AND METHODS Five-year relative survival of 11 cancers and close to 700,000 patients was estimated by municipality in Finland over 1962-2016 using hierarchical Bayesian modelling. Variation (i) between hospital districts, (ii) between municipalities within hospital districts, and (iii) between all municipalities (total variation) were quantified by the standard deviation of 5-year relative survival standardised by the average survival level. RESULTS In 2007-2016, the largest variation in 5-year relative survival between all municipalities was in stomach, prostate, kidney and liver cancer and skin melanoma. In male skin melanoma, prostate, and kidney cancer and in male and female pancreatic cancer, there was substantial and statistically significant variation between hospital districts, too. Variation within hospital districts was on average 67% (95% posterior interval [58%,76%]) out of the total variation and had decreased by 18% [2%, 33%] from 1997-2006. CONCLUSION The decrease in variation within hospital districts suggests that equity in diagnostics and primary care has improved in Finland. However, the variation between hospital districts in skin melanoma, prostate and kidney cancer reflects differences in early diagnostics. In pancreatic cancer, substantial variation between hospital districts may relate to regional differences in the accessibility and the quality of cancer treatments.
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Affiliation(s)
- Karri Seppä
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Nea Malila
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Janne Pitkäniemi
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
- Faculty of Medicine, Department of Public Health, University of Helsinki, Helsinki, Finland
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27
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Seikkula H, Hirvonen E, Kaipia A, Boström PJ, Malila N, Pitkäniemi J. Familial aggregation of testicular cancer among early-onset cancer survivors. A prospective observational cohort data from Finland. Cancer Epidemiol 2020; 69:101807. [PMID: 33045472 DOI: 10.1016/j.canep.2020.101807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/18/2020] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
Abstract
Testicular cancer (TC) is the most common form of cancer in men aged 15-35 years. Familial risk for TC is among highest of all cancers. MATERIAL AND METHODS A prospective observational cohort of 9111 relatives in 2,188 families of early-onset TC patients, called probands, diagnosed at age ≤40 years in Finland between 1970 and 2012. Standardized incidence ratios (SIR) were used as measures of familial aggregation for early-onset (≤40 years) TC. Follow-up ended at diagnosis of TC, death or 31 December 2014 whichever earliest. RESULTS Among first-degree relatives of early-onset TCs, in all 12 early-onset TC cases (0.24%) were diagnosed over the follow-up; the SIR for any first-degree relative was 4.59 (95% confidence interval (CI): 2.37-8.01) and for brothers the SIR was 6.51 (95% CI 3.12-11.96). DISCUSSION Familial aggregation of TC shows substantial risk for early-onset TC among first-degree relatives of early-onset TC patients in Finland. This is important to acknowledge to avoid diagnostic delay especially of TC.
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Affiliation(s)
- Heikki Seikkula
- Department of Surgery, Central Hospital of Central Finland, Keskussairaalantie 19, 40620 Jyväskylä, Finland.
| | - Elli Hirvonen
- Finnish Cancer Registry, Unioninkatu 22, 00130 Helsinki, Finland.
| | - Antti Kaipia
- Department of Urology, Tampere University Hospital, PL 2000, 33521 Tampere, Finland.
| | - Peter J Boström
- Department of Urology, Turku University Hospital, Turku, Finland; Department of Urology, University of Turku, Kiinamyllynkatu 4-8, 20100 Turku, Finland.
| | - Nea Malila
- Finnish Cancer Registry, Unioninkatu 22, 00130 Helsinki, Finland.
| | - Janne Pitkäniemi
- Finnish Cancer Registry, Unioninkatu 22, 00130 Helsinki, Finland; School of Health Sciences, University of Tampere, Finland; Department of Public Health, University of Helsinki, Helsinki, Finland.
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28
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Mroueh R, Tanskanen T, Haapaniemi A, Salo T, Malila N, Mäkitie A, Pitkäniemi J. Familial cancer risk in family members and spouses of patients with early-onset head and neck cancer. Head Neck 2020; 42:2524-2532. [PMID: 32472619 DOI: 10.1002/hed.26282] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/30/2020] [Accepted: 05/12/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Reported patterns of familial aggregation of head and neck cancer (HNC) vary greatly, with many studies hampered by the limited number of subjects. METHODS Altogether 923 early-onset (≤40 years old) HNC probands, their first-degree relatives, spouses, and siblings' offspring were ascertained. Cumulative risk and standardized incidence ratios (SIRs) were estimated. RESULTS Of all early-onset HNC families, only 21 (2.3%) had familial HNC cancers at any age and less than five familial early onset HNC cancers among first-degree relatives. The cumulative risk of HNC for siblings by age 60 (0.52%) was at population level (0.33%). No increased familial risk of early-onset HNC could be discerned in family members (SIR 2.68, 95% CI 0.32-9.68 for first-degree relatives). CONCLUSIONS Our study indicates that the cumulative and relative familial risk of early-onset HNC is modest in the Finnish population and, at most, only a minor proportion of early-onset HNCs are due solely to inherited genetic mutations.
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Affiliation(s)
- Rayan Mroueh
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
| | - Tomas Tanskanen
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer and Research, Helsinki, Finland
| | - Aaro Haapaniemi
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
| | - Tuula Salo
- Cancer and Translational Medicine Unit, University of Oulu, Oulu, Finland.,Medical Research Unit, Oral and Maxillofacial Diseases, University of Helsinki and Haartman Institute, Helsinki, Finland
| | - Nea Malila
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer and Research, Helsinki, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland.,Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden
| | - Janne Pitkäniemi
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer and Research, Helsinki, Finland.,Faculty of Social Sciences, University of Tampere, Tampere, Finland.,Department of Public Health, School of Medicine, University of Helsinki, Helsinki, Finland
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29
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Kyrönlahti A, Madanat-Harjuoja L, Pitkäniemi J, Rantanen M, Malila N, Taskinen M. Childhood cancer mortality and survival in immigrants: A population-based registry study in Finland. Int J Cancer 2020; 146:2746-2755. [PMID: 31407318 DOI: 10.1002/ijc.32625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 07/06/2019] [Accepted: 07/09/2019] [Indexed: 12/30/2022]
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.
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Affiliation(s)
- Anniina Kyrönlahti
- Finnish Cancer Registry, Helsinki, Finland.,New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Laura Madanat-Harjuoja
- Finnish Cancer Registry, Helsinki, Finland.,New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Janne Pitkäniemi
- Finnish Cancer Registry, Helsinki, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland
| | | | - Nea Malila
- Finnish Cancer Registry, Helsinki, Finland
| | - Mervi Taskinen
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Helsinki University Hospital, Helsinki, Finland
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30
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Korja M, Raj R, Seppä K, Luostarinen T, Malila N, Seppälä M, Mäenpää H, Pitkäniemi J. Glioblastoma survival is improving despite increasing incidence rates: a nationwide study between 2000 and 2013 in Finland. Neuro Oncol 2020; 21:370-379. [PMID: 30312433 DOI: 10.1093/neuonc/noy164] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND We assessed population-level changes in glioblastoma survival between 2000 and 2013 in Finland, with focus on elderly patients (>70 y) in order to assess if changes in treatment of glioblastoma are reflected also in population-based survival rates. METHODS We identified all patients (age ≥18 y) from the Finnish Cancer Registry (FCR) with a histopathological diagnosis of primary glioblastoma in 2000-2013. Patients were followed up until December 2015. The accuracy of register-based search of glioblastoma patients was internally validated. We report age-standardized relative survival ratios and relative excess risks (RERs) of death in 2000-2006 (pre-period) and 2007-2013 (post-period). RESULTS We identified 2045 glioblastoma patients from the FCR. The accuracy of the FCR-based search was 97%. Median age was 63.3 years, and 42% were women. Incidence increased on average by 1.6% (P = 0.004) and median age by 0.4 years per calendar year. Between the pre- and post-periods, the proportion of patients >70 years increased from 24% to 27%. In >70-year-old patients, the median survival time increased from 3.6 months in 2000-2006 to 4.5 months in 2007-2013 (RER 0.82, 95% CI: 0.68-0.98). In ≤70-year-old patients, the median survival time increased from 9.3 months in 2000-2006 to 11.7 months in 2007-2013 (RER 0.74, 95% CI: 0.67-0.82). CONCLUSION Despite the increased proportion of elderly glioblastoma patients, population-level survival of glioblastoma patients has improved since the year 2000. However, increasing incidence, increasing age of patients, and poor survival in elderly are alarming, and future studies should perhaps focus more on elderly.
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Affiliation(s)
- Miikka Korja
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Rahul Raj
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Karri Seppä
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Tapio Luostarinen
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Nea Malila
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Matti Seppälä
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hanna Mäenpää
- Department of Oncology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Janne Pitkäniemi
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
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31
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Madanat-Harjuoja LM, Pitkäniemi J, Hirvonen E, Malila N, Diller LR. Linking population-based registries to identify familial cancer risk in childhood cancer. Cancer 2020; 126:3076-3083. [PMID: 32315449 DOI: 10.1002/cncr.32882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/11/2020] [Accepted: 03/11/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Linked population-based registries provide a unique source for identification of new family cancer syndromes and for elucidating risk of early-onset cancer in close relatives of cancer patients. METHODS Using the Finnish Cancer Registry, we identified 9078 probands who had been diagnosed with cancer at <21 years of age between 1970 and 2012. Siblings, offspring, parents, nephews, and nieces of probands were identified from the Population Registry. Childhood and young adult (ChYA) cancer diagnoses (age 0-39 years) in relatives were identified by linking to the Finnish Cancer Registry. The relative risk of ChYA cancer in family members of probands was estimated using standardized incidence ratios (SIRs). RESULTS Among 58,010 family members of the 9078 probands, 363 ChYA cancers were diagnosed, 324 of which were expected (SIR, 1.12; 95% CI, 1.01-1.24). The risk of ChYA cancer was elevated both in offspring (SIR, 2.25; 95% CI, 1.51-3.24) and in siblings (SIR, 1.17; 95% CI, 1.01-1.36). Offspring of probands with retinoblastoma were at highest risk (SIR, 75.85; 95% CI, 32.75-149.45); risks were also elevated for siblings of probands with lymphoma (SIR, 1.62; 95% CI, 1.14-2.25). Known cancer predisposition syndromes were observed in 29 (66%) of 44 sibling pairs with cancers diagnosed at <21 years of age and in 20% of the 135 families with a childhood cancer proband whose sibling was diagnosed with a young adult malignancy. CONCLUSION Linked population-based registry data indicate a modestly increased risk of ChYA in relatives of children with cancer. Some of the observed cancer clusters in the cohort suggest novel patterns and familial cancer syndromes.
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Affiliation(s)
- Laura-Maria Madanat-Harjuoja
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Finnish Cancer Registry, Helsinki, Finland
| | - Janne Pitkäniemi
- Finnish Cancer Registry, Helsinki, Finland.,Faculty of Social Sciences (Health Sciences), Tampere University, Tampere, Finland.,School of Medicine, University of Helsinki, Helsinki, Finland
| | | | - Nea Malila
- Finnish Cancer Registry, Helsinki, Finland
| | - Lisa R Diller
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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32
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Seikkula H, Boström PJ, Seppä K, Pitkäniemi J, Malila N, Kaipia A. Survival and mortality of elderly men with localized prostate cancer managed with primary androgen deprivation therapy or by primary observation. BMC Urol 2020; 20:25. [PMID: 32164671 PMCID: PMC7069023 DOI: 10.1186/s12894-020-00593-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 02/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Androgen deprivation therapy (ADT) remains a primary treatment for localized prostate cancer (PCa) even though there is no evidence that its use is beneficial in the absence of curative treatment. METHODS Men aged ≥70 years (n = 16,534) diagnosed with localized PCa from 1985 to 2014 and managed either with primary observation or ADT in the absence of curative treatment were included. The cases were identified from the population-based Finnish Cancer Registry. We estimated the standardized mortality ratios (SMR) for overall mortality by treatment group. We determined the relative risk (RR) of PCa-specific mortality (PCSM) and other-cause mortality between the two treatment groups. Survival was determined using the life table method. Two age groups (70-79 years and ≥ 80 years) and three calendar time cohorts (1985-1994, 1995-2004, and 2005-2014) were compared following adjustment of propensity score matching between the treatment groups with four covariates (age, year of diagnosis, educational level, and hospital district). Follow-up continued until death or until December 31, 2015. RESULTS Patients in the observation group had lower overall SMRs than those in the ADT group in both age cohorts over the entire study period. PCSM was higher in men aged 70-79 years undergoing primary ADT compared to those managed by observation only (RR: 1.70, 95% confidence interval [CI]: 1.29-2.23 [1985-1994]; RR 1.55, 95% CI: 1.35-1.84 [1995-2004]; and RR 2.71, 95% CI: 2.08-3.53 [2005-2014]); p = 0.005 for periodic trend. A similar trend over time was also observed in men aged > 80 years; (p for age-period interaction = 0.237). Overall survival was also higher among men in their 70's managed by observation compared to those undergoing ADT. CONCLUSIONS Primary ADT within four months period from diagnosis is not associated with improved long-term overall survival or decreased PCSM compared to primary conservative management for men with localized PCa. However, this observational study's conclusions should be weighted with confounding factors related to cancer aggressiveness and comorbidities.
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Affiliation(s)
- Heikki Seikkula
- Department of Surgery, Central Hospital of Central Finland, Jyväskylä, Finland.
| | - Peter J Boström
- Department of Urology, Turku University Hospital, Turku, Finland.,Department of Urology, University of Turku, Turku, Finland
| | | | - Janne Pitkäniemi
- Finnish Cancer Registry, Helsinki, Finland.,Faculty of Social Sciences (Health Sciences), Tampere, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Nea Malila
- Finnish Cancer Registry, Helsinki, Finland.,School of Health Sciences, University of Tampere, Tampere, Finland
| | - Antti Kaipia
- Department of Urology, Tampere University Hospital, Tampere, Finland
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Raj R, Seppä K, Luostarinen T, Malila N, Seppälä M, Pitkäniemi J, Korja M. Disparities in glioblastoma survival by case volume: a nationwide observational study. J Neurooncol 2020; 147:361-370. [PMID: 32060840 PMCID: PMC7136186 DOI: 10.1007/s11060-020-03428-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 02/08/2020] [Indexed: 12/11/2022]
Abstract
Introduction High hospital case volumes are associated with improved treatment outcomes for numerous diseases. We assessed the association between academic non-profit hospital case volume and survival of adult glioblastoma patients. Methods From the nationwide Finnish Cancer Registry, we identified all adult (≥ 18 years) patients with histopathological diagnoses of glioblastoma from 2000 to 2013. Five university hospitals (treating all glioblastoma patients in Finland) were classified as high-volume (one hospital), middle-volume (one hospital), and low-volume (three hospitals) based on their annual numbers of cases. We estimated one-year survival rates, estimated median overall survival times, and compared relative excess risk (RER) of death between high, middle, and low-volume hospitals. Results A total of 2,045 patients were included. The mean numbers of annually treated patients were 54, 40, and 17 in the high, middle, and low-volume hospitals, respectively. One-year survival rates and median survival times were higher and longer in the high-volume (39%, 9.3 months) and medium-volume (38%, 8.9 months) hospitals than in the low-volume (32%, 7.8 months) hospitals. RER of death was higher in the low-volume hospitals than in the high-volume hospital (RER = 1.19, 95% CI 1.07–1.32, p = 0.002). There was no difference in RER of death between the high-volume and medium-volume hospitals (p = 0.690). Conclusion Higher glioblastoma case volumes were associated with improved survival. Future studies should assess whether this association is due to differences in patient-specific factors or treatment quality. Electronic supplementary material The online version of this article (10.1007/s11060-020-03428-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rahul Raj
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Topeliuksenkatu 5, P.O. Box 266, 00029, Helsinki, Finland
| | - Karri Seppä
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, 00130, Helsinki, Finland
| | - Tapio Luostarinen
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, 00130, Helsinki, Finland
| | - Nea Malila
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, 00130, Helsinki, Finland
| | - Matti Seppälä
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Topeliuksenkatu 5, P.O. Box 266, 00029, Helsinki, Finland
| | - Janne Pitkäniemi
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, 00130, Helsinki, Finland.,School of Social Sciences, Tampere University, Tampere, Finland.,Department of Public Health, School of Medicine, University of Helsinki, Helsinki, Finland
| | - Miikka Korja
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Topeliuksenkatu 5, P.O. Box 266, 00029, Helsinki, Finland.
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Mroueh R, Nevala A, Haapaniemi A, Pitkäniemi J, Salo T, Mäkitie AA. Risk of second primary cancer in oral squamous cell carcinoma. Head Neck 2020; 42:1848-1858. [PMID: 32057158 DOI: 10.1002/hed.26107] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/06/2020] [Accepted: 01/28/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The incidence and survival of oral squamous cell carcinoma (OSCC) patients have increased in recent years. Understanding their long-term survival aspects is essential for optimal treatment and follow-up planning. Almost one in five cancers diagnosed occurs nowadays in individuals with a previous diagnosis of cancer. METHODS Patients diagnosed with primary OSCC during 1953-2015 were retrieved from the Finnish Cancer Registry. Both standardized incidence ratios (SIR) and excess absolute risk (EAR) per 1000 person-years at risk (PYR) of second primary cancer (SPC) were calculated relative to the general population. RESULTS Among 6602 first primary OSCC patients there were 640 (10%) SPCs. The SIR for SPCs was 1.85 (95% CI: 1.71-1.99, P < .001) corresponding to an EAR of 8.78 (95% CI: 7.29-10.26). CONCLUSIONS Health care professionals should be aware of the second primary cancer risk after management of primary OSCC and patients need to be counseled about this phenomenon.
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Affiliation(s)
- Rayan Mroueh
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
| | | | - Aaro Haapaniemi
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
| | - Janne Pitkäniemi
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer and Research, Helsinki, Finland.,Faculty of Social Sciences, University of Tampere, Tampere, Finland.,Department of Public Health, School of Medicine, University of Helsinki, Helsinki, Finland
| | - Tuula Salo
- Cancer and Translational Medicine Unit, University of Oulu, Medical Research Unit, Oulu University Hospital, Helsinki, Finland.,Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland.,Haartman Institute, University of Helsinki, Helsinki, Finland
| | - Antti A Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland.,Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden.,Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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35
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Seppälä LK, Vettenranta K, Pitkäniemi J, Hirvonen E, Leinonen MK, Madanat-Harjuoja LM. Maternal diabetes and risk of childhood cancer in the offspring. Int J Cancer 2019; 147:662-668. [PMID: 31658368 DOI: 10.1002/ijc.32757] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 10/21/2019] [Indexed: 01/10/2023]
Abstract
An association between maternal diabetes, its medication and childhood cancer has not been previously explored in a registry-based setting. With a case-control design, we aimed to explore whether maternal diabetes is associated with an increased risk of childhood cancer in the offspring. Combining data from population-based registries, we analyzed a total of 2,029 cases, that is, persons with childhood cancer diagnosed under the age of 20 years between years 1996-2014 and a total of 10,103 matched population controls. The mothers of the cases/controls and their diagnoses of diabetes (DM) before/during pregnancy as well as their insulin/metformin prescriptions during pregnancy were identified. Conditional logistic regression modeling was used to analyze the risk of childhood cancer. The OR for childhood cancer among those exposed to any maternal diabetes was 1.32 (95% CI 1.14-1.54) compared to the offspring of the nondiabetic mothers. The effect of maternal diabetes on the risk of childhood cancer remained elevated even after adjusting for maternal age, parity and smoking. Our data suggest that maternal diabetes medication may reduce the risk for childhood cancer (adjusted OR 0.83, 95% CI 0.36-1.94), especially in gestational diabetes (adjusted OR 0.26, 95% CI 0.05-1.25), compared to the diabetic mothers without medication. The risk of childhood leukemia was significantly higher among children exposed to any maternal diabetes (OR 1.36, CI 1.04-1.77) compared to the unexposed. Maternal diabetes appears to be associated with an increased risk of childhood cancer in the offspring. The possible risk-reducing effect of an exposure to diabetes medication on offspring cancer risk warrants further investigation.
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Affiliation(s)
- Laura K Seppälä
- Pediatric Research Center, University of Helsinki, Helsinki, Finland.,The New Children's Hospital, University of Helsinki Hospital for Children and Adolescents, Helsinki, Finland
| | - Kim Vettenranta
- Pediatric Research Center, University of Helsinki, Helsinki, Finland.,The New Children's Hospital, University of Helsinki Hospital for Children and Adolescents, Helsinki, Finland.,Finnish Red Cross Blood Service, Helsinki, Finland
| | - Janne Pitkäniemi
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland.,Faculty of Social Sciences, School of Health Sciences, University of Tampere, Tampere, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Elli Hirvonen
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Maarit K Leinonen
- Information Services Department, Unit of Statistics and Registers, National Institute for Health and Welfare, Helsinki, Finland
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Seikkula H, Kaipia A, Hirvonen E, Rantanen M, Pitkäniemi J, Malila N, Boström PJ. Vasectomy and the risk of prostate cancer in a Finnish nationwide population-based cohort. Cancer Epidemiol 2019; 64:101631. [PMID: 31760357 DOI: 10.1016/j.canep.2019.101631] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/05/2019] [Accepted: 11/11/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION & OBJECTIVES There are conflicting reports on the association of vasectomy and the risk of prostate cancer (PCa). Our objective was to evaluate the association between vasectomy and PCa from a nationwide cohort in Finland. MATERIALS & METHODS Sterilization registry of Finland and the Finnish Cancer Registry data were utilized to identify all men who underwent vasectomy between years 1987-2014 in Finland. Standard incidence ratio (SIR) for PCa as well as all-cause standardized mortality ratios (SMR) were calculated. RESULTS We identified 38,124 men with vasectomy with a total of 429,937 person-years follow-up data. The median age at vasectomy was 39.7 years (interquartile range [IQR] 35.9-44.0), after vasectomy PCa was diagnosed in 413 men (122 cases 0-10 years, 219 cases 10-20 years and 72 cases >20 years from vasectomy). SIR for PCa for the vasectomy cohort was 1.15 (95% CI: 1.04-1.27). By the end of follow-up, 19 men had died from PCa, while the expected number was 20.5 (SMR 0.93 [95%CI: 0.56-1.44]). The overall mortality was decreased (SMR 0.54 [95%CI: 0.51-0.58]) among men with vasectomy. CONCLUSION We found a small statistically significant increase in PCa incidence after vasectomy, but in contrast the mortality of vasectomized men was significantly reduced. This may be due to higher likelihood of vasectomized men to undergo prostate-specific antigen testing, having healthier general lifestyle and other biological factors e.g. high reproductive fitness.
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Affiliation(s)
- Heikki Seikkula
- Department of Surgery, Central Hospital of Central Finland, Jyväskylä, Finland Keskussairaalantie 19, 40620, Jyväskylä, Finland.
| | - Antti Kaipia
- Department of Urology, Tampere University Hospital, Tampere, Finland PL 2000, 33521 Tampere, Finland.
| | - Elli Hirvonen
- Finnish Cancer Registry, Helsinki, Finland Unioninkatu 22, 00130, Helsinki, Finland.
| | - Matti Rantanen
- Finnish Cancer Registry, Helsinki, Finland Unioninkatu 22, 00130, Helsinki, Finland.
| | - Janne Pitkäniemi
- Finnish Cancer Registry, Helsinki, Finland Unioninkatu 22, 00130, Helsinki, Finland.
| | - Nea Malila
- Finnish Cancer Registry, Helsinki, Finland Unioninkatu 22, 00130, Helsinki, Finland; School of Health Sciences, University of Tampere, Finland.
| | - Peter J Boström
- Department of Urology, Turku University Hospital, Turku, Finland, Department of Urology, University of Turku, Turku, Finland Kiinamyllynkatu 4-8, 20100, Turku, Finland.
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Savijärvi S, Seppä K, Malila N, Pitkäniemi J, Heikkinen S. Trends of colorectal cancer incidence by education and socioeconomic status in Finland. Acta Oncol 2019; 58:1557-1563. [PMID: 31437070 DOI: 10.1080/0284186x.2019.1652340] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: The aim of this study was to investigate if the incidence of colorectal cancer (CRC) is associated with education and socioeconomic status (SES) in Finland, and if there are any changes in incidence differences between the groups over the period 1976-2014.Material and methods: CRC cases (N = 77,614) were retrieved from the Finnish Cancer Registry and linked with information on the education level and SES from Statistics Finland. We used Poisson regression model to quantify differences in incidence rates between the groups, and to assess changes over calendar time.Results and conclusions: Colon cancer incidence was higher among the highly educated, than in those with basic education. Similar differences were observed by SES in men. Incidence rates increased steeply over time among men with basic education (from 16.7/100,000 in 1976-1979 to 31.8 in 2010-2014), resulting in narrowed differences between the groups (p < .001). Incidence trends of proximal and distal colon and rectal cancer in men showed similar patterns. Heterogeneity across time periods by SES was observed only in colon cancer incidence in men (p = .009). No such large differences were detected in women. Steep increase in colon cancer incidence in men with basic education, and the respective persistent high incidence in the highly educated highlights the importance of focusing the preventive measures on modifiable lifestyle factors in order to reduce CRC incidence and to narrow the educational and socioeconomic health differences.
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Affiliation(s)
| | | | - Nea Malila
- Finnish Cancer Registry, Helsinki, Finland
| | - Janne Pitkäniemi
- Finnish Cancer Registry, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
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Madanat-Harjuoja LM, Pitkäniemi J, Hirvonen E, Malila N, Diller L. Risk of cancer in first-degree relatives of childhood cancer patients: A linked longitudinal population-based registry study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.1522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1522 Background: Population based data on risk of cancer in relatives of childhood cancer patients are sparse. Using linked population-based registries, we set out to evaluate risk of early onset cancer in first-degree relatives of childhood cancer patients. Methods: We queried the Finnish Cancer Registry and ascertained a cohort of 9135 individuals diagnosed with at least one cancer under the age of 21 years between 1970 and 2012. We then went on to identify a total of 58,211 unique first- and second-degree relatives by linking to the Central Population Registry. Relatives were then linked back to the annually updated Finnish Cancer Registry to identify cancer diagnoses in siblings, offspring and parents of childhood cancer patients, restricting to cancers occurring under the age of 40. Risk of cancer in relatives of the index case was estimated using standardized incidence ratios (SIRs) comparing cancer age and period specific incidence in relatives to that of the general population. Results: A total of 288 cancers were diagnosed in relatives during the 900,907 years of follow-up, while 266 cancers were expected. The overall risk of cancer in siblings of childhood cancer patients was elevated (SIR 1.18 95% CI 1.00-1.39). 144 of the childhood cancer patients were identified as having a sibling additional to index case with a diagnosis of cancer at age < 40; 44 of these 144 also had a parent with early onset cancer. The risk of early onset cancer was elevated in offspring overall (SIR 1.79 95%CI 1.05-2.81) and in offspring of retinoblastoma, malignant bone tumor and neuroblastoma patients. Siblings of lymphoma patients were at elevated risk of early cancer, and the mothers of 11 of 27 sibling pairs (lymphoma + cancer < 40 yo) also had cancer at age < 40. Conclusions: Linked registries allow family history of cancer to be evaluated across multiple relatives and to be longitudinally updated. Results are generally reassuring with regard to risk of cancer in relatives of childhood cancer patients. Elevated risk in relatives of retinoblastoma and malignant bone tumor patients are in line with the known cancer syndromes associated with these tumor types, and lymphoma and neuroblastoma families need further analysis.
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Affiliation(s)
| | - Janne Pitkäniemi
- Department of Health Sciences, University of Tampere, Tampere, Finland
| | | | - Nea Malila
- Finnish Cancer Registry, Helsinki, Finland
| | - Lisa Diller
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
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Melin J, Madanat‐Harjuoja L, Hirvonen E, Seppä K, Malila N, Pitkäniemi J, Gissler M, Tiitinen A. Use of fertility drugs in early‐onset female cancer survivors—A Finnish register‐based study on 8,929 survivors. Int J Cancer 2019; 146:829-838. [DOI: 10.1002/ijc.32346] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 04/08/2019] [Indexed: 02/02/2023]
Affiliation(s)
- Johanna Melin
- Finnish Cancer RegistryInstitute for Statistical and Epidemiological Cancer Research Helsinki Finland
- Department of Obstetrics and GynecologyKymenlaakso Central Hospital Kotka Finland
| | - Laura Madanat‐Harjuoja
- Finnish Cancer RegistryInstitute for Statistical and Epidemiological Cancer Research Helsinki Finland
| | - Elli Hirvonen
- Finnish Cancer RegistryInstitute for Statistical and Epidemiological Cancer Research Helsinki Finland
| | - Karri Seppä
- Finnish Cancer RegistryInstitute for Statistical and Epidemiological Cancer Research Helsinki Finland
| | - Nea Malila
- Finnish Cancer RegistryInstitute for Statistical and Epidemiological Cancer Research Helsinki Finland
| | - Janne Pitkäniemi
- Finnish Cancer RegistryInstitute for Statistical and Epidemiological Cancer Research Helsinki Finland
- Department of Public Health, School of MedicineUniversity of Helsinki Helsinki Finland
| | - Mika Gissler
- Information Services DepartmentNational Institute for Health and Welfare Helsinki Finland
- Department of Neurobiology, Care Science and SocietyKarolinska Institute Stockholm Sweden
| | - Aila Tiitinen
- Department of Obstetrics and GynecologyUniversity of Helsinki, Helsinki University Hospital Helsinki Finland
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Singh D, Miettinen J, Duffy S, Malila N, Pitkäniemi J, Anttila A. Correction: Association of symptoms and interval breast cancers in the mammography-screening programme: population-based matched cohort study. Br J Cancer 2019; 120:773-774. [PMID: 30837683 PMCID: PMC6461836 DOI: 10.1038/s41416-019-0417-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The authors report that the labels indicating the symptom types and no symptom lines in the original version of Figure 2 were missing. The correct version of Figure 2 with the labels included is provided below.
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Affiliation(s)
- Deependra Singh
- 0000 0000 8634 0612grid.424339.bMass Screening Registry, Finnish Cancer Registry, FI-00130 Helsinki, Finland ,0000 0001 2314 6254grid.502801.eEpidemiology group, Department of Health Sciences, University of Tampere, FI-33520 Tampere, Finland
| | - Joonas Miettinen
- 0000 0000 8634 0612grid.424339.bMass Screening Registry, Finnish Cancer Registry, FI-00130 Helsinki, Finland
| | - Stephen Duffy
- 0000 0001 2171 1133grid.4868.2Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London, England
| | - Nea Malila
- 0000 0000 8634 0612grid.424339.bMass Screening Registry, Finnish Cancer Registry, FI-00130 Helsinki, Finland ,0000 0001 2314 6254grid.502801.eEpidemiology group, Department of Health Sciences, University of Tampere, FI-33520 Tampere, Finland
| | - Janne Pitkäniemi
- 0000 0000 8634 0612grid.424339.bMass Screening Registry, Finnish Cancer Registry, FI-00130 Helsinki, Finland
| | - Ahti Anttila
- 0000 0000 8634 0612grid.424339.bMass Screening Registry, Finnish Cancer Registry, FI-00130 Helsinki, Finland
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Peltonen S, Kallionpää RA, Rantanen M, Uusitalo E, Lähteenmäki PM, Pöyhönen M, Pitkäniemi J, Peltonen J. Pediatric malignancies in neurofibromatosis type 1: A population-based cohort study. Int J Cancer 2019; 145:2926-2932. [PMID: 30724342 PMCID: PMC6849871 DOI: 10.1002/ijc.32187] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 01/08/2019] [Accepted: 01/22/2019] [Indexed: 12/18/2022]
Abstract
Neurofibromatosis type 1 (NF1) is a cancer predisposition syndrome with an incidence of 1:2,000. Patients with NF1 have an increased cancer risk and mortality, but there are no population‐based cohort studies specifically investigating the risk of childhood malignancies. We used the Finnish NF1 cohort to analyze the incidence, risk and prognosis of malignancies in NF1 patients <20 years of age. Persons born in 1987–2011 were included, and 524 persons were followed through the files of the Finnish Cancer Registry from birth up to age 20 years. This amounted to 8,376 person years. Fifty‐three patients had cancer <20 years of age, yielding a standardized incidence ratio (SIR) of 35.6. The most frequent location of pediatric cancers was the central nervous system (CNS); there were 45 cases and the SIR was 115.7. Exclusion of 22 optic pathway gliomas (OPGs) gave an SIR of 59.1 for the CNS and 21.6 for all cancers. There were nine malignant peripheral nerve sheath tumors (MPNSTs); their cumulative risk was 2.7% by age 20. No cases of leukemia were observed. NF1 patients showed considerable excess mortality with a standardized mortality ratio (SMR) of 73.1. The survival of NF1 patients with CNS tumors other than OPGs did not differ from that of non‐NF1 controls (HR 0.64, 95% CI 0.23 to 1.76). In conclusion, brain tumors in childhood and MPNSTs in adolescence are malignancies of major concern in patients with NF1. The risk for myeloid malignancies may not be as high as suggested in the literature. What's new? Patients with neurofibromatosis type 1 (NF1) are known to have a high risk of various cancers. What has not been well‐studied, however, are the types of cancers that are most common among children with NF1, and how those cancers impact mortality. In this cohort study, the authors found that malignancies do cause increased mortality in patients under age 20. Brain tumors in childhood and malignant peripheral nerve sheath tumors (MPNSTs) in adolescence are of particular concern. On the other hand, the risk of myeloid malignancies may be lower than previously assumed.
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Affiliation(s)
- Sirkku Peltonen
- Department of Dermatology, University of Turku, Turku, Finland.,Department of Dermatology, Turku University Hospital, Turku, Finland
| | | | - Matti Rantanen
- Finnish Cancer Registry - Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Elina Uusitalo
- Institute of Biomedicine, University of Turku, Turku, Finland
| | - Päivi M Lähteenmäki
- Department of Pediatric and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Minna Pöyhönen
- Department of Clinical Genetics, HUSLAB, Helsinki University Central Hospital, Helsinki, Finland.,Department of Medical Genetics, University of Helsinki, Helsinki, Finland
| | - Janne Pitkäniemi
- Finnish Cancer Registry - Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland.,Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Juha Peltonen
- Institute of Biomedicine, University of Turku, Turku, Finland
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Singh D, Malila N, Pitkäniemi J, Anttila A. Cancer incidence and mortality patterns in women with breast symptoms in the mammography screening programme: A matched cohort analysis. Int J Cancer 2019; 144:2928-2935. [PMID: 30511466 DOI: 10.1002/ijc.32035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/21/2018] [Accepted: 11/23/2018] [Indexed: 11/11/2022]
Abstract
Efforts to reduce mortality through early detection and diagnosis has intensified in the recent decade. An important risk factor, 'breast symptoms' reported by women during screening visit, remains overlooked. In this population based matched cohort study using Finnish National Breast Cancer Screening Program (FNBCSP), we assessed the association between breast symptoms reported at screening visit and the risk of cancer incidence and breast cancer mortality and all-cause mortality followed-up over a period of 24 years. For each visit with symptoms, non-symptomatic controls were matched (1:1 for lump and retraction; 1:2 for nipple discharge) based on age at screening visit, year of invitation, number of invited visits, and municipality of invitation. Women who reported lump or retraction had about two-fold risk of breast cancer incidence, three-fold risk of breast cancer mortality and all-cause mortality respectively as compared to women without respective symptoms (p-value<0.05). We found a substantial difference (p-value<0.05) in mortality rates throughout the follow-up period between symptomatic and asymptomatic group. In absolute terms, after the follow-up period for women who reported lump, 180 died from breast cancer as compared to 70 deaths in those without lump, per 10,000 person-years of follow-up, and 315 versus 160 all-cause deaths per 10,000 person-years in women with and without lump respectively. our study provides comprehensive evidence that women with breast symptoms remain in a higher risk of dying over a very long period. The findings indicate needs to develop improvements in the guidelines for screening and clinical services for women presenting with symptoms.
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Affiliation(s)
- Deependra Singh
- Mass Screening Registry, Finnish Cancer Registry, Helsinki, Finland.,Epidemiology Group, Department of Health Sciences, University of Tampere, Tampere, Finland
| | - Nea Malila
- Mass Screening Registry, Finnish Cancer Registry, Helsinki, Finland.,Epidemiology Group, Department of Health Sciences, University of Tampere, Tampere, Finland
| | - Janne Pitkäniemi
- Mass Screening Registry, Finnish Cancer Registry, Helsinki, Finland
| | - Ahti Anttila
- Mass Screening Registry, Finnish Cancer Registry, Helsinki, Finland
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Koskenvuo L, Malila N, Pitkäniemi J, Miettinen J, Heikkinen S, Sallinen V. Sex differences in faecal occult blood test screening for colorectal cancer. Br J Surg 2018; 106:436-447. [PMID: 30460999 PMCID: PMC6587743 DOI: 10.1002/bjs.11011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 08/16/2018] [Accepted: 09/05/2018] [Indexed: 02/06/2023]
Abstract
Background This analysis of patients in a randomized population‐based health services study was done to determine the effects of faecal occult blood test (FOBT) screening of colorectal cancer (CRC) in outcomes beyond mortality, and to obtain explanations for potential sex differences in screening effectiveness. Methods In the Finnish FOBT screening programme (2004–2011), people aged 60–69 years were randomized into the screening and control arms. Differences in incidence, symptoms, tumour location, TNM categories, non‐vital outcomes and survival in the screening and control arms were analysed. Results From 321 311 individuals randomized, 743 patients with screening‐detected tumours and 617 control patients with CRC were analysed. CRC was less common in women than in men (0·34 versus 0·50 per cent; risk ratio (RR) 0·82, 95 per cent c.i. 0·74 to 0·91) and women were less often asymptomatic (16·7 versus 22·0 per cent; RR 0·76, 0·61 to 0·93). Women more often had right‐sided tumours (32·0 versus 21·3 per cent; RR 1·51, 1·26 to 1·80). Among men with left‐sided tumours, those in the screening arm had lower N (RR 1·23, 1·02 to 1·48) and M (RR 1·57, 1·14 to 2·17) categories, as well as a higher overall survival rate than those in the control arm. Furthermore among men with left‐sided tumours, non‐radical resections (26·2 versus 15·7 per cent; RR 1·67, 1·22 to 2·30) and postoperative chemotherapy sessions (61·6 versus 48·2 per cent; RR 1·28, 1·10 to 1·48) were more frequent in the control arm. Similar benefits of screening were not detected in men with right‐sided tumours or in women. Conclusion Biennial FOBT screening seems to be effective in terms of improving several different outcomes in men, but not in women. Differences in incidence, symptoms and tumour location may explain the differences in screening efficacy between sexes. Only of benefit in men
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Affiliation(s)
- L Koskenvuo
- Department of Abdominal Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - N Malila
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - J Pitkäniemi
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland.,Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - J Miettinen
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - S Heikkinen
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - V Sallinen
- Department of Abdominal Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Singh D, Miettinen J, Duffy S, Malila N, Pitkäniemi J, Anttila A. Association of symptoms and interval breast cancers in the mammography-screening programme: population-based matched cohort study. Br J Cancer 2018; 119:1428-1435. [PMID: 30401890 PMCID: PMC6265247 DOI: 10.1038/s41416-018-0308-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 09/25/2018] [Accepted: 09/26/2018] [Indexed: 11/10/2022] Open
Abstract
Background We assessed the association between symptoms reported at breast cancer screening visits and interval cancers (ICs) in a prospective manner. Methods This population-based matched cohort study uses data of the Finnish National Breast Cancer Screening Programme that invites women aged 50–69 years old during 1992–2012. Subjects who attended screening with symptoms were matched with asymptomatic reference cohorts based on age at screening visit, year of invitation, number of invited visits and municipality of invitation. The primary outcome was ICs. Results Women with a lump had a threefold (hazard ratio 3.7, 95% confidence interval (CI) 3.0–4.6) risk of ICs and a higher risk (hazard ratio 1.7, 95% CI 1.4 to 2.0) at the subsequent visit compared with those without a lump. The fatal interval cancer risk increased by 0.39 per 1000 screens with a lump. The cumulative incidences of interval cancer increased within a month of a mammography-negative visit with a lump and after about 6 months of the visit with retraction or nipple discharge. Conclusion Women with breast symptoms have a clearly increased risk of interval breast cancer after the screening visit. Our findings indicate the need for different screening strategies in symptomatic women.
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Affiliation(s)
- Deependra Singh
- Mass Screening Registry, Finnish Cancer Registry, FI-00130, Helsinki, Finland. .,Epidemiology group, Department of Health Sciences, University of Tampere, FI-33520, Tampere, Finland.
| | - Joonas Miettinen
- Mass Screening Registry, Finnish Cancer Registry, FI-00130, Helsinki, Finland
| | - Stephen Duffy
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London, England
| | - Nea Malila
- Mass Screening Registry, Finnish Cancer Registry, FI-00130, Helsinki, Finland.,Epidemiology group, Department of Health Sciences, University of Tampere, FI-33520, Tampere, Finland
| | - Janne Pitkäniemi
- Mass Screening Registry, Finnish Cancer Registry, FI-00130, Helsinki, Finland
| | - Ahti Anttila
- Mass Screening Registry, Finnish Cancer Registry, FI-00130, Helsinki, Finland
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Tolkkinen A, Madanat-Harjuoja L, Taskinen M, Rantanen M, Malila N, Pitkäniemi J. Impact of parental socioeconomic factors on childhood cancer mortality: a population-based registry study. Acta Oncol 2018; 57:1547-1555. [PMID: 29863418 DOI: 10.1080/0284186x.2018.1478125] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Parental socioeconomic status has been proposed to have an influence on childhood cancer mortality even in high-income countries. Our study investigated the influence of parental socioeconomic factors on childhood cancer mortality. MATERIAL AND METHODS We identified 4437 patients diagnosed with cancer under the age of 20 from 1990 to 2009 and their parents from the Finnish cancer and central population registers. Information on death from primary cancer during five-year follow-up and parental socioeconomic factors was obtained from Statistics Finland. Poisson regression modeling was used to estimate hazard ratios (HRs) for factors related to cause-specific mortality and recursive tree based survival analysis to identify important risk factors and interactions. RESULTS Mortality was lower in the highest quartile of combined parental disposable income (HR 0.68, CI 95% 0.52-0.89) compared to the lowest quartile. In the most recent diagnostic period from 2000 to 2009, highest attained education of either parent being post-secondary predicted lower mortality (HR 0.73, CI 95% 0.60-0.88) compared to parents who had attained primary or lower education. CONCLUSION Despite high quality public health care and comprehensive social security, both high parental income and education were associated with lower mortality after childhood cancer. Lower health literacy and financial pressures limiting treatment adherence may explain higher mortality in children with less educated parents and parents with lower income. Motivation and support during treatment and follow-up period is needed concerning the families of these patients.
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Affiliation(s)
- Anniina Tolkkinen
- Finnish Cancer Registry, Helsinki, Finland
- Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Laura Madanat-Harjuoja
- Finnish Cancer Registry, Helsinki, Finland
- Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mervi Taskinen
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Helsinki University Hospital, Helsinki, Finland
| | | | - Nea Malila
- Finnish Cancer Registry, Helsinki, Finland
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Janne Pitkäniemi
- Finnish Cancer Registry, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
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Seppä K, Rue H, Hakulinen T, Läärä E, Sillanpää MJ, Pitkäniemi J. Estimating multilevel regional variation in excess mortality of cancer patients using integrated nested Laplace approximation. Stat Med 2018; 38:778-791. [DOI: 10.1002/sim.8010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/14/2018] [Accepted: 09/28/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Karri Seppä
- Finnish Cancer RegistryInstitute for Statistical and Epidemiological Cancer Research Helsinki Finland
| | - Håvard Rue
- Department of Mathematical SciencesNorwegian University of Science and Technology Trondheim Norway
| | - Timo Hakulinen
- Finnish Cancer RegistryInstitute for Statistical and Epidemiological Cancer Research Helsinki Finland
| | - Esa Läärä
- Research Unit of Mathematical SciencesUniversity of Oulu Oulu Finland
| | - Mikko J. Sillanpää
- Research Unit of Mathematical SciencesUniversity of Oulu Oulu Finland
- Biocenter Oulu Oulu Finland
| | - Janne Pitkäniemi
- Finnish Cancer RegistryInstitute for Statistical and Epidemiological Cancer Research Helsinki Finland
- Department of Public HealthUniversity of Helsinki Helsinki Finland
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Abstract
Finding new etiological components is of great interest in disease epidemiology.
We consider time series version of invariant coordinate selection (tICS) as an
exploratory tool in the search of hidden structures in the analysis of
population-based registry data. Increasing cancer burden inspired us to consider
a case study of age-stratified cervical cancer incidence in Finland between the
years 1953 and 2014. The latent components, which we uncover using tICS, show
that the etiology of cervical cancer is age dependent. This is in line with
recent findings related to the epidemiology of cervical cancer. Furthermore, we
are able to explain most of the variation of cervical cancer incidence in
different age groups by using only two latent tICS components. The second tICS
component, in particular, is interesting since it separates the age groups into
three distinct clusters. The factor that separates the three clusters is the
median age of menopause occurrence.
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Affiliation(s)
- Niko Lietzén
- 1 Department of Mathematics and Systems Analysis, Aalto University School of Science, Espoo, Finland
| | - Janne Pitkäniemi
- 2 Institute for Statistical and Epidemiological Cancer Research, Finnish Cancer Registry, Helsinki, Finland.,3 Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Sirpa Heinävaara
- 2 Institute for Statistical and Epidemiological Cancer Research, Finnish Cancer Registry, Helsinki, Finland.,3 Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Pauliina Ilmonen
- 1 Department of Mathematics and Systems Analysis, Aalto University School of Science, Espoo, Finland
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48
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Sjöberg L, Kaaja R, Gissler M, Tuomilehto J, Tiitinen A, Pitkäniemi J. Termination of pregnancy and sterilisation in women with childhood-onset type 1 diabetes. Diabetologia 2017; 60:2377-2383. [PMID: 28894893 PMCID: PMC6448903 DOI: 10.1007/s00125-017-4428-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 06/26/2017] [Indexed: 11/07/2022]
Abstract
AIMS/HYPOTHESIS The aim of this study was to explore the association between type 1 diabetes and reproductive health indicators in women, focusing on termination of pregnancy and sterilisation. METHODS We conducted a registry-based cohort study involving 2281 women with childhood-onset type 1 diabetes, matched for age and birthplace with women without diabetes: two control participants for each woman with diabetes. We compared the frequencies of termination of pregnancy and sterilisation over a 25 year period between women with type 1 diabetes and women without, and estimated standardised incidence ratios (SIRs). Smoothed age and period effects in the incidence of termination of pregnancy or sterilisation were tested statistically. RESULTS There were more terminations of pregnancy (SIR 1.67; 95% CI 1.51, 1.86) and sterilisations (SIR 1.69; 95% CI 1.56, 1.83) in women with diabetes than in control women. During recent years, sterilisations in women with diabetes have decreased and the difference compared with control women has vanished. The indications for both procedures showed a statistically highly significant difference: maternal medical indications were almost absent (< 1%) in procedures among control women, but comprised 23.6% of terminations of pregnancy and 22.9% of sterilisations in women with diabetes. CONCLUSIONS/INTERPRETATION The indications for termination of pregnancy and sterilisation are different in women with diabetes compared with other women. Pregnancies in women with type 1 diabetes are still terminated more often than in women without diabetes, but the difference in sterilisation rates has disappeared during recent years.
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Affiliation(s)
- Lena Sjöberg
- Department of Public Health, University of Helsinki, Helsinki, Finland.
- Department of General Practice and Primary Health Care, University of Helsinki, PO Box 20, 00014, Helsinki, Finland.
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland.
| | - Risto Kaaja
- Department of Internal Medicine, Institute of Clinical Medicine, University of Turku, Turku, Finland
- Turku University Hospital, Turku, Finland
| | - Mika Gissler
- Information Services Department, National Institute for Health and Welfare, Helsinki, Finland.
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden.
| | - Jaakko Tuomilehto
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
- Dasman Diabetes Institute, Dasman, Kuwait
- Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Aila Tiitinen
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland
- Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland
| | - Janne Pitkäniemi
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Finnish Cancer Registry, Helsinki, Finland
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Hirvonen K, Rantanen M, Haapaniemi A, Pitkäniemi J, Malila N, Mäkitie AA. Second primary cancer after major salivary gland carcinoma. Head Neck 2017; 40:251-258. [PMID: 28960648 DOI: 10.1002/hed.24937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 07/13/2017] [Accepted: 07/27/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND We investigated the risk of second primary cancers after major salivary gland carcinoma in Finland, with a population of 5.5 million. METHODS Nationwide cancer registry data were used to identify patients with major salivary gland carcinoma diagnosed between 1953 and 2014. Standardized incidence ratios (SIRs) were estimated to compare their second primary cancer risk with the respective site-specific cancer risk in the general population. RESULTS There were 1727 patients with major salivary gland carcinomas and 222 second primary cancers had been diagnosed in these patients (SIR 1.43). The risk was increased for cancers of the thyroid (SIR 5.12), breast (SIR 1.63), respiratory organs (SIR 1.63), male genital organs (SIR 1.48), melanoma of the skin (SIR 3.35), and nonmelanoma skin cancer (SIR 2.50). The risk was high during the first 5 years and after 20 years of diagnosis. CONCLUSION Second primary cancers can occur among patients with major salivary gland carcinoma even after a long time period. This needs to be recognized in the follow-up of these patients.
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Affiliation(s)
- Karoliina Hirvonen
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Aaro Haapaniemi
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Janne Pitkäniemi
- Finnish Cancer Registry, Helsinki, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Nea Malila
- Finnish Cancer Registry, Helsinki, Finland.,Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Antti A Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Division of Ear, Nose, and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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50
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He L, Pitkäniemi J, Silventoinen K, Sillanpää MJ. ACEt: An R Package for Estimating Dynamic Heritability and Comparing Twin Models. Behav Genet 2017; 47:620-641. [PMID: 28879484 DOI: 10.1007/s10519-017-9866-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 08/09/2017] [Indexed: 01/12/2023]
Abstract
Estimating dynamic effects of age on the genetic and environmental variance components in twin studies may contribute to the investigation of gene-environment interactions, and may provide more insights into more accurate and powerful estimation of heritability. Existing parametric models for estimating dynamic variance components suffer from various drawbacks such as limitation of predefined functions. We present ACEt, an R package for fast estimating dynamic variance components and heritability that may change with respect to age or other moderators. Building on the twin models using penalized splines, ACEt provides a unified framework to incorporate a class of ACE models, in which each component can be modeled independently and is not limited by a linear or quadratic function. We demonstrate that ACEt is robust against misspecification of the number of spline knots, and offers a refined resolution of dynamic behavior of the genetic and environmental components and thus a detailed estimation of age-specific heritability. Moreover, we develop resampling methods for testing twin models with different variance functions including splines, log-linearity and constancy, which can be easily employed to verify various model assumptions. We evaluated the type I error rate and statistical power of the proposed hypothesis testing procedures under various scenarios using simulated datasets. Potential numerical issues and computational cost were also assessed through simulations. We applied the ACEt package to a Finnish twin cohort to investigate age-specific heritability of body mass index and height. Our results show that the age-specific variance components of these two traits exhibited substantially different patterns despite of comparable estimates of heritability. In summary, the ACEt R package offers a useful tool for the exploration of age-dependent heritability and model comparison in twin studies.
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Affiliation(s)
- Liang He
- Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Computer Science and Artificial Intelligence Laboratory, MIT, Cambridge, MA, USA.
| | - Janne Pitkäniemi
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Karri Silventoinen
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Population Research Unit, Department of Social Research, University of Helsinki, Helsinki, Finland
| | - Mikko J Sillanpää
- Department of Mathematical Sciences, University of Oulu, Oulu, Finland
- Biocenter Oulu, University of Oulu, Oulu, Finland
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