Cancer incidence in Danish phenoxy herbicide workers, 1947-1993.

A cohort study was undertaken of 2119 workers from Denmark who were potentially exposed to phenoxy herbicides. The workers were from two factories that produced phenoxy herbicides since 1947 and 1951, respectively. They had been employed either in the manufacture of phenoxy herbicide or in the manual service functions. The main product was 4-chloro-2-methylphenoxyacetic acid (MCPA). From 1947 to 1993 the 2119 workers had a slightly lower overall cancer incidence than the Danish population (observed = 204; expected [Exp] = 234.23; standardized incidence ratio [SIR] = 0.87; 95% confidence interval [CI] 0.8-1.0). Four soft-tissue sarcoma cases were observed (Exp = 2.47; SIR = 1.62; 95% CI = 0.4-4.1). All four cases occurred among men from Kemisk Vaerk Køge (Exp = 1.68; SIR = 2.38; 95% CI = 0.7-6.1). There were six cases of non-Hodgkin's lymphoma (Exp = 5.07; SIR = 1.10; 95% CI = 0.4-2.6) and no significantly elevated risk of other cancers. Based on small numbers, the study suggests an association between the exposure to MCPA and related phenoxy herbicides and the risk of soft-tissue sarcoma. The study does not indicate a risk of non-Hodgkin's lymphoma after exposure to these phenoxy herbicides or a risk of other cancer diseases

Spirometry in Greenland:A cross-sectional study on patients treated with medication targeting obstructive pulmonary disease

Background: Chronic obstructive pulmonary disease (COPD) is globally increasing in frequency and is expected to be the third largest cause of death by 2020. Smoking is the main risk factor of developing COPD. In Greenland, more than half of the adult population are daily smokers, and COPD may be common. International guidelines recommend the usage of spirometry as a golden standard for diagnosing COPD. The current number of spirometries performed among patients treated with medication targeting obstructive pulmonary disease in Greenland remains unexplored. Objective: To estimate the prevalence of patients aged 50 years or above treated with medication targeting obstructive pulmonary disease and the extent to which spirometry was performed among them within 2 years. Design: An observational, cross-sectional study based on the review of data obtained from electronic medical records in Greenland was performed. The inclusion criterion was that patients must have been permanent residents aged 50 years or above who had medication targeting obstructive pulmonary disease prescribed within a period of 15 months prior to data extraction. A full review of electronic patient records was done on each of the identified users of medication targeting obstructive pulmonary disease. Information on age, gender, town and spirometry was registered for each patient within the period from October 2013 to October 2015. Results: The prevalence of patients treated with medication targeting obstructive pulmonary disease aged 50 years or above was 7.9%. Of those, 34.8% had spirometry performed within 2 years and 50% had a forced expiratory volume (1 sec)/ forced vital capacity (FEV1/FVC) under 70% indicating obstructive pulmonary disease. Conclusion: The use of medication targeting obstructive pulmonary disease among patients over 50 years old is common in Greenland. About one third of the patients had a spirometry performed within 2 years. To further increase spirometry performance, it is recommended to explore possible barriers in health care professionals’ usage of spirometry in different health care settings in Greenland

Complexities in the estimation of overdiagnosis in breast cancer screening

There is interest in estimating and attributing temporal changes in incidence of breast cancer in relation to the initiation of screening programmes, in particular to estimation of overdiagnosis of breast cancer as a result of screening. In this paper, we show how screening introduces complexities of analysis and interpretation of incidence data. For example, lead time brings forward time- and age-related increases in incidence. In addition, risk factors such as hormone replacement therapy use have been changing contemporaneously with the introduction of screening. Although we do not indicate exactly how such complexities should be corrected for, we use some simple informal adjustments to show how they may account for a substantial proportion of increased incidence, which might otherwise erroneously have been attributed to overdiagnosis. We illustrate this using an example of analysis of breast cancer incidence data from Sweden