Cancer incidence among musicians: 45 years of follow-up in four Nordic countries

cited By 0Background There are studies suggesting that participation in musical activities may protect from cancer. On the other hand, some musicians have a lifestyle that might increase the risk of cancer. The objective of this study was to assess the cancer pattern of musicians in four Nordic countries. Material and methods This study combines census and cancer registry data from 1961 to 2005 for 13 million people from Finland, Iceland, Norway, and Sweden. Standardized incidence ratio (SIR) analyses were conducted with the cancer incidence rates for entire national populations used as reference rates. Results There were 11,401 male and 3105 female musicians with 2039 cancer cases. The SIR for all sites combined was 1.02 (95% confidence interval 0.97-1.07) in men and 1.04 (0.94-1.15) in women. In male musicians, there were statistically significant excesses in oropharyngeal cancer (4.36, 2.73-6.60), esophageal cancer (2.08, 1.51-2.81), liver cancer (1.81, 1.26-2.52), and skin melanoma (1.40, 1.10-1.75). The risk was decreased in lip cancer (0.13, 0.02-0.48), stomach cancer (0.66, 0.50-0.82), and lung cancer (0.77, 0.65-0.90). In female musicians, there were no statistically significant SIRs in any of the cancer types studied, but the risk of breast cancer was significantly elevated in the age category of 70+ (1.52, 1.04-2.15). The overall SIR was stable over the 45 year period of observation, but strong decreases were observed in the SIRs of esophageal cancer, liver cancer, laryngeal cancer, and skin melanoma. Conclusion Musicians have characteristics of indoor workers such as low incidence of lip cancer and high incidence of skin melanoma. The low incidence of lung cancer suggests that the prevalence of smoking among musicians is lower than in the general population while the elevated risk of alcohol-related cancer types suggest that drinking is likely more common among musicians. The cancer risk for all sites combined is still similar to that of the general population in the four countries studied.Peer reviewe

Screening and cervical cancer cure: population based cohort study

Objective To determine whether detection of invasive cervical cancer by screening results in better prognosis or merely increases the lead time until death

Guillain-Barré syndrome and adjuvanted pandemic influenza A (H1N1) 2009 vaccines: A multinational self-controlled case series in Europe

BACKGROUND: The risk of Guillain-Barré syndrome (GBS) following the United States' 1976 swine flu vaccination campaign in the USA led to enhanced active surveillance during the pandemic influenza (A(H1N1)pdm09) immunization campaign. This study aimed to estimate the risk of GBS following influenza A(H1N1)pdm09 vaccination. METHODS: A self-controlled case series (SCCS) analysis was performed in Denmark, Finland, France, Netherlands, Norway, Sweden, and the United Kingdom. Information was collected according to a common protocol and standardised procedures. Cases classified at levels 1-4a of the Brighton Collaboration case definition were included. The risk window was 42 days starting the day after vaccination. Conditional Poisson regression and pooled random effects models estimated adjusted relative incidences (RI). Pseudo likelihood and vaccinated-only methods addressed the potential contraindication for vaccination following GBS. RESULTS: Three hundred and three (303) GBS and Miller Fisher syndrome cases were included. Ninety-nine (99) were exposed to A(H1N1)pdm09 vaccination, which was most frequently adjuvanted (Pandemrix and Focetria). The unadjusted pooled RI for A(H1N1)pdm09 vaccination and GBS was 3.5 (95% Confidence Interval (CI): 2.2-5.5), based on all countries. This lowered to 2.0 (95% CI: 1.2-3.1) after adjustment for calendartime and to 1.9 (95% CI: 1.1-3.2) when we accounted for contra-indications. In a subset (Netherlands, Norway, and United Kingdom) we further adjusted for other confounders and there the RI decreased from 1.7 (adjusted for calendar month) to 1.4 (95% CI: 0.7-2.8), which is the main finding. CONCLUSION: This study illustrates the potential of conducting European collaborative vaccine safety studies. The main, fully adjusted analysis, showed that the RI of GBS was not significantly elevated after influenza A(H1N1)pdm09 vaccination (RI = 1.4 (95% CI: 0.7-2.8). Based on the upper limits of the pooled estimate we can rule out with 95% certainty that the number of excess GBS cases after influenza A(H1N1)pdm09 vaccination would be more than 3 per million vaccinated

Immediate Risk for Cardiovascular Events and Suicide Following a Prostate Cancer Diagnosis: Prospective Cohort Study

Katja Fall and Fang Fang and colleagues find that men newly diagnosed with prostate cancer are at increased risk of cardiovascular events and suicide

Assessing Perceived Risk and STI Prevention Behavior: A National Population-Based Study with Special Reference to HPV

Aim: This thesis aims to provide a multidimensional assessment of infection risks and to evaluate strategies for HPV prevention including vaccination with quadrivalent HPVvaccines, dose-level vaccine effectiveness and condom use in high STI risk situations. Methods: Multiple population-based registers and questionnaire responses provided data for this thesis. Various multivariable and univariate regression models were fit. Findings: Overall, quadrivalent HPV-vaccination was highly effective against genital warts (GW) also referred to as condyloma, which is the first HPV disease endpoint possible to measure. However, effectiveness was contingent upon young age-at-first vaccination, with effectiveness declining steadily the older the age-at-first vaccination. Among women above 20 years of age there was low to immeasurable effectiveness and suggestive evidence vaccinations in this age group tended to reach women at high GW risk. There were marked socioeconomic disparities in the opportunistic (on-demand with co-pay) vaccination strategy evaluated, with women and girls who have parents with the highest education level compared to the lowest having a 15 times greater likelihood to be vaccinated (Study III). Once vaccination was initiated, however, high parental education level was unrelated to vaccination completion. Maximum protection against GW was found among girls vaccinated under the age of 17 who had received three doses of the vaccine. No differences in effectiveness were found for girls who received twodoses between ages 10-16 with that of those who received three-doses between ages 17- 19 (Study IV). GW affects more men than women in Sweden as of 2010 with 453 per 100 000 men and 365 per 100 000 women treated. A decline between 25-30% was seen between 2006 and 2010 among women in the age groups with the highest vaccination coverage. No decline was found amongst men and their GW incidence has steadily increased between 2006 and 2010 (Study II). Reported condom use in high risk situations was low among both men and women, with 41% of men and 34% of women reporting always/almost always condom use with temporary partners. STI risk perception was also low, with approximately 10% of sexually active respondents considering themselves at large risk of contracting an STI. There was no association between men’s condom use and their STI risk perception but there was an association for women (Study I). Conclusions: Results suggest that males bear a substantial burden of HPV-related condyloma where incidence has dropped among women. When planning HPVvaccination among females, efforts should target girls under age 14 for maximum effectiveness. Quadrivalent HPV-vaccination offers most protection against condyloma at three doses. Gross social inequity was found with opportunistic HPV-vaccination. There were large gender differences in factors associated with condom use in high risk situations and STI risk perceptions

Förekomst av humant papillomvirus av högrisktyp och prognos för invasiv cervixcancer: en nationell kohortstudie. Dataset 1

High-risk human papillomavirus (hrHPV) infection is established as the major cause of invasive cervical cancer (ICC). However, whether hrHPV status in the tumor is associated with subsequent prognosis of ICC is controversial. We aim to evaluate the association between tumor hrHPV status and ICC prognosis using national registers and comprehensive human papillomavirus (HPV) genotyping. In this nationwide population-based cohort study, we identified all ICC diagnosed in Sweden during the years 2002–2011 (4,254 confirmed cases), requested all archival formalin-fixed paraffin-embedded blocks, and performed HPV genotyping. Twenty out of 25 pathology biobanks agreed to the study, yielding a total of 2,845 confirmed cases with valid HPV results. Cases were prospectively followed up from date of cancer diagnosis to 31 December 2015, migration from Sweden, or death, whichever occurred first. The main exposure was tumor hrHPV status classified as hrHPV-positive and hrHPV-negative. The primary outcome was all-cause mortality by 31 December 2015. Five-year relative survival ratios (RSRs) were calculated, and excess hazard ratios (EHRs) with 95% confidence intervals (CIs) were estimated using Poisson regression, adjusting for education, time since cancer diagnosis, and clinical factors including age at cancer diagnosis and International Federation of Gynecology and Obstetrics (FIGO) stage. Of the 2,845 included cases, hrHPV was detected in 2,293 (80.6%), and we observed 1,131 (39.8%) deaths during an average of 6.2 years follow-up. The majority of ICC cases were diagnosed at age 30–59 years (57.5%) and classified as stage IB (40.7%). hrHPV positivity was significantly associated with screen-detected tumors, young age, high education level, and early stage at diagnosis (p < 0.001). The 5-year RSR compared to the general female population was 0.74 (95% CI 0.72–0.76) for hrHPV-positive cases and 0.54 (95% CI 0.50–0.59) for hrHPV-negative cases, yielding a crude EHR of 0.45 (95% CI 0.38–0.52) and an adjusted EHR of 0.61 (95% CI 0.52–0.71). Risk of all-cause mortality as measured by EHR was consistently and statistically significantly lower for cases with hrHPV-positive tumors for each age group above 29 years and each FIGO stage above IA. The difference in prognosis by hrHPV status was highly robust, regardless of the clinical, histological, and educational characteristics of the cases. The main limitation was that, except for education, we were not able to adjust for lifestyle factors or other unmeasured confounders. In conclusion, women with hrHPV-positive cervical tumors had a substantially better prognosis than women with hrHPV-negative tumors. hrHPV appears to be a biomarker for better prognosis in cervical cancer independent of age, FIGO stage, and histological type, extending information from already established prognostic factors. The underlying biological mechanisms relating lack of detectable tumor hrHPV to considerably worse prognosis are not known and should be further investigated. Purpose: To compile a comprehensive survival and HPV genotyping data and provide a large-scale population-based evaluation of the association between tumor high risk HPV status and prognosis of invasive cervical cancer. This dataset (ccHPV_RelativeSurvival.dta) comprises 2845 invasive cervical cancer (ICC) cases diagnosed in Sweden during the years 2002-2011, and had valid human papillomavirus (HPV) results assessed from the formalin-fixed, paraffin-embedded (FFPE) blocks. In order to control the risk of incidental disclosure of personal information, the data available here has been anonymized in the following manner: • The date of diagnosis has been moved to 2008-07-01 for all subjects. • Follow-up time has been censored at five years after diagnosis. • Age at diagnosis and follow-up time after diagnosis have been microaggregated in groups of five subjects (using function microaggregation in R package sdcMicro 2.5.9, available from https://cran.r-project.org/package=sdcMicro) Analysis of the anonymized data replicates the results presented in main part of the study (Figures 2 & 3, Tables 1-3) with only minor numerical differences, with the following exceptions: • In Figure 2, relative survival can only be calculated up to five years after diagnosis. • In Table 1, the number of person years and the mean follow-up time differ considerably due to censoring; the distribution of subjects between age groups varies somewhat due to microaggregation. • In Figure 3, the excess hazard ratios for age groups 30-44 and 45-59 in Panel A shift noticeably, but without affecting the overall message (comparable reduced risk across all age strata). The dataset includes 12 variables, eight of which are necessary for the analysis (core variables) and four of which are included for administrative purposes and convenience of coding the analysis (extra variables). Core variables: • dx_date: Date of diagnosis • age: Age (in years) at diagnosis • x_stage_group: International Federation of Gynecology and Obstetrics (FIGO) stage of tumor, IA; IB; II and III+ • edu_cat: Education (categorical, three levels): 1=low (less than high school); 2=middle (high school); 3=high (university exam and above); 99=missing • exit_new: End of follow-up (date) • censor_new: Censoring status: 1=death; 2=censored due to migration, loss of follow-up or end of study • final_type: Histological type of tumor: SCC=squamous cell carcinoma; AC=adenocarcinoma. • hr_hpv: High-risk HPV status of tumor (main exposure, binary): 0=hrHPV negative; 1= hrHPV positive Extra variables: • entry: Entry date (copy of diagnosis date) • sex: Gender (all female, for linking to standard population mortality file): 2=female. • dx_year: Year of diagnosis (for linking to standard population mortality file)Humant papillomavirus av högrisk-typ (hrHPV) är den främsta orsaken till livmoderhalscancer. Huruvida förekomst av hrHPV-status i den invasiva tumörvävnaden har betydelse för prognosen är dock oklart. Vi samlade in information om alla fall av invasiv livmoderhalscancer i Sverige under åren 2002-2011 (4254 bekräftade fall efter en fullständig journalgenomgång). Vi begärde ut motsvarande vävnadsblock för invasiv livmoderhalscancer från alla landets biobanker för att undersöka förekomst av humant papillomvirus (HPV). Tjugo av tjugofem tillfrågade biobanker lämnade ut vävnadsblocken, så att vi för totalt 2845 kvinnor med bekräftad invasiv livmoderhalscancer kunde analysera förekomst av HPV. Alla kvinnor med invasiv livmoderhalscancer följdes från datum för cancerdiagnos till dödsdatum (alla dödsorsaker) eller till och med den 31 december 2015. Vi påvisade hrHPV i 2293/2845 (80,6 %) av tumörerna. Kvinnor med hrHPV-positiva tumörer var oftare screeningupptäckta, var yngre och hade en högre socioekonomisk status. De var också upptäckta i ett tidigare stadium jämfört med kvinnor med hrHPV-negativa tumörer. Den femåriga relativa överlevnaden för hrHPV-positiva fall var 74 % jämfört med den kvinnliga befolkningen i motsvarande ålder och under motsvarande kalenderår, medan den endast var 54 % för hrHPV-negativa fall. Efter att ha kontrollerat för ålder, tumörstadium vid diagnos och utbildningsnivå har de hrHPV-positiva fallen 39 %, högst signifikant, lägre överdödlighet jämfört med de hrHPV-negativa kvinnorna. Skillnaden var robust oavsett skillnader i kliniska egenskaper, histopatologisk tumörtyp eller kvinnans utbildningsbakgrund. Status för hrHPV i invasiv tumörvävnad är således en stark och samtidigt rutinmässigt tillgänglig prognostisk biomarkör för prognosen av invasiv livmoderhalscancer. De underliggande biologiska mekanismerna till att avsaknad av detekterbar hrHPV i tumören leder till avsevärt sämre prognoser är inte kända och behöver undersökas ytterligare. Syfte: Att sammanställa nationella överlevnads- och HPV-genotypdata och utföra en storskalig populationbaserad utvärdering av sambandet mellan högrisk-HPV status och prognos för invasiv livmoderhalscancer. Denna dataset består av 2845 invasiva fall av livmoderhalscancer som diagnostiserats i Sverige under åren 2002-2011 och hade giltiga human papillomavirus (HPV)-resultat bedömda från de formalin-fixerade, paraffin-inbäddade blocken

Förekomst av humant papillomvirus av högrisktyp och prognos för invasiv cervixcancer: en nationell kohortstudie. Dataset 2

High-risk human papillomavirus (hrHPV) infection is established as the major cause of invasive cervical cancer (ICC). However, whether hrHPV status in the tumor is associated with subsequent prognosis of ICC is controversial. We aim to evaluate the association between tumor hrHPV status and ICC prognosis using national registers and comprehensive human papillomavirus (HPV) genotyping. In this nationwide population-based cohort study, we identified all ICC diagnosed in Sweden during the years 2002–2011 (4,254 confirmed cases), requested all archival formalin-fixed paraffin-embedded blocks, and performed HPV genotyping. Twenty out of 25 pathology biobanks agreed to the study, yielding a total of 2,845 confirmed cases with valid HPV results. Cases were prospectively followed up from date of cancer diagnosis to 31 December 2015, migration from Sweden, or death, whichever occurred first. The main exposure was tumor hrHPV status classified as hrHPV-positive and hrHPV-negative. The primary outcome was all-cause mortality by 31 December 2015. Five-year relative survival ratios (RSRs) were calculated, and excess hazard ratios (EHRs) with 95% confidence intervals (CIs) were estimated using Poisson regression, adjusting for education, time since cancer diagnosis, and clinical factors including age at cancer diagnosis and International Federation of Gynecology and Obstetrics (FIGO) stage. Of the 2,845 included cases, hrHPV was detected in 2,293 (80.6%), and we observed 1,131 (39.8%) deaths during an average of 6.2 years follow-up. The majority of ICC cases were diagnosed at age 30–59 years (57.5%) and classified as stage IB (40.7%). hrHPV positivity was significantly associated with screen-detected tumors, young age, high education level, and early stage at diagnosis (p < 0.001). The 5-year RSR compared to the general female population was 0.74 (95% CI 0.72–0.76) for hrHPV-positive cases and 0.54 (95% CI 0.50–0.59) for hrHPV-negative cases, yielding a crude EHR of 0.45 (95% CI 0.38–0.52) and an adjusted EHR of 0.61 (95% CI 0.52–0.71). Risk of all-cause mortality as measured by EHR was consistently and statistically significantly lower for cases with hrHPV-positive tumors for each age group above 29 years and each FIGO stage above IA. The difference in prognosis by hrHPV status was highly robust, regardless of the clinical, histological, and educational characteristics of the cases. The main limitation was that, except for education, we were not able to adjust for lifestyle factors or other unmeasured confounders. In conclusion, women with hrHPV-positive cervical tumors had a substantially better prognosis than women with hrHPV-negative tumors. hrHPV appears to be a biomarker for better prognosis in cervical cancer independent of age, FIGO stage, and histological type, extending information from already established prognostic factors. The underlying biological mechanisms relating lack of detectable tumor hrHPV to considerably worse prognosis are not known and should be further investigated. Purpose: To compile a comprehensive survival and HPV genotyping data and provide a large-scale population-based evaluation of the association between tumor high risk HPV status and prognosis of invasive cervical cancer. This is an aggregated dataset (popmort_agg_2000_2015.dta) including the average survival rates of the Swedish female population, by age, for years 2000-2015. The dataset is generated based on the age-, gender- and calender year- specific survival rates of the Swedish population during the same calendar period. The dataset included 4 variables: • Sex: Gender (all female): 2=female. • _age: Age (in years) • _year: Calendar year • Prob: Survival probability in corresponding age and calendar yearHumant papillomavirus av högrisk-typ (hrHPV) är den främsta orsaken till livmoderhalscancer. Huruvida förekomst av hrHPV-status i den invasiva tumörvävnaden har betydelse för prognosen är dock oklart. Vi samlade in information om alla fall av invasiv livmoderhalscancer i Sverige under åren 2002-2011 (4254 bekräftade fall efter en fullständig journalgenomgång). Vi begärde ut motsvarande vävnadsblock för invasiv livmoderhalscancer från alla landets biobanker för att undersöka förekomst av humant papillomvirus (HPV). Tjugo av tjugofem tillfrågade biobanker lämnade ut vävnadsblocken, så att vi för totalt 2845 kvinnor med bekräftad invasiv livmoderhalscancer kunde analysera förekomst av HPV. Alla kvinnor med invasiv livmoderhalscancer följdes från datum för cancerdiagnos till dödsdatum (alla dödsorsaker) eller till och med den 31 december 2015. Vi påvisade hrHPV i 2293/2845 (80,6 %) av tumörerna. Kvinnor med hrHPV-positiva tumörer var oftare screeningupptäckta, var yngre och hade en högre socioekonomisk status. De var också upptäckta i ett tidigare stadium jämfört med kvinnor med hrHPV-negativa tumörer. Den femåriga relativa överlevnaden för hrHPV-positiva fall var 74 % jämfört med den kvinnliga befolkningen i motsvarande ålder och under motsvarande kalenderår, medan den endast var 54 % för hrHPV-negativa fall. Efter att ha kontrollerat för ålder, tumörstadium vid diagnos och utbildningsnivå har de hrHPV-positiva fallen 39 %, högst signifikant, lägre överdödlighet jämfört med de hrHPV-negativa kvinnorna. Skillnaden var robust oavsett skillnader i kliniska egenskaper, histopatologisk tumörtyp eller kvinnans utbildningsbakgrund. Status för hrHPV i invasiv tumörvävnad är således en stark och samtidigt rutinmässigt tillgänglig prognostisk biomarkör för prognosen av invasiv livmoderhalscancer. De underliggande biologiska mekanismerna till att avsaknad av detekterbar hrHPV i tumören leder till avsevärt sämre prognoser är inte kända och behöver undersökas ytterligare. Syfte: Att sammanställa nationella överlevnads- och HPV-genotypdata och utföra en storskalig populationbaserad utvärdering av sambandet mellan högrisk-HPV status och prognos för invasiv livmoderhalscancer. Detta är en aggregerad dataset inklusive den genomsnittliga överlevnadsgraden för den svenska kvinnopopulationen, efter ålder, under åren 2000-2015. Datasetet genereras utifrån den svenska befolkningens ålder, kön och kalender årliga överlevnadsnivåer under samma kalenderperiod

Effektivitet av screening med cellprover för att förebygga livmoderhalscancer efter 60 års ålder beroende av tidigare screening

The relatively high incidence of cervical cancer in women at older ages is an issue in countries performing cervical screening for decades. Controversy remains on when and how to cease screening. Existing population-based studies on effectiveness of cervical screening at older ages have not considered women’s screening history. We performed a nationwide cohort study to investigate the incidence of cervical cancer after age 60 and its association with cervical screening at ages 61-65, stratified by screening history at ages 51-60. Using the Total Population Register, we identified women born between January 1919 and December 1945, resident in Sweden since age 51. According to the year that each county started the electronic record of cervical screening and women’s resident county, we further identified 569,132 women that have cervical screening record available since age 51. Women’s screening records, cervical cancer occurrence, and level of education were retrieved from the Swedish National Cervical Screening Registry, the National Cancer Register, and LISA (Longitudinal integration database for health insurance and labour market studies) respectively. We presented the cumulative incidence of cervical cancer from age 61-80 by using competing risk regression models, and compared the hazard ratio of cervical cancer by screening status at ages 61-65 from Cox models, adjusted for birth cohort and level of education, conditioning on screening history in their 50s. We find that Cervical screening at ages 61-65 is associated with a statistically significant reduction of subsequent cervical cancer risk for women unscreened, or screened with abnormalities, in their 50s. In women screened negative in their 50s, the risk for future cancer is not sizeable, and the risk reduction associated with continued screening appears limited. These findings should inform the current debate regarding age and criteria to discontinue cervical screening. Purpose: In order to provide evidence for age and criteria to discontinue cervical screening, we use this data to investigate the impact of cervical screening at ages 61-65 on cervical cancer incidence and stage at ages 61-80, stratifying by screening history at ages 51-60. This data comprises women born between January 1919 and December 1945, resident in Sweden since age 51, and having cervical screening record available since age 51. It contains the following variables: - Seq_nr: sequence number indicating each individual woman, from 1 to 569,132. - Edu_cat: level of education in three categories: 1=low (less than high school); 2=high school; 3=university exam and above; .=missing. Data are retrieved from LISA (Longitudinal integration database for health insurance and labour market studies). - Birth_cat: five categories of birth-year: 1=1919-1925; 2=1926-1930; 3=1931-1935; 4=1936-1940; 5=1941-1945. - Scr_51_60: Screening history at ages 51-60, in five categories: 1=adequately screened, negative; 2=inadequately screened, negative; 3=unscreened; 4=having low-grade abnormality; 5=having high-grade abnormality. Data are retrieved from the Swedish National Cervical Screening Registry. - Age_first_scr_6165: age at having the first screening test at ages 61-65. (Missing value indicates there is no screening test at ages 61-65). Data are retrieved from the Swedish National Cervical Screening Registry. - Orgscr_county: If in the county that had more than 40% women being screened at ages 61-65: 0=no; 1=yes. - Age_entry: age when entering the cohort, which is 61 for all women. - Age_exit: age when the follow-up is finished. - Cx_fail: the event of finishing follow-up: 1=having cervical cancer; 2=competing events (death or having total hysterectomy); 3=censoring (emigration, turning age 81, or 2011-12-31). The information is retrieved from the Swedish National Cancer Registry (cervical cancer), Cause of Death Register (death), Patient Register (hysterectomy), and Migration Register (emigration). The dataset also includes three variables created by Swedish National Dataservice (SND-study, SND-dataset, SND-version).Bakgrund: I länder som har infört screening med cellprover för att förebygga livmoderhalscancer finns genomgående en hög incidens av sjukdomen hos äldre kvinnor (över 60 år). Hittills finns det inga studier som har undersökt effektiviteten av screening med cellprover mot livmoderhalscancer hos äldre kvinnor (över 60 år) som har tagit hänsyn till kvinnornas screeninghistoria i åldrarna 51-60 år. Vi utförde en nationell kohortstudie för att undersöka förekomsten av livmoderhalscancer efter 60 års ålder och effekten av screening med cellprover i åldrarna 61-65, beroende av kvinnornas screeninghistoria i åldrarna 51-60 år. Metod och resultat: Med hjälp av det svenska befolkningsregistret följde vi 569 132 kvinnor födda 1919-1945 och folkbokförda i Sverige sedan 51 års ålder. Information om screening mot livmoderhalscancer, förekomst av livmoderhalscancer och kliniskt stadium hämtades från nationella register och kliniska journaler. Vi beräknade den kumulativa incidensen av livmoderhalscancer i åldrarna 61-80 år genom att använda ”competing risk regression models”. I Cox-regressionmodeller beräknade vi relativa risk att drabbas av livmoderhalscancer beroende på deltagande i screening efter 60 års ålder, för kvinnor med olika screeninghistoria i åldrarna 51-60 år, samt kontrollerade för födelsekohort och utbildningsnivå. För kvinnor som inte hade tagit cellprover i 50-årsåldern var den kumulativa incidensen 5,0 per 1000 kvinnor och screening i åldern 61-65 år minskade risken med 58% (HR=0.42, 95%CI=0.24-0.72), motsvarande en minskning med 3,3 cancerfall per 1000 kvinnor. För kvinnor med onormala cellprover i 50-årsåldern var den kumulativa riskminskningen dubbelt så stor och den relativa riskminskningen 40-57%. För kvinnor med enbart normala cellprover i 50-årsåldern fanns ingen statistiskt signifikant riskminskning av att ta cellprover efter 60 års ålder, oavsett ett eller flera negativa cellprover i 50-årsåldern. Däremot minskade antalet avancerade cancerfall i åldrarna 61-65 år för dessa kvinnor. Slutsatser: Screening med cellprover i åldern 61-65 år minskar risken för livmoderhalscancer för kvinnor som inte har tagit cellprover i 50-årsåldern och för kvinnor som har haft onormala cellprover i denna ålder. För kvinnor med enbart normala cellprover i 50-årsåldern är riskminskningen inte statistiskt mätbar, men däremot ökar chansen att cancer upptäcks i tidigare stadier än annars. Dessa resultat är viktiga för att utforma riktlinjer om i vid vilken ålder och under vilka förutsättningar screening med cellprover mot livmoderhalscancer ska avslutas. Syfte: Att ge vetenskaplig evidens för vid vilken ålder och under vilka kriterier screening med cellprover mot livmoderhalscancer ska avslutas. Vi undersökte därför effekten av screening med cellprover i åldrarna 61-65 år för att förebygga livmoderhalscancer i åldrarna 61-80 år, beroende av screeninghistoria i åldrarna 51-60 år

Stagnation, sammanbrott och social nyordning - rötterna till den ryska folkhälsokrisen

Stagnation, break-down and a new social order - the roots of the Russian public health crisis Long term trends of deteriorating health status in Soviet Union and Eastern Europe during the last two decades of communism were followed by a new crisis in health, after the collapse of its social system. In contrast, the perestroika period coincided with strongly improved public health. Explanations for the latest Russian health crisis are discussed. It is concluded that explanations based on poor medical care, excessive alcohol consumption or nutrional deprivation are, at best, insufficient. The collapse of the social system itself has lead to a narrowing of individual and collective decision latitudes; we speculate that historical factors, such as vulnerability of specific birth cohorts or segments of the population, may be part of the unexpected and very steep rise of mortality during the first half of the 1990s.Sociologisk Forsknings digitala arkiv</p

Opportunistic HPV vaccination at age 16–23 and cervical screening attendance in Sweden: a national register-based cohort study

Objectives To investigate whether cervical screening attendance differs between human papillomavirus (HPV)-vaccinated and unvaccinated women and to investigate potential underlying socioeconomic factors. Design Prospective cohort using registry linkage of vaccinations, screening invitations, screening attendance and socioeconomic covariates. Setting Swedish national HPV vaccination and cervical screening programmes. Participants All Swedish women born between 1988 and 1991 and invited to screening (n=261 434). Outcome measures All participants were followed for up to 3 years. Screening attendance was compared between HPV-vaccinated and unvaccinated women. HR and 95% CI were estimated using Cox regression. Results Vaccination age averaged 18.1 years and the coverage for≥1 dose was 13.5%. In HPV-vaccinated women (n=35 460), screening attendance was higher than in unvaccinated women (n=225 974) (74%vs69%, p<0.001). The crude HR of attendance in HPV-vaccinated women was 1.32 (95% CI 1.30 to 1.34). A positive association remained after adjustment for education, income and migration history (HR=1.10, 95% CI 1.09 to 1.12). Conclusion HPV-vaccinated women were more likely to attend screening than unvaccinated women. Yet, the question needs to be reassessed in routinely vaccinated cohorts, since the vaccinated women included here represent a selected group and may be prone to more health-conscious habits.Peer Reviewe