[European guidelines for quality assurance in the screening for cancer of the uterine cervix].
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Europe↗
Biomedical subjects
E Lynge
Publications and source records attributed to E Lynge.
European directive on confidential data: a threat to epidemiology.
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Advisory Committees↗
[Status of preventive screening for uterine cervix cancer in Denmark in 1994].
In 1986 The National Board of Health published guidelines for cervical cancer screening in Denmark. These guidelines recommend organized screening with personal invitations every three years to women in the age group 23-59 years, and in the years to come also invitation of women aged 60-74 years. We studied the organization of cervical cancer screening in Danish counties at the beginning of 1994. Organized screening programmes are running in 15 out of the 16 "counties" (this include the municipalities of København and Frederiksberg). Four counties completely follow the national guidelines. Eight counties follow these guidelines in general, but they do not invite women above the age of 60 years. In total, 72% of women aged 25-74 years are at present invited for cervical cancer screening in Denmark.
Adult↗
Regional trends in breast cancer incidence and mortality in Denmark prior to mammographic screening.
To provide a basis for the evaluation of mammographic screening programmes in Denmark, a study was undertaken of the regional differences in breast cancer incidence and mortality. All 16 regions were followed for the 20 year period, 1970-89, before the start of the first population-based mammographic screening programme in the Copenhagen municipality in 1991. Multiplicative Poisson models were used for the analysis. In general, the incidence increased during this period from 55 to 70 [per 100,000 standardised world standard population (WSP)], and the analysis shows this to be most pronounced among women below age 60. The mortality was more stable, changing only from 24 to 28 (per 100,000 standardised WSP), but a significant increase occurred in the late 1980s. The study showed regional differences in both incidence and mortality of breast cancer in Denmark. Both the incidence and the mortality varied between the regions, with maximum differences of 22%. The analysis showed no variation in the time trends in the different regions, and thus indicates that the use of a regional comparison group would be a valid basis for evaluation of the Copenhagen programme. Our study, however, underlies the difficulties inherent in the evaluation of screening programmes without internal control groups.
Adolescent↗
Danish Cancer Registry as a resource for occupational research.
With its long tradition of population registration, Denmark has outstanding possibilities for occupational health research. The municipality registers date back to 1924, the national death and cancer registers to 1943, and unique personal identification numbers were introduced in 1968. For studies on occupational cancer, the cancer register has been linked with census data, pension data, and personnel files from various companies. Suspected associations between occupational exposures and cancer have been studied. For example, women in dry cleaning exposed to tetrachloroethylene had an excess risk of liver cancer (observed = 14; expected = 5.2; standardized incidence ratio (SIR) = 2.7; 95% CI = 1.5-4.5), and oncology nurses handling antineoplastic drugs had an excess risk of leukemia (SIR = 10.7), based on two cases. The linked registers have also been used to systematically search for associations between occupations and cancer risks (eg, female hairdressers). Cancer patterns differ greatly across countries and across main occupational groups within countries. Future efforts should focus not only on traditional approaches to occupational cancer research but also incorporate indirect influences of the work environment (eg, smoking, parity, age at first birth) and labor market participation on cancer risk.
Denmark↗
Cancer risk and exposures to carcinogens in hairdressers.
A number of epidemiologic studies have focused on the risk of bladder and lung cancer in hairdressers and beauticians, and the risk of breast cancer, and bladder cancer associated with the private use of hair dyes has also been addressed. The most consistent, although by no means unequivocal, finding is the increased risk of bladder cancer in male hairdressers. The use of brillantine containing p-dimethylaminoazobenzene could be suggested as a relevant exposure. We present recent incidence data on bladder cancer in Danish hairdressers showing relative risk (RR) = 2.05 (men) and RR = 1.75 (women) in 1970-1980 and RR = 1.17 (men) and RR = 0.88 (women) in 1981-1987. Furthermore, in female hairdressers, the risk of non-Hodgkin's lymphoma was increased for the whole period of 1970-1987.
Adult↗
Incidence of lymphohematopoietic malignancies among styrene-exposed workers of the reinforced plastics industry.
OBJECTIVES: The goal of this study was to determine the risk of lymphohematopoietic malignancies for workers exposed to styrene. METHODS: This was a historical cohort study. The observed numbers of newly diagnosed cases of lymphohematopoietic malignancies in the study population were compared with expected numbers based on the national rates. The study took place in the Danish reinforced plastic industry, in which high exposure levels of styrene occur frequently in an environment free of most other suspected carcinogens. Altogether 36,525 male employees of 386 companies producing reinforced plastics and 14,254 nonstyrene exposed employees of similar industries were studied. RESULTS: An insignificantly increased standardized incidence ratio (SIR) of 1.22 [95% confidence interval (95% CI) 0.88-1.65] was found for leukemia among all employees of the reinforced plastics industry. Workers employed in the 1960s (the period with the highest recorded styrene levels) or in companies with the highest exposure probability showed increased SIR values of 1.54 (95% CI 1.04-2.19) and 1.38 (95% CI 0.75-2.32), respectively. Both estimates increased when a 10-year latency period was considered. CONCLUSIONS: An increased risk of leukemia was shown for workers in the early phase of the reinforced plastics industry in Denmark. If this association is not due to chance or confounding, the most likely cause is styrene exposure.
Cohort Studies↗
Equity and improvement in outcome of breast cancer in Denmark.
The trend in the prognosis for female breast cancer patients was investigated by comparing Kaplan-Meier survival curves of different patient cohorts diagnosed during the period 1948-87. The study is based on 71,448 patients from the Danish Cancer Registry. The cohorts were defined by age at diagnosis, year of diagnosis, and residential area. The survival time from diagnosis nearly doubled from 1948-57 to 1978-87, the most important improvement taking place after 1978. Patients diagnosed in 1948-77 in the Copenhagen area had a far better prognosis than patients diagnosed during this period in other parts of Denmark. For patients diagnosed in 1978-87 the prognosis, however, reached an equal level in all parts of the country. Thus, it is reasonable to assume that the national programme introduced in 1977 by the Danish Breast Cancer Cooperative Group (DBCG) has played an important role and not only brought about therapeutic improvements in breast cancer treatment in Denmark, but also ensured equity in the outcome on a national scale.
Adult↗
Employment as hairdresser and risk of ovarian cancer and non-Hodgkin's lymphomas among women.
The incidence of ovarian cancer and non-Hodgkin's lymphomas (NHL) between 1971 and 1985 or 1987 has been studied on the basis of cancer registry data among women employed in hairdressing or related occupations at 1970 census in Denmark, Sweden, Norway, and Finland. Overall, the standardized incidence ratio (SIR) for ovarian cancer was 1.18 (95% confidence interval, 0.98 to 1.40). The increase was present among hairdressers from Denmark (SIR, 1.23) and Finland (SIR, 1.88); whereas hairdressers from Sweden and Norway had an incidence close to expectation (SIR 0.95 and 0.96, respectively). In three of the four countries, the SIR was higher in 1971 to 1975 than in later years. The SIR for NHL was 1.20 (0.84 to 1.66); an excess was seen in Denmark (SIR, 1.92) and a decrease was found in Sweden (SIR, 0.63). In previous studies, hairdressers have been reported to be at increased risk of ovarian cancer: this study adds some evidence in favor of the presence of an association. This study also offers some support to the hypothesis of an association between exposure to hair dyes and risk of NHL, that was reported among personal users from the United States. This study, however, strongly suggests that occupational cancer risk among female hairdressers depends on temporal and geographical factors.
Adult↗
[Effect of a safe-sex campaign on women attending a clinic of venereology. Sex behavior and prevalence of sexually transmitted diseases in women examined at the Venereaklinik in Copenhagen in 1984 and 1988].
Consecutive female patients attending the Copenhagen Venereal Disease Clinic were interviewed about sexual behaviour in 1984 (981 women) and in 1988 (684 women). Details of symptoms, age at coitarche, number of sexual partners, contraceptive methods, and obstetric history were recorded together with the results of the venereological examination. A substantially higher proportion of women used condoms in 1988 (51%) than in 1984 (11%), but otherwise the safe sex campaigns had had a limited effect on the sexual behaviour in this group of women until 1988. The prevalence of gonorrhea decreased significantly (from 22% to 6%, p < 0.01), whereas an increase in the prevalence of genital warts was observed (from 4% to 10%, p < 0.01).
Adolescent↗
[Frequency and follow-up of non-negative cervical smears in the counties of Storstrøm, Vestsjaelland and Bornholm in 1979-1989].
The outcome of the cervical cancer screening in Storstrøm, West Zeeland and Bornholm counties in 1979-1989 was evaluated. About 6% of the screened women had at least one non-negative smear requiring further follow-up. 2% were women with positive smears. Only 3/4 of women with positive smears were followed up within the first three months after the positive smear. Late follow-up probably resulted in a few cases of invasive cervical cancer. The computerized pathology registration system permits automatic monitoring of women with positive smears, and it is suggested that these facilities should be used systematically.
Adolescent↗
Chemical exposure in manufacture of phenoxy herbicides and chlorophenols and in spraying of phenoxy herbicides.
Exposure patterns are reported for manufacturing and sprayer cohorts incorporated in the "IARC International Register of Workers exposed to Phenoxy Herbicides and Contaminants." Information was based on company questionnaires, company reports, plant visits, and serum 2, 3, 7, 8-TCDD measurements. In addition to phenoxy herbicides and chlorophenols, workers in manufacturing plants may have been exposed to raw materials, process chemicals, other agents synthesized or formulated, and impurities of all these agents. Sprayers also had a complex exposure pattern, including phenoxy herbicides and some other pesticides, their carriers and additives, and residues of chemicals formed during manufacture. Occurrence of agents, including dioxins, varied between countries. Biological monitoring and industrial hygiene data were rarely available, most since the late 1970s. Exposure of workers depended mainly on the jobs they performed, but several factors influenced level of exposure. A quantitative exposure classification is not feasible in this study. Semiquantitative exposure estimates may be derived through a critical interpretation of biological monitoring and industrial hygiene data together with individual work histories.
2-Methyl-4-chlorophenoxyacetic Acid↗
Cancer in phenoxy herbicide manufacturing workers in Denmark, 1947-87--an update.
This report is an update of a cohort study from the two Danish phenoxy herbicide manufacturing plants. The study originally covered the period 1947-82. Data now have been added for the period 1983-87. In 1943-87, the 940 phenoxy herbicide manufacturing and packaging workers experienced the same overall cancer incidence as the Danish population (observed [Obs] = 66; expected [Exp] = 64.27; standardized incidence ratio [SIR] = 1.0; 95 percent confidence interval [CI] = 0.8-1.3). The same was true for the 1,179 workers employed in manual service functions. The data for 1947-82 included five cases of soft tissue sarcoma (STS). One of these patients had his diagnosis changed when he died in 1985. One new STS case was diagnosed during the period 1983-87. This updated study thus includes a total of five STS cases. Four of the STS cases were observed among persons potentially exposed to phenoxy herbicide (Exp = 1.76; SIR = 2.3; CI = 0.6-5.8). Three of the cases occurred among men employed for at least one year in one factory. In this subgroup, an SIR of 6.4 (CI = 1.3-18.7) was observed when a 10-year latency period was taken into account. Based on small numbers, this Danish study thus continues to add to the evidence for a possible association between phenoxy herbicide exposure and risk of STS. Persons potentially exposed to phenoxy herbicide had an incidence of non-Hodgkin's lymphoma close to that of the Danish population (Obs = 4; Exp = 3.08; SIR = 1.3; CI = 0.4-3.3).
2-Methyl-4-chlorophenoxyacetic Acid↗
Case-control study of risk factors for cervical squamous-cell neoplasia in Denmark. III. Role of oral contraceptive use.
The role of oral contraceptive (OC) use in relation to the risk of cervical neoplasia (squamous cell) was investigated in a population-based case-control study in Denmark of 586 women with histologically verified cervical carcinoma in situ (CIS), 59 women with invasive cervical cancer from Copenhagen, and 614 controls drawn at random from the female population in the study area. Ever use of OCs was associated with an increased crude risk for carcinoma in situ (relative risk [RR] = 1.8, 95 percent confidence interval [CI] = 1.3-2.5). The crude risk in relation to invasive carcinoma was 1.6 (CI = 0.7-3.5). After adjustment for potential confounders (excluding human papillomavirus), the risks were marginally increased, but not statistically significant (CIS: RR = 1.4, CI = 0.9-21: invasive: RR = 1.3, CI = 0.5-3.3). The risk increased with duration of use; compared with never users, the adjusted RR for carcinoma in situ was 1.9 (CI = 1.1-3.1) for women who had used OCs for six to nine years, and 1.7 (CI = 1.0-2.7) for women who used OCs for 10 years or more. This was independent of years since last use since both recent and non-recent long-term users were at an increased risk. This trend in risk with duration did not apply to the same extent to invasive lesions. The observation that the risks related to OC use were found both in women who had ever had a Pap smear and in women who had never been screened previously may speak against detection bias as an important factor.
Adult↗
Cancer incidence and mortality in women occupationally exposed to chlorophenoxy herbicides, chlorophenols, and dioxins.
The association between exposure to chlorophenoxy herbicides contaminated with dioxins and occurrence of cancer has been studied mainly in male populations. In animal experiments, gender differences have been recorded in the cancer response to administered 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). Mortality and cancer incidence in an international cohort of 701 women from an International Register of Workers occupationally exposed to chlorophenoxy herbicides, chlorophenols, and dioxins is examined. Cause-specific, national death rates and cancer incidence rates were used as referents. Cancer risk was not increased overall, with a standardized incidence ratio (SIR) of 96 and 95 percent confidence interval (CI) of 64-137, based on 29 cases. Among workers exposed to those chlorophenoxy herbicides contaminated with TCDD, excess cancer incidence (for all sites) was observed (SIR = 222, CI = 102-422, 9 cases); this was highest in the first 10 years after exposure. No excess was observed for breast cancer, the most common cancer in this cohort. Results on cancer mortality were consistent with those on incidence.
2,4,5-Trichlorophenoxyacetic Acid↗
Colorectal cancer in Denmark 1943-1988.
Nation-wide incidence rates are presented of colorectal cancer in Denmark from 1943 to 1988. In Denmark notification of malignant and related diseases is mandatory. The percentage of histologically confirmed tumours is now 95. The annual incidence rate of colon cancer in Denmark has been increasing among men and women combined from 684 cases in 1943-47 to 2020 cases in 1988. In the same period the incidence of rectal cancer has been increasing from 762 cases in 1943-47 to 1108 cases in 1988. We analyzed the effects of age, calendar time, and birth cohort with multiplicative Poisson models. We did not find consistent period effects in the models. We suggest the trends in colorectal cancer incidence rates may be due to changes in environmental factors such as dietary habits and in physical activity. Furthermore, we suggest an etiologic distinction between carcinoma of the rectum, the left colon and the right colon.
Cohort Effect↗
Vasectomy and testicular cancer: epidemiological evidence of association.
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Adult↗
Smear misclassification in a cervical cancer screening programme.
A nested case-control study was undertaken in the Maribo County cohort of 27,811 women with negative Pap smears. Sixty women who later developed invasive cervical cancer constituted the cases, and five matched controls were selected from the cohort for each case. A total of 633 previous, negative smears for the cases and controls were reviewed independently by two pathologists. The review showed misclassification to be frequent in these smears collected in the period 1966-82. Thirty-five smears were considered positive at the review. The misclassification was differential in respect to the women's later disease status. The odds ratio for patients compared with controls for having at least one positive smear was 22.12 (95% CI 7.54-64.94). We were unable to identify specific characteristics of misclassified smears coming from later cases. Koilocytosis/dyskeratosis, herpes virus changed cells and hyperkeratosis were equally rare in smears from patients and controls. The Maribo County data indicate that the fraction of preventable cases of invasive cervical cancer in women aged 30-64 within the first 5 years after a negative smear could be increased from 62-72% to 83-86%, if misclassification of true positive smears could be eliminated. As a rough estimate, this would be at the cost of a 2% increase in the work load. It should be remembered that there is a large element of extrapolation in applying these results based on relatively poor quality specimens from 1966-82 as compared to a modern screening service.
Adenocarcinoma↗