Biomedical subjects

G Engholm

Publications and source records attributed to G Engholm.

At least 55 records · Page 3Linked to original sources

PubMed1996

Human papillomavirus--the most significant risk determinant of cervical intraepithelial neoplasia.

Sexual behavior has been consistently identified as a major risk factor for cervical cancer. Population-based studies have demonstrated that risk related to sexual activity is mediated by human papillomavirus (HPV) infection. We conducted a case-control study of 199 cases with low-grade squamous intraepithelial lesions or high-grade squamous intraepithelial lesions as defined by cytology and 1000 control women selected from an ongoing prospective cohort study in Copenhagen, Denmark. Furthermore, 131 women with equivocal smears (atypical squamous cells of undetermined significance) were examined as a separate borderline case group. At enrollment, all women had a personal interview and a gynecological examination including cervical swabs for HPV testing and a Pap smear. HPV testing was performed using a combination of general primer 5/6-mediated and type-specific polymerase-chain-reaction-based methods. Cervical HPV infection was by far the most significant risk factor for cervical squamous intraepithelial lesions. The relationship with HPV was observed for all grades, while strength of association was greater for more severe lesions. The importance of the previously identified epidemiological risk factors for cervical neoplasia was also demonstrated. However, most of the effect of these factors could be explained by taking HPV infection into account, except for schooling and smoking. Non-use of barrier contraceptives and smoking were the only significant risk factors in HPV-positive women. In HPV-negative women, a residual effect existed for different measures of sexual activity, and use of oral contraceptives and smoking constituted significant risk determinants Overall, 66% of cases could be attributed to HPV; however, if the results were restricted to histologically confirmed high-grade lesions, the proportion of cases that could be attributed to HPV infection increased to 80%.

Adult↗

PubMed1996

Breast cancer incidence subsequent to surgical reduction of the female breast.

The incidence of breast cancer among 1240 women who were treated surgically for breast hypertrophy in Copenhagen, Denmark between 1943 and 1971 was determined and compared with age- and calendar period-specific rates for the Danish female population. A total of 32 cases of breast cancer had developed by the end of 1990; the expected number was 52.55, yielding a relative risk (RR) of 0.61 [95% confidence interval (CI) 0.42-0.86]. The greatest reduction in risk was observed for women who had 600 g or more of breast tissue removed (RR=0.30; 95% CI 0.10-0.69). This suggests that the number of potential foci is important for cancer development in the female breast. In the group of women who were operated on before the age of 20, four cases of breast cancer developed, compared with 2.23 expected cases, to give an RR of 1.79, suggesting that the aetiology of their breast hypertrophy may be different from that for the rest of the group.

Adult↗

PubMed1996

Genital anomalies and risk for testicular cancer in Danish men.

In a cohort of Danish boys characterized by (1) being born between 1941 and 1957, (2) having attended schools in a defined area of Denmark, and (3) having a school health record available, 183 were registered in the Danish Cancer Registry with testicular cancer diagnosed before January 1, 1985. We selected 366 age- and sex-matched controls from the same cohort. Using information recorded by school physicians, we performed logistic regression analyses to estimate the relative risks (RR) associated with various genital anomalies. We found the risk for testicular cancer to be raised for men with a history of cryptorchidism [RR = 5.2; 95% confidence interval (CI) = 2.1-13.0], inguinal hernia (RR = 1.8; 95% CI = 0.9-3.7), hypospadias (RR = 4.2; 95% CI = 0.4-42.7), and hydrocele (RR = 2.4; 95% CI = 0.6-9.0). We observed no decrease in the risk associated with cryptorchidism after correction of the maldescent in early childhood. The RR of testicular cancer in the contralateral, normally descended testis in unilateral cryptorchid men was increased to 3.6. The results add to the growing evidence for a common causal factor for both testicular cancer and cryptorchidism and support the findings from other studies of associations between other genital anomalies involving the closure of the processus vaginalis and the risk of testicular cancer.

Adolescent↗

PubMed1996

Case-control study of risk factors for cervical squamous cell neoplasia in Denmark. IV: role of smoking habits.

The role of smoking and other risk factors for cervical neoplasia was investigated in a population-based case-control study of 586 women with histologically verified cervical squamous-cell carcinoma in situ (CIS), and 59 women with invasive squamous-cell cervical cancer from Copenhagen. Controls were randomly selected from the general female population using the computerized Danish Central Population Register. After adjustment for a variety of confounding variables, which were all significantly associated with CIS risk and included age, number of partners, proportion of sexually active life without barrier contraceptive use, years with intra-uterine devices, number of births, and age at first episode of genital warts (as a proxy measure for human papillomavirus exposure), current cigarette smoking was found to be significantly associated with CIS [adjusted relative risk (RR) = 2.4; 95% confidence interval (CI): 1.7-3.4]. Ex-smokers had a lower, but still significantly increased risk (RR = 1.6; 95% CI: 1.0-2.7). A dose-response relationship was present, especially for number of cigarettes smoked per day. In contrast, the crude estimates showed a weak association between invasive cervical cancer and smoking, which however disappeared after confounder control. The results of the present study support the hypothesis implicating smoking as a risk factor for CIS.

Adult↗

PubMed1996

Risk of colorectal cancer and other cancers in patients with gall stones.

BACKGROUND: The occurrence of gall stones has repeatedly been associated with an increased risk for cancer of the colon, but risk associated with cholecystectomy remains unclear. AIMS: To evaluate the hypothesis in a nationwide cohort of more than 40,000 gall stone patients with complete follow up including information of cholecystectomy and obesity. PATIENTS: In the population based study described here, 42,098 patients with gall stones in 1977-1989 were identified in the Danish Hospital Discharge Register. METHODS: These patients were linked to the Danish Cancer Registry to assess their risks for colorectal and other cancers during follow up to the end of 1992. RESULTS: The analysis showed a modest increase in the number of cancers at all sites combined (n = 3940; RR, 1.07; 95% confidence intervals (CI), 1.0 to 1.1). A weak association was found for cancer of the colon (n = 360; RR, 1.09; 95% CI 1.0 to 1.2), which remained unchanged when analysed by sex, anatomical subsite, and duration of follow up. Multivariate analysis with adjustment for cholecystectomy and clinically defined obesity did not change these estimates to any significant extent. Excess risks were found for cancers of the pancreas and the small intestine. A non-significant increased risk for breast cancer was seen in women five years after initial discharge for gall stones. CONCLUSION: A borderline significant association was seen between gall stones and cancer of the colon, and for cancer of pancreas and small intestine as well as for breast cancer in women.

Adult↗

PubMed1996

Lung cancer in asbestos cement workers in Denmark.

OBJECTIVES: To study the relative and absolute risks of main types of lung cancer in a cohort of asbestos cement workers from Denmark. METHOD: A cohort of 7887 men and 576 women employed between 1928 and 1984 was compiled from the personnel files of Danish Eternit Production. The cohort was followed up for deaths, emigrations, and incident cancer cases during the period 1943-90. The observed number of lung cancer cases in the cohort was compared with the expected number based on incidences for the Danish population. Internal comparison was made with Poisson modelling. RESULTS: A total of 226 lung cancer cases were observed (223 men and three women). The standardised incidence ratio (SIR) for all lung cancer among men was 1.7 (observed number 223, expected number 129.7, 95% confidence interval (95% CI) 1.5-2.0). The SIRs were raised for all main types of lung cancer; adenocarcinoma 2.6, squamous cell carcinoma 1.7, and anaplastic carcinoma 1.5. The higher SIR for adenocarcinomas was found particularly with a latency period of 25 years or more. Among the 93 excess lung cancer cases, 36 were squamous cell carcinomas and 32 were adenocarcinomas. CONCLUSION: Asbestos cement work is associated with an increased risk of lung cancer of all main types. During the first 25 years after the start of employment this excess risk is shared almost equally between the different histological types of lung cancer, but the risk of adenocarcinomas is clearly higher after this point.

Adenocarcinoma↗

PubMed1994

Risk factors for renal-cell carcinoma in Denmark. III. Role of weight, physical activity and reproductive factors.

A population-based case-control study of risk factors for renal-cell carcinoma was conducted in Denmark from 1989 to 1992. A total of 368 histologically verified cases and 396 controls were included. Information on weight, height, physical activity and reproductive factors were collected in a structured interview, along with information on other suspected risk factors. A significant increase in risk was seen for obese women but not obese men. Although there was no clear gradient, the risk was highest among women with a relative weight in the upper 5% (OR 6.1; 95% CI, 2.3 to 16.1). The increased risk was most evident for high relative weight in ages 30 to 50. No association was observed for height or physical activity. Use of amphetamines was associated with increased risk but, because of the close link with obesity, we were unable to provide evidence that amphetamines are an independent risk factor. We found some evidence for an association with reproductive variables, including decreased risk for women with late menarche and first pregnancy and birth. We observed no association with number of pregnancies or age at menopause, or use of estrogen-containing medication.

Adult↗

PubMed1994

Risk factors for renal cell carcinoma in Denmark. I. Role of socioeconomic status, tobacco use, beverages, and family history.

Risk factors for renal cell carcinoma were examined in a population based case-control study in Denmark. A total of 368 cases and 396 age- and gender-matched controls were interviewed in their homes. Increased risk was associated with low socioeconomic status. For men, an increasing risk with decreasing socioeconomic status was seen (odds ratio [OR] = 2.2, 95 percent confidence interval [CI] = 1.0-4.6 for men in the lowest socioeconomic stratum cf the highest). For women, the risk was lower in the highest socioeconomic stratum compared with the rest (OR = 2.4, CI = 0.9-5.9 for the lowest strata cf the highest). Cigarette smoking was a risk factor in men with an OR = 2.3 (CI = 1.1-5.1) for cigarette smokers with a total consumption of more than 40 pack-years compared with nonsmokers. Family history of kidney cancer was associated with an increased risk in both genders (for men, OR = 4.1, CI = 1.1-14.9; for women, OR = 4.8, CI = 1.0-23). Observations were inconsistent regarding coffee and alcohol consumption, and we found no association with tea drinking. The association with socioeconomic status remained after adjustment for other factors.

Adult↗

PubMed1994

Risk factors for renal cell carcinoma in Denmark: role of medication and medical history.

BACKGROUND: Several recent studies of risk factors for renal cell carcinoma have indicated that use of diuretics may increase risk of this cancer. It has also been suggested that use of weak analgesics, which are known to increase risk of cancer of the renal pelvis and ureter, may also be associated with an increased risk of renal cell carcinoma--the most frequent type of kidney cancer. METHODS: A population-based case-control study was undertaken to investigate the role of diuretics, other anti-hypertensive drugs, analgesics, and medical history in the aetiology of renal cell carcinoma. The study base was the total Danish population, and 368 histologically verified cases and 396 sex- and age-matched controls who were interviewed from February 1989 to May 1992. RESULTS: Response rates were 76% among cases and 79% among controls. We found no general increase in risk among users of diuretics or analgesics, although women taking loop diuretics and heavy users of acetyl salicylic acid had slightly increased risks. The use of nondiuretic anti-hypertensive medications was associated with decreased risk in women. We found non-significantly increased risks for history of hypertension and other cardiovascular disorders. We also observed elevated risks for urological disorders in both sexes which may be a result of recall bias. CONCLUSION: This study provides only limited support for the suggested association between risk of renal cell carcinoma and use of diuretics and analgesics. The coexistence of renal cell carcinoma and cardiovascular diseases could be caused by risk factors that are common to these conditions.

Adult↗

PubMed1994

Occupational risk factors for renal-cell carcinoma in Denmark.

OBJECTIVES: Risk factors for renal-cell carcinoma, the most frequent type of kidney cancer, remains enigmatic. Time trends in incidence and changes in the regional distribution of this cancer are suggestive of environmental risk factors. This study reports on occupational risk factors for renal-cell carcinoma in Denmark. METHODS: In a population-based study, 365 persons with histologically verified renal-cell carcinoma and 396 referents were interviewed. Information was collected on occupation, education, and occupational exposure to a number of suspected substances, including hydrocarbons, asbestos, and radiation. RESULTS: Risk of renal-cell carcinoma was found to be associated with employment as a truck driver, exposure to gasoline, other hydrocarbons, and insecticides and herbicides. The risk of renal-cell carcinoma was higher in the lower socioeconomic strata for both the men and the women. Nonsignificantly elevated risks were observed for employment in oil refineries, gasoline stations, and the iron and steel industry. No association was found for exposure to radiation or for employment in industries such as leather manufacturing and health care, which have previously been linked to an increased risk of renal-cell carcinoma. CONCLUSIONS: The risk of renal-cell carcinoma is increased in lower socioeconomic strata, and previously identified or suspected risk factors do not explain the excess in risk. This study adds additional support to the hypothesis of a link between renal-cell carcinoma and hydrocarbons and also demonstrates the need for further studies on occupational risk factors for renal-cell carcinoma.

Adult↗

PubMed1993

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↗

PubMed1993

Human papillomavirus, herpes simplex virus and other potential risk factors for cervical cancer in a high-risk area (Greenland) and a low-risk area (Denmark)--a second look.

The prevalence of human papillomavirus (HPV) infection and other risk factors were studied in a high risk area for cervical cancer (Greenland) and in a low risk area (Denmark). From Nuuk (Greenland) and Nykøbing Falster (Denmark), random samples of 150 women aged 20-39 years were drawn. A total of 129 and 126 women were included in Greenland and Denmark, respectively. The proportion of HPV infected women assessed by ViraPap was similar in Denmark and Greenland (4.8 vs 3.9%). When type specific polymerase chain reaction (PCR) was used, the total HPV detection rate was 38.9% in the Danish population and 43.4% in the Greenlandic. A similar interrelationship between Greenland and Denmark applied to the HPV types 11, 16, 18 and 33. No relationship was observed between HPV detection and number of partners for any of the diagnostic methods. Significantly more Greenlandic than Danish women had antibodies to HSV 2, 76.0% and 26.2%, respectively. The prevalence of self-reported histories of selected venereal diseases was also highest among Greenlanders, except for genital warts where the prevalence was similar in the two areas. Greenlandic women had significantly more sexual partners, earlier age at first intercourse, more current smokers and less use of barrier contraceptives compared to the Danish women. This study confirms the results of our previous population-based cross-sectional comparison study in these areas, corroborating the conclusion that the prevalence of detectable HPV infection does not seem to be a determinant of cervical cancer incidence. However, by using DNA hybridisation techniques, temporal virus shedding is only measured at one point in time. Detectable virus shedding may not correlate with the risk of cervical cancer. In fact, HPV DNA detection may have different implications in different populations. In Denmark, HPV DNA detection may reflect transient, recently acquired infection, whereas in Greenland, it is more indicative of chronic persistent infection.

Adult↗

PubMed1993

The risk of lung cancer from asbestos among Swedish construction workers: self-reported exposure and a job exposure matrix compared.

A total of 719 lung cancers were identified in a follow-up of 135,000 Swedish construction workers interviewed during 1971-1974 by occupational health nurses as part of a routine health check-up. These were analysed in a matched case-control study nested within this cohort, to compare different methods of characterizing exposure to asbestos. Self-reported exposure was contrasted with a job exposure matrix (JEM) of five levels of exposure intensity, applied to the job at the time of health check-up. Smoking adjusted odds ratios were computed and the JEM performed better than self-reported exposure, in being able to discriminate high risk subgroups. The same pattern was evident in a parallel analysis of 41 mesotheliomas. However both measures appeared subject to misclassification, and the question put seemed to pick up the use of asbestos cement products more effectively than asbestos insulation products. It is concluded that a simple JEM can be more reliable than a simple question, but that both should be much more detailed, to take account of different types of asbestos exposure and their variation over time.

Asbestos↗

PubMed1992

[The significance of organized screening for uterine cervix cancer in Denmark during 1968-1987].

The policy concerning organization of screening for cervical cancer has varied in the Danish counties. Organized programmes started in the municipality of Frederiksberg in 1962, in the municipality of Copenhagen and the county of Maribo in 1967, and in the country of Copenhagen in 1968. On the other hand organized screening programmes have never existed in the counties of Vestsjaelland, Viborg, Ringkøbing and Ribe. We have used this "natural experiment" to study the influence of organized screening on the incidence and mortality of cervical cancer in Denmark. Women aged 30-59 years during the period 1968-87 are included in the study. The effect of organized screening has been estimated employing multiplicative Poisson models, where age, period, region and organized screening have been considered. Women living in counties where organized screening started three or more years ago have a statistically significantly reduced risk of cervical cancer. The relative risk for the incidence in this group is 0.77 (95% confidence interval 0.69-0.86), and the relative risk for the mortality is 0.75 (95% confidence interval 0.61-0.92). Only a part of the decrease in the incidence and mortality of cervical cancer which can be attributed to the organized screening activity. The additional decrease can be attributed to the considerable unorganized screening activity during the past 20 years, and to changes in exposure to risk factors.

Adult↗

PubMed1992

Serum lipids and breast cancer risk: a cohort study of 5,207 Danish women.

The association between serum lipids and breast cancer risk was investigated in a cohort of 5,207 Danish women, who participated in The Glostrup Population Studies between 1964 and 1986. During four to 26 years of follow-up, 51 incident cases of breast cancer were identified by linkage to the Danish Cancer Registry. At the time of lipid measurement, the women were between 30 and 80 years of age. An inverse association was found between serum high-density lipoprotein (HDL) cholesterol and risk of breast cancer, which was not changed by adjustment for potential confounders such as social class, age at menarche and menopause, number of full-term pregnancies, body mass index, or alcohol and coffee consumption. The relative risk was 0.3 (95 percent confidence interval = 0.1-0.8) for women in the highest quartile of serum HDL-cholesterol compared with women in the lowest quartile and the relation displayed a significant negative trend (P = 0.01). For serum triglycerides there was a suggestion of a positive association with breast cancer incidence, but the trend was not significant (P = 0.06). No relationship between total serum cholesterol or low-density lipoprotein cholesterol and risk of breast cancer was observed. Risk estimates for well known breast cancer risk factors such as social class, age at menopause, number of full-term pregnancies, and obesity were in the directions expected.

Adult↗

PubMed1992

Birth order and risk of testicular cancer.

To explore the etiology of testicular cancer, cases of testicular cancer were identified among members of a cohort of Danish boys born between 1941 and 1957 (inclusive), who had attended schools in Copenhagen and Gentofte and whose school health records were contained in an archive under the supervision of the Danish Cancer Registry. One hundred and eighty-three cases of testicular cancer diagnosed before 31 December 1984 were identified; 366 controls, matched to cases by sex and age, were selected from the same cohort. Information on potential risk factors and confounders was obtained from two sources: school health records and midwife protocols, both of which were recorded prior to the diagnosis of testicular cancer in cases. Relative risks (RR) approximated by the odds ratios were calculated and, in logistic regression analyses, adjustments were done for known or suspected confounders. A decreasing risk of testicular cancer with increasing birth order was observed (P = 0.020). Compared with being firstborn, being number four or more in birth order was associated with a significantly decreased RR for all testicular cancers (RR = 0.3, 95 percent confidence interval [CI] = 0.3-0.8) and testicular seminoma (RR = 0.1, CI = 0.02-0.9). No association was observed between high social class and the risk of testicular cancer (RR = 1.4, CI = 0.8-2.3); neither was age at which the study subjects had mumps or measles related to risk of testicular cancer. No cases of mumps orchitis were observed before or during school years. A slightly increased RR for testicular cancer among boys from small families could be explained by the association between family size and birth order.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1992

Case-control study of risk factors for cervical neoplasia in Denmark. II. Role of sexual activity, reproductive factors, and venereal infections.

Sexual, reproductive and venereal risk factors for cervical neoplasia were investigated in a population-based case-control study of 586 women with histologically verified, cervical squamous-cell carcinoma in situ, and 59 women with invasive squamous-cell cervical cancer, diagnosed from 1985 to 1986 in Copenhagen. Cases were identified from the computerized Danish Cancer Registry. An age-stratified control group (n = 614) was drawn at random from the female population in the study area by means of the Danish Central Population Register. A structured questionnaire was mailed to cases as well as controls. Increasing number of sexual partners exerted a significant effect on the risk both for carcinoma in situ, and invasive cancer, independently of age at first intercourse and other potential confounders. Conversely, the association with early age at first intercourse became statistically insignificant after allowance for other risk factors, although an increasing risk was still observed with decreasing age at sexual debut. Early age at first episode with genital warts was a significant risk factor for carcinoma in situ, perhaps indicating a possible increased susceptibility of the cervix epithelium during adolescence. A history of genital warts was a good predictor of risk for carcinoma in situ, whereas a history of previous gonorrhea was associated with an increased risk for invasive carcinoma. Women with multiple births had a significantly increased adjusted risk, especially for carcinoma in situ, although some association was also observed with invasive cervical cancer. The study supports the hypothesis of cervical neoplasia being a sexually transmitted disease, and that carcinoma in situ and invasive cervical carcinoma, to a high degree, have similar patterns of risk factors.

Adult↗

PubMed1992

Chest x ray films from construction workers: International Labour Office (ILO 1980) classification compared with routine readings.

The extent of agreement between International Labour Office (ILO) and clinical readings of chest x ray films from construction workers was studied. From a survey of 5898 workers 258 subjects with a profusion of small opacities of > or = 1/1 and a stratified sample of subjects with profusion < 1/1 were selected. Only 41% of the films classified as ILO profusion category > or = 1/1 were clinically recorded as non-normal for the parenchyma. The proportion of films recorded as pneumoconiotic (or possibly so) was especially low for irregular opacities (22%), but increased with the profusion category (both rounded and irregular) as well as with the size of rounded opacities (p 3/11, q 12/25, r 3/4). Only with the profusion category > or = 2/1 were most of the films recorded as pneumoconiotic. The specificity and sensitivity were highest in the geographical areas where a few clinical readers had assessed many films each. The proportion of false negative clinical reports was low for circumscribed pleural thickening of the chest wall (9%) and diaphragmatic pleural thickening (6%). For calcified pleural changes and for the combination of diffuse pleural thickening and obliteration of the costophrenic angle, false negative reports were absent. The present study shows an unsatisfactory sensitivity for clinical compared with ILO readings as a means for screening the parenchyma of workers with a risk of pneumoconiosis.

Humans↗