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H O Adami

Publications and source records attributed to H O Adami.

At least 145 records · Page 8Linked to original sources
PubMed1996

International renal cell cancer study. VII. Role of diet.

We investigated the role of diet in the etiology of renal cell cancer (RCC) in a multi-center, population-based case-control study conducted in Australia, Denmark, Sweden and the United States, using a shared protocol. A total of 1,185 incident histopathologically confirmed cases (698 men, 487 women) and 1,526 controls (915 men, 611 women) frequency-matched to cases by sex and age were included in the analyses. The association between RCC and diet was estimated by relative risks (RR) and 95% confidence intervals (CI) adjusted for age, sex, study center, body mass index and smoking. A statistically significant positive association was observed for total energy intake (RR = 1.7, 95% CI = 1.4-2.2 for the highest vs. lowest quartile, p value for trend < 0.00001), while the hypothesis that protein and fat are risk factors independent of energy was not supported. Fried meats were associated with increased RCC risk, while vegetables and fruits were protective, with the strongest effect observed for the highest quartile of consumption of orange/dark green vegetables but not vitamin C or beta carotene. Increased risk was associated with low intake (lowest decile) of vitamin E and magnesium. We observed an apparent protective effect of alcohol confined to women and probably due to chance. Our findings indicate an important role of nutrition in the development of RCC. The apparent positive association of energy intake with risk of RCC needs further investigation in a prospective cohort study to exclude the possible impact of differences in recall between cases and controls.

Adult↗
PubMed1996

Maternal risk of breast cancer following multiple births: a nationwide study in Sweden.

The association between multiple births and subsequent maternal breast cancer risk was explored in a nested case-control study in Sweden encompassing 19,368 parous women with breast cancer diagnosed up to age 65 years, and 100,459 parous controls. Among cases and controls, there were 329 and 2,031 women, respectively, with a history of at least one live multiple birth. Compared with singleton mothers, breast cancer risk was 12 percent lower (odds ratio = 0.88, 95 percent confidence interval = 0.78-0.99) in women who had had a multiple birth. After stratification for age at diagnosis, evidence of a significant inverse association was found only in women aged 54 years or younger. Birth order of the multiple pregnancy had no apparent risk-modifying effect. Age at earliest multiple birth was unrelated to breast cancer risk. The inverse association between twinning and breast cancer risk may reflect protective physiological features of twin pregnancies. Further research is needed to investigate the role, if any, of increased levels of steroid hormone-binding globulins in mothers of twins and the proposed inhibitory effects of human chorionic gonadotropin and alpha-fetoprotein, both of which are increased during multiple gestations, on breast carcinogenesis. Breast feeding patterns in mothers of twins also may modify their risk of developing breast cancer.

Adult↗
PubMed1996

Maternal and perinatal risk factors for childhood brain tumors (Sweden).

Childhood brain tumors (CBT) include a diversity of rare neoplasms of largely unknown etiology. To assess possible maternal and perinatal risk factors for CBT according to subtype, we carried out a nested (within Swedish birth-cohorts, 1973-89) case-control study, utilizing data from the nationwide Birth Registry. We ascertained incident brain tumor cases through linkage of the nationwide Birth and Cancer Registries and randomly selected five living controls from the former, matching each case on gender and birthdate. There were 570 CBT cases, including 205 low grade astrocytomas, 58 high grade astrocytomas, 93 medulloblastomas, 54 ependymomas, and 160 'others.' Risks for all brain tumors combined were elevated in relation to: (i) three maternal exposures-oral contraceptives prior to conception (odds ratios [OR] = 1.6, 95 percent confidence interval [CI] = 1.0-2.8), use of narcotics (OR = 1.3, CI = 1.0-1.6), or penthrane (OR = 1.5, CI = 1.1-2.0) during delivery); (ii) characteristics of neonatal distress (a combined variable including low one-minute Apgar score, asphyxia [OR = 1.5, CI = 1.1-2.0]) or treatments for neonatal distress (use of supplemental oxygen, ventilated on mask, use of incubator, scalp vein infusion, feeding with a jejunal tube [OR = 1.6, CI = 0.9-2.6]); and (iii) neonatal infections (OR = 2.4, CI = 1.5-4.0). Higher subtype-specific risks, observed for a few risk factors, did not differ significantly from the risk estimates for all subtypes combined for the corresponding risk factors. Childhood brain tumors were not associated significantly with other maternal reproductive, lifestyle, or disease factors; perinatal pain, anesthetic medications, birth-related complications; or with birthweight, birth defects, or early neonatal diseases. These findings suggest several new leads, but only weak evidence of brain tumor subtype-specific differences.

Adjuvants, Anesthesia↗
PubMed1996

Nutrition and renal cell cancer.

Epidemiologic evidence on the relation between nutrition and renal cell cancer is reviewed. Kidney cancer, comprising 1.7 percent of all malignant diseases diagnosed worldwide, shows about a 20-fold international variation in the incidence in men and 10-fold in women. This substantial variation indicates an important causal role of environmental factors. Renal cell (parenchymal) cancer (RCC) accounts for about 80 percent of all kidney cancers. While the etiology of RCC is incompletely understood, analytic epidemiologic studies provide consistent support for a positive association of obesity with risk of RCC; the dose-response observed supports a causal relationship. Only a few prospective studies, all of them limited in size, have been published, while ecologic and case-control studies suggest that diet may be important in the etiology of RCC. However, contradictory results and methodologic limitations in some case-control studies prevent definite conclusions concerning diet and RCC. A positive association of protein and fat intake, as well as their main food sources (meat, milk, fats), with risk of RCC-as suggested by ecologic studies-has no clear support in analytic epidemiologic studies. A protective effect of vegetables and fruits has been observed in most case-control studies, while the majority do not show an association between alcohol, coffee, and risk of RCC. Recent reports indicated an increased risk of RCC associated with consumption of fried/sautéed meat and low intakes of magnesium or vitamin E. An apparent positive association with total energy intake, perhaps due to bias, needs further investigation.

Carcinoma, Renal Cell↗
PubMed1996

Parity, age at first and last birth, and risk of breast cancer: a population-based study in Sweden.

Associations between parity and the risk of breast cancer, and the relative importance of age at first and age at last birth on breast cancer risk, were estimated in a case-control study nested in a nation-wide cohort of Swedish women born between 1925 and 1960. A total of 12,782 women with breast cancer and five times as many individually age-matched controls, aged less than 60 years with concomitant fertility information, were included in the analysis. Increasing parity was associated with a pronounced decrease in the risk of breast cancer with each additional birth conferring a 10 percent risk reduction (odds ratio 0.90 [95% CI 0.88-0.91]). In an analysis limited to women with two or more parities, and after adjustment for the effects of ages at interim births, the risk of breast cancer increased by about 13 percent for each five-year increment in age at first birth (odds ratio 1.13 [1.08-1.19]). For every five year-increase in age at last birth there was a small risk increase of marginal statistical significance (odds ratio 1.05 [1.01-1.09]). The present findings contradict recent claims that age at last birth has a stronger effect than age at first birth on breast cancer risk. The dominance of age at first birth as risk modulator is likely to reflect the protection afforded by the terminal differentiation of breast cells induced by a first pregnancy.

Age Factors↗
PubMed1996

Risk of pancreatic and periampullar cancer following cholecystectomy: a population-based cohort study.

An increased risk of pancreatic cancer following cholecystectomy has been reported in some studies but not in others. In order to settle this question, a population-based cohort consisting of 62,615 patients who had undergone cholecystectomy was followed up for the occurrence of pancreatic and periampullar cancer up to 23 years. After excluding the first year after operation, there were 261 pancreatic cancers vs 216.8 expected [standardized incidence ratio (SIR) = 1.20; 95% confidence interval (CI) = 1.06-1.37]; and 11 periampullar cancers vs 7.2 expected (SIR = 1.52; 95% CI = 0.76-2.72). The increased risk of pancreatic cancer was most prominent up to four years after operation, but was also significantly increased 15 years or more after operation (SIR = 1.35; 95% CI = 1.00-1.78). We conclude that there is a modest excess risk of pancreatic and periampullar cancer following cholecystectomy, most prominent up to four years after operation, but that also exists 15 years or more after operation.

Ampulla of Vater↗
PubMed1996

Does age at the last birth affect breast cancer risk?

We studied the relative importance of age at first and age at last full-term pregnancy (FTP) in a large data set of 3950 cases and 11,510 controls, of whom 2263 cases and 7359 controls had two or more FTPs. We found that a 5-year delay in age at first FTP is associated with an odds ratio of 1.17 (95% confidence interval of 1.05-1.29), whereas a 5-year delay in the age of last FTP is associated with an odds ratio of 1.05 (95% confidence interval 0.96-1.14). Misleading results concerning the relative importance of age at first and last FTP may be obtained when parity is only adjusted in broad categories, uniparous women whose FTP is, simultaneously, both the first and the last are not excluded from the analysis, and age at any FTP between the first and last is not controlled for.

Adult↗
PubMed1996

Causes of death among patients surviving at least one year following splenectomy.

BACKGROUND: To assess the mortality (mostly long-term sequelae) of patients undergoing splenectomy, we carried out a population-based study in Sweden. METHODS: Using the unique personal identification number assigned to each Swedish resident, we linked centralized hospitalization records with nationwide mortality data. After initially assessing risks within the first 12 months after splenectomy, we excluded deaths during the first year and computed standardized mortality ratios (SMRs) for 1,297 patients splenectomized for external trauma and 991 surgically treated for nonmalignant conditions of adjacent organs who were alive at 12 months following surgery. The general Swedish population was used as the comparison. RESULTS: Both men and women undergoing splenectomy for external trauma had a 1.6-fold (SMR = 1.6) significantly elevated mortality risk, due mainly to circulatory diseases (particularly thromboembolism), alcoholism, digestive disorders, and external causes. Men also had a 28-fold increased mortality from septicemia and an excess of liver cirrhosis (mostly alcohol-related). Patients of both genders splenectomized for nonmalignant conditions had small but significantly elevated mortality overall (SMR = 1.4 to 1.5) reflecting excess risks for malignancies, diseases of blood-forming organs, external causes, and circulatory, respiratory, and digestive disorders. In addition, men had increased mortality from thromboembolism and pneumonia while women experienced elevated risks from septicemia. CONCLUSION: The excess mortality resulted from functional postsplenectomy defects (including sepsis and thromboembolism), behaviors increasing risk of traumatic splenic injury (eg, alcoholism), damage to other organs from the external trauma (eg, traumatic injury to the central nervous system/spinal cord), or the same or recurrent nonmalignant conditions for which surgery was performed (eg, gastric and duodenal ulcers).

Adolescent↗
PubMed1996

Amputation risk and survival after embolectomy for acute arterial ischaemia. Time trends in a defined Swedish population.

OBJECTIVES: To assess the outcome of embolectomy over an 19 year period. METHODS: Time trends in the outcome of acute arterial thrombo-embolectomy of the extremities were analysed in a population-based cohort of 1190 patients operated on between 1965-83. RESULTS: A total of 262 (22%) initial amputations were performed. The limb salvage rates at 5 years postoperatively were lower between 1975-79 (61%) than between 1965-69 (81%). A proportional hazards model revealed a relative hazard (RH) of amputation of 2.2 (95% confidence interval (CI) 1.3-3.3) for 1975-79 compared with 1965-69. Operation at any district hospital entailed a 70% higher risk of amputation (RH 1.7; 95% CI 1.3-2.5) compared with the University hospital. The relative survival rate at 5 years postoperatively decreased towards the end of the study period (33% between 1975-79 compared with 43% between 1965-69). Younger age-groups had a considerably lower risk of death in the University hospital compared with the county and district hospitals. CONCLUSIONS: Contrary to the results in other hospital based reports no improvement in amputation or survival rates since 1965 could be demonstrated in this large series with no patient selection.

Acute Disease↗
PubMed1996

A search for recall bias in a case-control study of diet and breast cancer.

BACKGROUND: In retrospective studies of dietary habits and breast cancer risk, recall bias is a concern since diet has been publicized as a cause of breast cancer. METHODS: In a case-control study of diet and breast cancer risk nested within a cohort of women screened with mammography, we contrasted answers to a retrospective dietary interview with answers to a dietary questionnaire which was filled out before any diagnostic procedures for breast cancer were undertaken. The source population was all women aged 40-74 in two counties in Sweden invited to mammographic screening and asked to fill out a questionnaire before the screening. Cases and controls were subsequently defined -- matched on age, county of residence, and time of mammography -- and approached for an interview. RESULTS: In all, 265 cases and 431 controls participated in the study. Means of frequencies differed between the agreement in the questionnaire's and the interview's classifications of study subjects into quartiles of monthly intake varied between 31 percent and 57 percent. Kappa statistics in all food groups were below 0.41. In a regression analysis, case subjects with low responses on the questionnaire about intake of meat, snacks, and coffee and tea gave higher responses on interview than did controls who had low questionnaire responses for these food groups. The reverse was also true: cases' responses that were high on the questionnaire were lower on interview for these food groups than were controls' responses. CONCLUSIONS: We found few signs of recall bias, and the few indications of a differential misclassification that we found were not in food groups that have been publicly discussed as causes of breast cancer.

Adult↗
PubMed1996

Serum steroid hormone levels, sex hormone-binding globulin, and body mass index in the etiology of postmenopausal breast cancer.

Serum concentrations of estrone, androstenedione, testosterone, and sex hormone-binding globulin (SHBG) were measured postoperatively in 122 postmenopausal women with incident breast cancer and 122 age-matched population controls. After mutual adjustment, through conditional logistic regression, between the hormonal variables and body mass index (BMI), the odds ratios for increasing control-defined quartiles of estrone and androstenedione, respectively, were 1.00, 1.44, 1.76, 1.94 and 1.00, 0.83, 0.97, 2.43; there was no association of testosterone with breast cancer risk. Moreover, the odds ratios for increasing quartiles of SHBG and BMI were 1.00, 0.72, 0.28, 0.25 and 1.00, 0.39, 0.28, 0.19, respectively. This study reveals sharp contrasts in breast cancer risk between women with high estrone and low BMI and SHBG, vs women with low estrone and high BMI and SHBG.

Aged↗
PubMed1996

The accuracy of skin self-examination for atypical nevi.

We conducted a validation study to assess laypersons' ability to self-report atypical nevi. Study subjects were drawn from a large population-based cohort of middle-aged Swedish women who had responded to a previous health survey. The health survey questionnaire included color photographs of atypical nevi. Respondents were asked to examine their lower extremities for similar lesions. We invited 500 survey respondents to participate in a physician-conducted skin examination; 400 (80%) subjects agreed. We compared the results of skin self-examination for atypical nevi to the results of the physician-conducted skin examination. Using methods developed for this study, we estimated sensitivity as 29% and specificity as 85%. Positive predictive value was 20%; negative predictive value was 90%. We estimated that 12% of Swedish women have atypical nevi on the lower extremities. Although these findings suggest poor accuracy of skin self-examination for atypical nevi, our results may have been adversely affected by limiting self-examination to the legs and by the severity of atypical nevi shown in the comparison photographs used by survey respondents.

Adult↗
PubMed1996

Breast size and mammographic pattern in relation to breast cancer risk.

The relation of Wolfe's parenchymal patterns and radiographically-assessed breast size with breast cancer risk was evaluated in a population-based nested case-control study in Uppsala, Sweden. All women who attended a mammographic screening programme in Uppsala county starting in 1988 have been followed for the occurrence of breast cancer through 1993. The analysis was based on 295 cases and 589 age-matched controls, whose mammograms were blindly evaluated for parenchymal pattern and breast size. Women with P2 or DY pattern had a significantly elevated risk of breast cancer compared with women with N1 or P1 (OR = 2.09; 95% CI = 1.52-2.86). There was an inverse association of breast size with breast cancer risk, which disappeared after adjusting for parenchymal pattern, because breasts of smaller size tended to have high-risk parenchymal patterns. It is concluded that in Swedish women, and perhaps in Caucasian women in general, small breast size is associated with increasing breast risk through its association with high-risk parenchymal pattern. This is in contrast to the fact that Asian women, who in general have breasts of smaller size, have low prevalence of high-risk parenchymal pattern as well as low rates of breast cancer.

Adult↗
PubMed1996

Malignant melanoma: reduced risk associated with early childbearing and multiparity.

Pigmentary changes during pregnancy and sex-specific differences in incidence patterns of cutaneous malignant melanoma (CMM) suggest that sex hormones may be involved in the development of CMM. We explored possible associations between childbearing and the risk of CMM in a case-control study "nested' in a nation-wide cohort. A total of 4,779 incident cases of CMM in women aged 24-65 were compared with 23,888 individually age-matched controls. Delayed childbearing was associated with an increased risk of CMM, corresponding to approximately 16% per 5 years. Parous women had a significantly lower risk of CMM compared with nulliparous women; in univariate analysis there was an 8% reduction in risk for each additional birth (odds ratio = 0.92; 95% confidence interval = 0.89-0.95). In multivariate analyses the risk of CMM was best explained by a model including both age at first birth and parity. Age at first birth was the most important variable. Time since most recent birth was unrelated to risk of CMM. These findings indicate that early childbearing and multiparity reduce the risk of CMM. Conceivable explanations are hormonal changes induced by childbearing, enhanced immunologic activity via exposure to fetal antigens during pregnancy, or long-lasting effects of pregnancy-associated hyperpigmentation. Our results need confirmation in studies with proper adjustment for confounding; less sun exposure in young mothers and high parity women may represent an alternative explanation but is unlikely to explain entirely the twofold difference in risk found between extreme categories of age at first birth and parity.

Adult↗
PubMed1996

Lifestyle factors and prostate cancer risk: a case-control study in Sweden.

We examined associations between lifestyle factors and subsequent risk of prostate cancer in a population-based case-control study. Information on smoking and alcohol habits, socioeconomic factors, marital status, family history, and sexual habits were obtained from a questionnaire and a face-to-face interview with 256 (74.6%) eligible patients and 252 (76.6%) selected controls, frequency matched by age and screened for prostate cancer with negative findings. Unconditional logistic regression was used to estimate the odds ratios (ORs). Risk was elevated among current smokers of cigarettes (OR, 1.8) and current users of hard liquor (OR, 1.4); however, the lack of dose-response trend for both of these exposures argues against a causal association. We found tentative evidence that early first intercourse, a larger number of sexual partners, and other indices of high sexual activity are associated with increased risk. Similarly, adult height, an indicator of nutrition during childhood and adolescence, was weakly positively associated with risk, although larger studies are needed to establish this link. Unmarried men had a lower risk than married men (OR, 0.3), and socioeconomic status did not appear to be strongly associated with prostate cancer. Men with a father who had prostate cancer had a more than 2-fold increased risk of prostate cancer, whereas those with a brother affected had about a 5-folk risk.

Adult↗
PubMed1995

Low efficiency of cytologic screening for cancer in situ of the cervix in older women.

Cytologic screening for cervical cancer has proven to be beneficial in many countries, although the value of this intervention in women older than 50 years remains controversial. The purpose of this study was to investigate the efficiency of detecting cancer in situ by means of a cytologic smear at different ages, with special emphasis on the benefit of screening in women above the age of 50. We analyzed 466,275 smears taken in an open cohort of 118,890 women in Sweden between 1969 and 1988. The number of cancers in situ detected per 1,000 smears, the detection ratio, was used as an outcome measure in univariate analyses and in multivariate regression models. Cancer in situ was detected in 1,076 women in the study cohort. The detection ratio peaked at ages 30 to 34 and decreased heavily during the next 15 years of age. The efficiency of taking smears at ages above 50 was only 20 per cent (OR, 0.19; 95% CI, 0.14-0.26) of that at ages 30 to 34. These results were not changed when adjusting for time period and time interval since the previous smear. In spite of a high incidence of invasive cervical cancer in older women, the benefit of cytologic screening to detect cancer in situ above the age of 50 is uncertain.

Adult↗