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Biomedical subjects

M Ewertz

Publications and source records attributed to M Ewertz.

At least 19 recordsLinked to original sources
PubMed2006

Use of postmenopausal hormone replacement therapy and risk of non-Hodgkin's lymphoma: a Danish population-based cohort study.

Use of postmenopausal hormone replacement therapy (HRT) has been hypothesised to be associated with a reduced risk of non-Hodgkin's lymphoma (NHL), but the epidemiologic evidence is conflicting. To examine the risk of NHL in HRT users aged 40 and older, we conducted a cohort study in the County of North Jutland, Denmark (population 0.5 million) using data from population-based health registries for the period 1989-2002. We computed age-standardised NHL incidence rates and used Cox regression analysis to compute the relative risk (RR) and corresponding 95% confidence intervals (CI) of NHL among HRT users compared with non-users, adjusting for age and calendar period. The number of prescriptions redeemed (1, 2-4, 5-9, 10-19, or 20 or more prescriptions) was used as a proxy for duration of HRT. We identified 40 NHL cases among HRT users during 179 838 person-years of follow-up and 310 NHL cases among non-users during 1 247 302 person-years of follow-up. The age-standardised incidence rates of NHL were 25.7 per 100,000 among HRT users and 24.2 per 100,000 among non-users, yielding an adjusted RR of 0.99 (95% CI: 0.71-1.39). Our data did not support an association between HRT use and risk of NHL.

Adult↗
PubMed2005

Does timing of adjuvant chemotherapy influence the prognosis after early breast cancer? Results of the Danish Breast Cancer Cooperative Group (DBCG).

The purpose of this study was to examine the effect on survival of delaying the start of adjuvant chemotherapy for early breast cancer for up to 3 months after surgery. In the nation-wide clinical trials of the Danish Breast Cancer Cooperative Group, 7501 breast cancer patients received chemotherapy within 3 months of surgery between 1977 and 1999: 352 with classical cyclofosfamide, metotrexate and 5-fluorouracil (CMF); 6065 with CMF i.v. and 1084 with cyclofosfamide, epirubicin and 5-fluorouracil. For the analysis, the time between surgery and the start of chemotherapy was divided into four strata (1-3, 4, 5 and 6-13 weeks). The results show that within the three groups of chemotherapy, there was an even distribution of known prognostic factors across the four strata of initiation of chemotherapy. There was no pattern indicating a benefit from early start of chemotherapy. No significant interactions were found for subgroups of patients with a poorer prognosis (many involved lymph nodes, high-grade malignancies or hormone receptor negative disease). In conclusion, we have found no evidence for a survival benefit due to early initiation of adjuvant chemotherapy within the first 2-3 months after surgery.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2005

Hormone use for menopausal symptoms and risk of breast cancer. A Danish cohort study.

Numerous studies and meta-analyses have shown that hormone replacement therapy (HRT) for menopausal symptoms increases the risk of developing breast cancer, estimated to be 2.3% for each year of use. The influence of different oestrogen-progestin regimens has still not been fully evaluated. Using longitudinal data from the population-based prescription database of the county of North Jutland, Denmark, and the Danish Cancer Registry, we examined the risk of developing breast cancer in relation to HRT in a cohort of 78,380 women aged 40-67 years from 1989 to 2002. A total of 1462 cases of breast cancer were identified during a mean follow-up of 10 years. Use of HRT did not increase the risk of breast cancer in women aged 40-49 years. Restricting the cohort to 48,812 women aged 50 years or more at entry, of whom 15 631 were HRT users, we found an increased risk associated with current use of HRT (relative risk 1.61, 95% confidence interval 1.38-1.88). The risk increased with increasing duration of use and decreased with time since last HRT prescription, reaching unity after 5 years. No material risk difference was observed among the various HRT-regimens. This population-based cohort study provides further confirmation that HRT increases the risk of developing breast cancer in women aged 50 years or more.

Adult↗
PubMed2003

Time trends and regional differences in registration, stage distribution, surgical management and survival of breast cancer in Denmark.

The aim of this study was to analyse time trends, stage at diagnosis, survival and registration of population-based cohorts of breast cancer patients in selected Danish counties (in total 2504) in 1986 and 1996-1997. In 1986, no differences in the extent of disease were observed between the counties. Patients from one county (Funen) had centralised surgery, significantly more lymph nodes removed and a better survival in the multivariate analysis. In 1996-1997, mammographical screening had been implemented in Funen, leading to a significantly better stage distribution, whereas stage remained unchanged in the other counties. In Funen, survival was significantly better than in the other counties in univariate, but not in multivariate analysis. Survival increased significantly with time only in Funen. Inclusion in clinical trials increased over time and the coverage of the database in the Danish Breast Cancer Cooperative Group (DBCG) was high. However, patients not notified in DBCG had, beside older age, also worse stage of disease distribution and less extensive surgery. A difference in survival was observed between the counties. In 1986, this may be explained by a centralised surgical system in one county, whereas in 1996-1997 improvements could be due to an early diagnosis and other as yet unknown factors. The DBCG database cannot be considered as representative of the Danish population of breast cancer patients.

Adult↗
PubMed2002

Alcohol, tobacco and breast cancer--collaborative reanalysis of individual data from 53 epidemiological studies, including 58,515 women with breast cancer and 95,067 women without the disease.

Alcohol and tobacco consumption are closely correlated and published results on their association with breast cancer have not always allowed adequately for confounding between these exposures. Over 80% of the relevant information worldwide on alcohol and tobacco consumption and breast cancer were collated, checked and analysed centrally. Analyses included 58,515 women with invasive breast cancer and 95,067 controls from 53 studies. Relative risks of breast cancer were estimated, after stratifying by study, age, parity and, where appropriate, women's age when their first child was born and consumption of alcohol and tobacco. The average consumption of alcohol reported by controls from developed countries was 6.0 g per day, i.e. about half a unit/drink of alcohol per day, and was greater in ever-smokers than never-smokers, (8.4 g per day and 5.0 g per day, respectively). Compared with women who reported drinking no alcohol, the relative risk of breast cancer was 1.32 (1.19-1.45, P<0.00001) for an intake of 35-44 g per day alcohol, and 1.46 (1.33-1.61, P<0.00001) for >/=45 g per day alcohol. The relative risk of breast cancer increased by 7.1% (95% CI 5.5-8.7%; P<0.00001) for each additional 10 g per day intake of alcohol, i.e. for each extra unit or drink of alcohol consumed on a daily basis. This increase was the same in ever-smokers and never-smokers (7.1% per 10 g per day, P<0.00001, in each group). By contrast, the relationship between smoking and breast cancer was substantially confounded by the effect of alcohol. When analyses were restricted to 22 255 women with breast cancer and 40 832 controls who reported drinking no alcohol, smoking was not associated with breast cancer (compared to never-smokers, relative risk for ever-smokers=1.03, 95% CI 0.98-1.07, and for current smokers=0.99, 0.92-1.05). The results for alcohol and for tobacco did not vary substantially across studies, study designs, or according to 15 personal characteristics of the women; nor were the findings materially confounded by any of these factors. If the observed relationship for alcohol is causal, these results suggest that about 4% of the breast cancers in developed countries are attributable to alcohol. In developing countries, where alcohol consumption among controls averaged only 0.4 g per day, alcohol would have a negligible effect on the incidence of breast cancer. In conclusion, smoking has little or no independent effect on the risk of developing breast cancer; the effect of alcohol on breast cancer needs to be interpreted in the context of its beneficial effects, in moderation, on cardiovascular disease and its harmful effects on cirrhosis and cancers of the mouth, larynx, oesophagus and liver.

Adult↗
PubMed2001

Risk factors for male breast cancer--a case-control study from Scandinavia.

We report a population-based case-control study on risk factors for male breast cancer. Data on a broad range of previously suggested risk factors were collected in a set of Scandinavian breast cancer cases and matched controls. Incident cases (n = 282) with histologically verified carcinomas of the breast were identified from notification to the cancer registries of Denmark, Norway and Sweden over a 4-year period 1987-1991 and of these cases, 156 men could be approached and responded. Controls were identified through national central population registers and were matched individually for country, sex and year of birth. Controls with a diagnosis of breast cancer were excluded; 468 of 780 controls responded. Data on risk factors were collected by self-administered questionnaires mailed to the cases between land 2 years after diagnosis and to controls during the same period. The findings were compatible with an increased risk associated with family history of breast cancer (odds ratio (OR) = 3.3, 95% confidence interval (CI) 2.0-5.6), obesity 10 years before diagnosis (OR = 2.1, 95% CI 1.0-4.5) for BMI > 30, diabetes (OR = 2.6, 95% CI 1.3-5.3) and the use of digoxin and methyldopa (OR = 2.0 and 2.1, respectively). The association with family history of breast cancer has been repeated in several studies, while the relation to anthropometric measures has been equivocal. We could not substantiate some associations seen in other studies; namely those with high education, fertility, marital status, testicular injury, liver disease and religion. The detailed questions about gynaecomastia indicated that many cases reported signs of breast cancer as a gynaecomastia. This type of misunderstanding may explain the strong association with gynaecomastia seen in other studies. Several patients died before contact. Thus, risk factors related to a more aggressive male breast cancer or related to high risk of dying (e.g. liver cirrhosis, heavy smoking) may have been missed.

Anthropometry↗
PubMed1996

Hormone therapy in the menopause and breast cancer risk--a review.

OBJECTIVES: To evaluate the association between use of hormones in the menopause and breast cancer risk. METHODS: A qualitative review of reports published between 1970 and 1995. RESULTS: The risk of breast cancer starts to increase after 5 or more years of hormone use and remains elevated while taking hormones. Use for 10 or more years may be associated with a 30-80% increase in risk. From 2 to 5 years after stopping taking hormones, the risk seems to return to unity. There is no difference in risk between different types of oestrogens and the addition of progestins does not lower the risk. CONCLUSIONS: Short term use (less than 5 years) seems safe with respect to breast cancer risk, while longer durations of use may be associated with a small, but significant increase in risk.

Adult↗
PubMed1996

Epidemiology of breast cancer: the Nordic contribution.

In the Nordic countries, breast cancer, is the most common malignant disease among women and the incidence has been increasing steadily for the past 30 years. The age-specific incidence curve of female breast cancer suggests that the menopause has a protective effect. Nordic studies have provided evidence of an increased breast cancer risk in women of low parity, those who have their first child late, and those who have used oral contraceptives and hormone replacement therapy for a long time.

Breast Neoplasms↗
PubMed1994

Incidence of female breast cancer in relation to prevalence of risk factors in Denmark.

The extent to which changes in prevalence of risk determinants for female breast cancer could explain the temporal variation in incidence was examined using incidence figures from Denmark for the years 1943-1989. Significant increases in incidence were observed for more recent time periods and birth cohorts. Using deviance statistics from Poisson regression measures of variability explained, only a small proportion of the increase in incidence could be accounted for by fertility rates, average age at menarche and exposure to exogenous hormones. Dietary factors, on the other hand, accounted for the greater proportion of the variation observed by time period or birth cohort. In particular, there was a strong positive association of incidence with alcohol consumption and a negative association with carbohydrate intake.

Adult↗
PubMed1994

Dietary risk factors for cancer and adenomas of the large intestine. A case-control study within a screening trial in Denmark.

The aims of the study were to estimate the importance of dietary habits for colorectal cancers and adenomas. By comparing risk factors among cancer and adenoma patients the adenoma cancer theory was indirectly evaluated. The study was performed as a case-control study within a large screening trial in Denmark. All cancer and adenoma patients diagnosed at the screening were recruited as cases; controls were selected among test negatives after matching for age, sex and time of screening. All those selected except 85, participated in a 7-day dietary recall. Altogether 49 colorectal cancer patients and 172 with adenomas were examined; 362 individuals who were test negatives in the Hemoccult-II screen served as controls. The intake of crude dietary fibres was shown to be associated with reduced risk of cancer as well as adenomas. Neither cancer nor adenoma occurrences were related to total energy intake or body mass. Vitamins E and A were negatively associated with adenoma occurrence.

Adenoma↗
PubMed1993

Adipose tissue fatty acids as biomarkers of dietary exposure in Danish men and women.

Adipose tissue fatty acids, it has been proposed, reflect dietary intake. Using data from a validation study preceding a prospective study on diet, cancer, and health in Denmark, we were able to compare fatty acid profiles in adipose tissue biopsies from 86 individuals (23 men and 63 women) aged 40-64 y and dietary intake of fatty acids (as percentage of total fat) assessed by two 7-d weighed-diet records or by a semi-quantitative food frequency questionnaire. Correlation coefficients (Pearson r) between fatty acid concentrations in adipose tissue biopsies (as percentage of total peak area) and dietary intake of fatty acid (percentage of total fat), determined from the diet records for men and women, respectively, were as follows: polyunsaturated fatty acids r = 0.74 and r = 0.46; n - 3 fatty acids of marine origin: eicosapentaenoic acid r = 0.15 and r = 0.61, and docosahexaenoic acid r = 0.47 and r = 0.57. Correlation coefficients obtained by using the food frequency questionnaire were slightly lower for most fatty acids.

Adipose Tissue↗
PubMed1993

Breast cancer in Denmark. Incidence, risk factors, and characteristics of survival.

In Denmark, incidence of female breast cancer remained constant from 1943 to around 1960, whereafter a steady increase has occurred, the level today being about 50% higher than in 1960. No equivalent rise has been observed for breast cancer mortality. Influence of hormonal and dietary factors on breast cancer risk and survival was evaluated in a combined population-based case-control and follow-up study, including 2,445 women, aged less than 70 years, diagnosed with breast cancer in Denmark between 1 March 1983 and 31 August 1984, identified from the files of the nation-wide clinical trial of the Danish Breast Cancer Co-operative Group (DBCG) and the Danish Cancer Registry. The control group was an age-stratified random sample of the general female population, selected from the Central Population Register. Data on risk factors were collected by self-administered questionnaires. Clinical and pathological tumour characteristics derived from DBCG. The case-control analysis confirmed an overall increased risk of breast cancer associated with urban residence, high social status, nulliparity, early age at menarche, late age at natural menopause, hormonal replacement therapy, high dietary fat intake, and high alcohol consumption in a subgroup. It failed to detect an association with age at first childbirth, oral contraceptives, smoking, intake of vegetables, tea, coffee, and sweeteners. Survival was determined by tumour size, skin invasion, number of positive lymph nodes, and grade. There was no relation between survival and reproductive or hormonal factors, dietary variables, alcohol consumption, or smoking. However, a complex relationship may exist between survival and body mass index.

Adult↗
PubMed1993

Survival of Danish cancer patients 1943-1987. Breast.

Survival from breast cancer was examined in approximately 76,000 women and 600 men diagnosed in Denmark between 1943 and 1987. About 5% of patients mainly known from death certificates only were excluded from the analysis. Overall, survival improved with time, the relative five-year survival rates increasing from 47 to 69% in women and from 40 to 58% in men. Women had significantly better survival than men. Age at diagnosis was a prognostic factor in women as well as in men, the survival rates decreasing with increasing age at diagnosis. This age effect persisted after stratification for extent of disease. Although it was not demonstrated that the proportion of early-stage breast cancers increased with time, the improvement in survival may be related to increased diagnostic activity. The introduction of adjuvant breast cancer therapy has also improved survival, particularly among women aged less than 45.

Age Factors↗
PubMed1992

[P-pills and risk of breast cancer. A review of studies published 1970-1990].

A review of five cohort and 33 case-control studies provides evidence of an increased risk of breast cancer in women aged less than 45 years who were exposed to oral contraceptives for 5-10 years. It is probable that the increased risk is related to oral contraceptive use before the first pregnancy. No association was found between oral contraceptive use and breast cancer risk in women aged 45 years or more.

Adult↗
PubMed1992

Oral contraceptives and breast cancer risk in Denmark.

To evaluate the influence of oral contraceptives (OCs) on breast cancer risk, a population-based case-control study was conducted in Denmark. The study population included women aged less than 40 years (203 cases, diagnosed between 1 March 1983 and 31 August 1984, and 212 controls) and women aged 40-59 years (856 cases, diagnosed between 1 March 1983 and 29 February 1984, and 779 controls). Cases were identified from the nationwide clinical trial of the Danish Breast Co-operative Group and the Danish Cancer Registry. The control groups were age-stratified random samples of the general female population. Data on OC use and breast cancer risk factors were collected by self-administered questionnaires. In both age groups, no significant association was detected between breast cancer risk and duration, age at start, latency or recency of OC use. However, the data provided some limited support that OCs containing 50 micrograms or more oestrogen may be more harmful than pills with a lower oestrogen dose.

Adult↗
PubMed1992

Oxidative DNA damage estimated by 8-hydroxydeoxyguanosine excretion in humans: influence of smoking, gender and body mass index.

Oxidative DNA damage may be implicated in ageing, carcinogenesis and other degenerative diseases. Oxidative DNA damage can be assessed in humans in vivo from the urinary excretion of the DNA-repair product 8-hydroxydeoxyguanosine (8OHdG). We investigated factors influencing the excretion of 8OHdG in 24 h urine from 83 randomly selected healthy subjects (52 women) aged 40-64 years. For 2 weeks prior to urine collection the subjects kept a weighed diet record. 8OHdG was quantified by an automatic three-dimensional HPLC analysis with electrochemical detection. The 8OHdG excretion was 252 +/- 103 (mean +/- SD) pmol kg body weight/24 h with a range from 78 to 527. Multiple regression analysis identified three factors, smoking, body mass index (BMI) and gender, as significant predictors of the 8OHdG excretion. In 30 smokers the 8OHdG excretion was 320 +/- 99 pmol/kg/24 h opposed to 213 +/- 84 pmol/kg/24 h in 53 non-smokers. According to multiple regression analysis smokers excreted 50% (31-69%; 95% confidence interval) more 8OHdG than non-smokers. In 52 women the 8OHdG excretion was 240 +/- 106 pmol/kg/24 h opposed to 271 +/- 96 pmol/kg/24 h in 31 men. According to the multiple regression analysis men excreted 29% (10-48%) more 8OHdG than women. According to multiple regression analysis the 8OHdG excretion decreased with 4% (2-6%) per increment in BMI measured in kg/m2. The dietary distribution of energy demonstrated no important predictive value with respect to 8OHdG excretion. The intake of the antioxidant vitamins C and E and of vitamin A equivalents, including beta-carotene, was not associated with 8OHdG excretion. The results suggest that smoking increases oxidative DNA damage by approximately 50%. This effect implies potential serious health effects adding to the other well-known health hazards of smoking. The higher 8OHdG excretion in men and lean subjects may be related to a higher rate of metabolism with increased availability of reactive oxygen species. The apparent 7-fold individual variation in oxidative DNA damage carries implications regarding the rate of ageing and the risk of cancer and other degenerative diseases. The excretion of 8OHdG into urine offers a valuable tool for testing such hypotheses in humans.

8-Hydroxy-2'-Deoxyguanosine↗
PubMed1992

Influence of individually estimated portion size data on the validity of a semiquantitative food frequency questionnaire.

Using data from a Danish dietary validity study, we evaluated the influence of including individually estimated portion size data on the validity of a semiquantitative food frequency questionnaire. A total of 144 subjects, aged 40-64 years were included. Correlation coefficients and classification of subjects into quintiles according to their intake of foods and nutrients were used to compare questionnaire data, with and without individually estimated portion size data, with data obtained by 2 x 7 days weighed diet records. For men, the mean correlation coefficient for food group comparisons was 0.47 when information about individually estimated portion sizes for food items that do not come in natural units was included in the analysis. Using a common average portion size reduced the mean correlation coefficient to 0.45. For women, similar changes were observed (0.36 to 0.35). For nutrients the mean values for the comparison changed from 0.51 to 0.49 and from 0.39 to 0.40 for men and women, respectively. For both men and women the classification into quintiles according to their intake of foods and nutrients showed only minor differences. We conclude that little extra information was gained by including individual portion size information for food items that do not come in natural units. This may reflect that portion sizes are of minor importance compared with frequencies or that the relevant individual portion sizes were not estimated correctly.

Adult↗