| 1. |
- Agnarsdóttir, Margrét, 1970-, et al.
(författare)
-
MITF as a Prognostic Marker in Cutaneous Malignant Melanoma
-
Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: Microphthalmia associated transcription factor (MITF) protein has a central role in the differentiation and survival of melanocytes. The aim of the study was to investigate whether MITF can be employed as a prognostic marker in patients operated on for cutaneous malignant melanoma. Methods: A cohort study design based on information collected from population-based registers. For included patients tissue microarrays and immunohistochemistry were employed to study the protein expression of MITF in the primary malignant melanoma tumors by estimating the fraction of positive tumor cells and the staining intensity. Results: The vast majority of tumors expressed MITF in >25% of the tumor cells with a strong staining intensity and looking at these factors individually these patients had a better prognosis. When cell fraction and intensity were combined a high-risk group dying of malignant melanoma was identified as those with 25% -75% of tumor cells staining with weak intensity and those with <25% of tumor cells staining with strong intensity. However, the majority of the deaths occurred in the lower risk groups. Conclusions: Although a high-risk group for death in malignant melanoma was identified we conclude that MITF is not useful as a prognostic marker because of the distribution of that particular expression in the population. Impact: Our results indicate a bi-phasic pattern of MITF expression and although not useful as a prognostic marker these results are in line with other experimental studies and are relevant to explore further.
|
|
| 2. |
- Berglund, Anders, et al.
(författare)
-
Social inequalities in non-small cell lung cancer management and survival : a population-based study in central Sweden
- 2010
-
Ingår i: Thorax. - : BMJ. - 0040-6376 .- 1468-3296. ; 65:4, s. 327-333
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives To examine possible associations between socioeconomic status, management and survival of patients with non-small cell lung cancer (NSCLC). Methods In a population-based cohort study, information was retrieved from the Regional Lung Cancer Register in central Sweden, the Cause of Death Register and a social database. ORs and HRs were compared to assess associations between educational level and management and survival. Results 3370 eligible patients with an NSCLC diagnosis between 1996 and 2004 were identified. There were no differences in stage at diagnosis between educational groups. A higher diagnostic intensity was observed in patients with high compared with low education. There were also social gradients in time between referral and diagnosis in early stage disease ( median time: low, 32 days; high, 17 days). Social differences in treatment remained following adjustment for prognostic factors ( surgery in early stage disease, high vs low OR 2.84; CI 1.40 to 5.79). Following adjustment for prognostic factors and treatment, the risk of death in early stage disease was lower in women with a high education ( high vs low HR 0.33; CI 0.14 to 0.77). Conclusion The results of this study indicate that socioeconomically disadvantaged groups with NSCLC receive less intensive care. Low education remained an independent predictor of poor survival only in women with early stage disease. The exact underlying mechanisms of these social inequalities are unknown, but differences in access to care, co-morbidity and lifestyle factors may all contribute.
|
|
| 3. |
- Cavalli-Björkman, Nina, 1970-, et al.
(författare)
-
Differences according to educational level in the management and survival of colorectal cancer in Sweden
- 2011
-
Ingår i: European Journal of Cancer. - : Elsevier BV. - 0959-8049 .- 1879-0852. ; 47:9, s. 1398-1406
-
Tidskriftsartikel (refereegranskat)abstract
- Socioeconomic status (SES) affects survival after a cancer diagnosis. The extent to which differences in management can explain this is not known. Record-linkage between two Swedish Regional Clinical Quality Registers of colorectal cancer and a socio-economic database generated a dataset with information on diagnostic procedures, treatment and survival in patients of different educational background. Three thousand eight hundred and ninety-nine rectal cancer patients from the years 1995 to 2006 and 5715 colon cancer patients from 1997 to 2006 were evaluated. Compared to patients with high education, those with shorter education had poorer relative and overall survival (57.9% 5-year relative survival versus 63.8% in colon cancer, 58.7% versus 69.1% in rectal cancer). There were also differences in diagnostic activity with preoperative computer tomography (40% versus 47.3%) and colonoscopy (56.3% versus 62.8%) being more frequent in highly educated groups (p = 0.001 and 0.037, respectively). Surgery resulting in colostomy was performed in 26.9% of rectal cancer patients of high education compared to 35.5% of those with low education (p = 0.005). Although rectal cancer has poorer prognosis than colon cancer, it was noted that among the highly educated, rectal cancer patients had better survival than colon cancer patients (69.1% versus 63.8% 5-year relative survival). It thus appears that improved rectal cancer management has benefited mainly patients of middle and higher educational levels. We conclude that socioeconomic differences exist in diagnostic activity and management of colorectal cancer, which may affect survival.
|
|
| 4. |
- Eaker, Sonja, et al.
(författare)
-
Breast cancer, sickness absence, income and marital status : A study on life situation 1 year prior diagnosis compared to 3 and 5 years after diagnosis
- 2011
-
Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 6:3, s. e18040-
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Improved cancer survival poses important questions about future life conditions of the survivor. We examined the possible influence of a breast cancer diagnosis on subsequent working and marital status, sickness absence and income. MATERIALS: We conducted a matched cohort study including 4,761 women 40-59 years of age and registered with primary breast cancer in a Swedish population-based clinical register during 1993-2003, and 2,3805 women without breast cancer. Information on socioeconomic standing was obtained from a social database 1 year prior and 3 and 5 years following the diagnosis. In Conditional Poisson Regression models, risk ratios (RRs) and 95% confidence intervals (CIs) were estimated to assess the impact of a breast cancer diagnosis. FINDINGS: Three years after diagnosis, women who had had breast cancer more often had received sickness benefits (RR = 1.49, 95% CI 1.40-1.58) or disability pension (RR = 1.47, 95% CI 1.37-1.58) than had women without breast cancer. We found no effect on income (RR = 0.99), welfare payments (RR = 0.98), or marital status (RR = 1.02). A higher use of sickness benefits and disability pension was evident in all stages of the disease, although the difference in use of sickness benefits decreased after 5 years, whereas the difference in disability pension increased. For woman with early stage breast cancer, the sickness absence was higher following diagnosis among those with low education, who had undergone mastectomy, and had received chemo- or hormonal therapy. Neither tumour size nor presence of lymph nodes metastasis was associated with sickness absence after adjustment for treatment. INTERPRETATION: Even in early stage breast cancer, a diagnosis negatively influences working capacity both 3 and 5 years after diagnosis, and it seems that the type of treatment received had the largest impact. A greater focus needs to be put on rehabilitation of breast cancer patients, work-place adaptations and research on long-term sequelae of treatment.
|
|
| 5. |
- Eaker, Sonja, et al.
(författare)
-
Differences in management of older women influence breast cancer survival : results from a population-based database in Sweden
- 2006
-
Ingår i: PLoS Medicine. - : Public Library of Science (PLoS). - 1549-1676. ; 3:3, s. e25-
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Several reports have shown that less aggressive patterns of diagnostic activity and care are provided to elderly breast carcinoma patients. We sought to investigate whether differences in the management of older women with breast cancer are associated with survival. METHODS AND FINDINGS: In an observational study using a population-based clinical breast cancer register of one health-care region in Sweden, we identified 9,059 women aged 50-84 y diagnosed with primary breast cancer between 1992 and 2002. The 5-y relative survival ratio was estimated for patients classified by age group, diagnostic activity, tumor characteristics, and treatment. The 5-y relative survival for breast cancer patients was lower (up to 13%) in women 70-84 y of age compared to women aged 50-69 y, and the difference was most pronounced in stage IIB-III and in the unstaged. Significant differences in disease management were found, as older women had larger tumors, had fewer nodes examined, and did not receive treatment by radiotherapy or by chemotherapy as often as the younger women. Adjustment for diagnostic activity, tumor characteristics, and treatment diminished the relative excess mortality in stages III and in the unstaged, whereas the excess mortality was only marginally affected in stage IIB. CONCLUSIONS: Less diagnostic activity, less aggressive treatment, and later diagnosis in older women are associated with poorer survival. The large differences in treatment of older women are difficult to explain by co-morbidity alone.
|
|
| 6. |
- Eaker, Sonja
(författare)
-
Optimization of compliance in epidemiologic research and disease prevention : with special emphasis on PAP-smear screening
- 2003
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis was to investigate factors affecting attendance in screening for cervical cancer, and to evaluate various measures aimed at increasing compliance to self-administered postal questionnaires and screening for cervical cancer. A population-based randomized controlled trial including 2000 men and women aged 20-79 years and living in Sweden was conducted to investigate compliance to postal questionnaires. In a randomized 2 3 factorial design three factors were tested: 1) preliminary notification or not, 2), questionnaire length, and 3) mention of a possible telephone contact or not. Preliminary notification increased the response rate by 7%, a short questionnaire with 5%, whereas mention of a possible telephone contact did not influence attendance. Combinations of preliminary notification and short questionnaires increased the response rate by 16%, whereas young age, male gender and urban residence lowered the response rate. The relation between non-attendance to screening for cervical cancer (Pap smear screening) and sociodemographic factors, gynecological examinations, risk behavior, general health behavior, knowledge, attitudes and beliefs was investigated in a population-based case-control study with 430 non-attenders and 514 attenders at Pap smear screening in Uppsala county. Non-attendance was more likely among women who had not used oral contraceptives, who had not taken their own initiative to a Pap smear, who had visited different gynecologists, and who had visited a physician very often or not at all. Regular condom use, living in rural/semirural areas, and not knowing the recommended screening interval were all associated with non-attendance, whereas socioeconomic status was not, when tested in a multivariate model. Multivariate analysis also showed that non-attendance was more likely among women who did not perceive cervical cancer to be as severe as other malignancies, who did not perceive the benefits of a Pap smear, who had time-consuming and economical barriers, and who did not feel anxious about the test results or cervical cancer. The results were strengthened with increasing time since the last smear or if self-reported attendance status was used instead of true attendance. Non-attenders also kept holding on harder to their preferences than did attenders, stating that they would not participate if their preferences were not met and were less likely to intend to participate in future screening. Among the non-attenders, 57% underestimated the time lapse since the last smear. Modifications of the invitation and call-recall system for Pap smear screening was investigated in a randomized controlled trial including all 12,240 women invited to organized screening during 17 weeks in 2001 in Uppsala County. Three successive interventions were tested: 1) modified invitation vs. the standard invitation letter, 2) reminder letter vs. no reminder letter, and 3) phone reminder vs. no phone reminder. Whereas the modified invitation did not increase attendance, a reminder letter increased the proportion attending by 9%, and a phone reminder by 31%. Combinations of modified invitation, written reminder and phone reminder almost doubled attendance within 12 months, and the number of detected cytologic abnormalities was more than tripled.
|
|
| 7. |
- Eaker, Sonja, et al.
(författare)
-
Regional differences in breast cancer survival despite common guidelines
- 2005
-
Ingår i: Cancer Epidemiology, Biomarkers and Prevention. - 1055-9965 .- 1538-7755. ; 14:12, s. 2914-8
-
Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Despite a uniform regional breast cancer care program, breast cancer survival differs within regions. We therefore examined breast cancer survival in relation to differences in diagnostic activity, tumor characteristics, and treatment in seven Swedish counties within a single health care region. METHODS: We conducted a population-based observational study using a clinical breast cancer register in one Swedish health care region. Eligible women (n = 7,656) ages 40 to 69 years diagnosed with primary breast cancer between 1992 and 2002 were followed up until 2003. The 7-year relative survival ratio was used to estimate breast cancer survival. Excess mortality was modeled using Poisson regression to study differences in survival between counties. RESULTS: The 7-year relative survival for breast cancer patients was significantly lower (up to 7% in absolute risk difference) in one county (county A) compared with the others. This difference existed only among women diagnosed before 1998, ages 50 to 59 years, and was strongest among stage II breast cancer patients. Adjustment for amount of diagnostic activity eliminated the survival differences among the counties. The amount of diagnostic activity was also lower in county A during the same time period. After county A, during 1997-1998, began to adhere strictly to the regional breast cancer care program, neither any survival differences nor diagnostic activity differences were observed. INTERPRETATIONS: Markers of diagnostic activity explained survival differences within our region, and the underlying mechanisms may be several. Low diagnostic activity may entail later diagnosis or inadequate characterization of the tumor and thereby missed treatment opportunities. Strengthening of multidisciplinary management of breast cancer can improve survival.
|
|
| 8. |
- Eaker, Sonja, et al.
(författare)
-
Social differences in breast cancer survival in relation to patient management within a National Health Care System (Sweden)
- 2009
-
Ingår i: International Journal of Cancer. - : Wiley. - 0020-7136 .- 1097-0215. ; 124:1, s. 180-187
-
Tidskriftsartikel (refereegranskat)abstract
- Epidemiologic studies have shown that cancer survival is poorer in low compared with high socioeconomic groups. We investigated whether these differences were associated with disparities in tumour characteristics and management. This cohort study was based on 9,908 women aged 20-79 years at diagnosis with primary breast cancer identified in a Swedish population-based clinical register. Information on socioeconomic standing was obtained from a social database. The 5-year cause-specific survival (CSS) and mortality hazard ratios (HR) were estimated by Cox proportional hazard models to assess differences in survival between socioeconomic groups while adjusting for diagnostic intensity, tumour characteristics and treatment. Following adjustment for age, year and stage at diagnosis, the risk of dying of breast cancer was 35% lower among women with high education compared with that of low education (HR = 0.65, 95% CI 0.53-0.80). When compared with women with high education, a lower percentage of women with low education had been investigated for proliferation (84 vs. 76%) or hormone receptor status (89 vs. 81%), had tumours
|
|
| 9. |
- Fredholm, Hanna, et al.
(författare)
-
Breast cancer in young women : poor survival despite intensive treatment
- 2009
-
Ingår i: PLoS one. - : Public Library of Science (PLoS). - 1932-6203. ; 4:11, s. e7695-
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Breast cancer is uncommon in young women and correlates with a less favourable prognosis; still it is the most frequent cancer in women under 40, accounting for 30-40% of all incident female cancer. The aim of this study was to study prognosis in young women, quantifying how much stage at diagnosis and management on the one hand, and tumour biology on the other; each contribute to the worse prognosis seen in this age group. METHODOLOGY/PRINCIPAL FINDINGS: In a registry based cohort of women aged 20-69 (n = 22 017) with a primary diagnosis of invasive breast cancer (1992-2005), women aged 20-34 (n = 471), 35-39 (n = 858) and 40-49 (n = 4789) were compared with women aged 50-69 years (n = 15 899). The cumulative 5-year relative survival ratio and the relative excess mortality (RER) were calculated. The cumulative 5-year relative survival ratio was lowest in women aged 20-34. The RER was 2.84 for women aged 20-34 and decreased with increasing age (RER 1.76 and 1.17 for women aged 35-39 and 40-49, respectively). The excess risk was, however, present only in disease stages I and II. For women aged 20-34 with stage I disease RER was 4.63, and 6.70 in the subgroup with tumour size 1-10 mm. The absolute difference in stage I between the youngest and the reference groups amounted to nearly 8%, with a 90% 5-year survival in women aged 20-34. In stages IIa and IIb, the relative excess risk was not as dramatic, but the absolute differences approached 15%. The youngest women with small tumours generally received more aggressive treatment than women in older age groups. CONCLUSIONS: After correction for stage, tumour characteristics and treatment, age remained an independent risk factor for breast cancer death in women <35 years of age. The excess risk for young women was only seen in early stages of disease and was most pronounced in women with small tumours. Young women affected by breast cancer have a high risk of dying compared to their middle-aged counterparts even if diagnosed early and receiving an intense treatment.
|
|
| 10. |
|
|
