| 1. |
- Hammarstedt, Lilian, et al.
(författare)
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Human papillomavirus as a risk factor for the increase in incidence of tonsillar cancer
- 2006
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Ingår i: Int J Cancer. - : Wiley. - 0020-7136 .- 1097-0215. ; 119:11, s. 2620-3
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Tidskriftsartikel (refereegranskat)abstract
- Smoking and alcohol are well-known etiological factors in tonsillar cancer. However, as in cervical cancer, human papillomavirus (HPV) is currently found in a sizable proportion of tonsillar cancer. Recent reports from the U.S. and Finland show an increase in the incidence of tonsillar cancer, without a parallel rise in smoking and alcohol consumption. This study investigates whether the incidence of tonsillar cancer has also changed in Sweden and whether a possible explanation of the increase is a higher proportion of HPV-positive tonsillar cancer. The incidence of tonsillar cancer between 1970 and 2002 in the Stockholm area was obtained from the Swedish Cancer Registry. In parallel, 203 pretreatment paraffin-embedded tonsillar cancer biopsies taken during 1970-2002 from patients in the Stockholm area were tested for presence of HPV DNA by PCR. The incidence of tonsillar cancer increased 2.8-fold (2.6 in men and 3.5 in women) from 1970 to 2002. During the same period, a significant increase in the proportion of HPV-positive tonsillar cancer cases was observed, as it increased 2.9-fold (p < 0.001). The distribution of HPV-positive cases was 7/30 (23.3%) in the 1970s, 12/42 (29%) in the 1980s, 48/84 (57%) in the 1990s and 32/47 (68%) during 2000-2002. We have demonstrated a highly significant and parallel increase both in the incidence of tonsillar cancer and the proportion of HPV-positive tumors. Hence, HPV may play an important role for the increased incidence of tonsillar cancer. This should definitely influence future preventive strategies as well as treatment for this type of cancer.
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| 2. |
- Hammarstedt, Lalle, et al.
(författare)
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The incidence of tonsillar cancer in Sweden is increasing.
- 2007
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Ingår i: Acta Oto-Laryngologica. - : Informa UK Limited. - 0001-6489 .- 1651-2251. ; 127:9, s. 988-92
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Tidskriftsartikel (refereegranskat)abstract
- CONCLUSIONS: The incidence of tonsillar cancer in Sweden is increasing, particularly among men. Risk factors other than smoking may have contributed to the observed secular trend in men. In women, however, smoking can be a part of the explanation. Further studies to look at changes in other environmental factors, such as human papilloma virus (HPV) infection, are clearly warranted. OBJECTIVES: Head and neck cancer is related to smoking habits and smoking has decreased substantially during the last 30 years in Sweden. However, there is suspicion that the incidence of tonsillar cancer has increased in the last 30 years as it has in the USA and Finland, in spite of reduced prevalence of known risk factors. The time trends of oral and oropharygeal cancer have been studied in Sweden, but not tonsillar cancer specifically. SUBJECTS AND METHODS: We used the Swedish Cancer Registry to assess the secular trend of incidence of tonsillar cancer in Sweden since 1960. For comparison we investigated the incidence of other oral cancers and lung cancer, which are also smoking-related. The prevalence of smoking was investigated for reference. Age-standardized incidence rates were calculated and linear regression was used to evaluate secular trends. RESULTS: The incidence of tonsillar cancer increased by 2.6% per year in men and 1.1% in women. No similar increase was seen in the other oral cancers. For lung cancer there was a decrease in the incidence in men, but in women the incidence is still increasing.
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| 3. |
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| 4. |
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| 5. |
- Hammarstedt, Lilian, et al.
(författare)
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Adrenal lesions in patients with extra-adrenal malignancy - benign or malignant?
- 2012
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Ingår i: Acta oncologica. - 1651-226X. ; 51:2, s. 215-221
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Background. Adrenal lesions in patients with extra-adrenal malignancy can be part of disseminated tumour disease, but may also be incidental, benign finding. Strict characterisation is therefore crucial, and may have profound effects on patient management. Purpose. To prospectively characterise and follow-up adrenal lesions in patients with extra-adrenal malignancy, stratified into those with past or concurrent malignancy, with or without metastases. Material and methods. All incidentally detected adrenal lesions identified at cross-sectional imaging during 18 months in a defined geographical region were prospectively reported. All adult oncologic patients with adrenal lesions were subjected to biochemical work-up and dedicated adrenal imaging for lesion characterisation, including a two year follow-up. Results. Benign adrenal lesions were found in 74% (29/39) of patients who had a history of extra-adrenal malignancy, in 53% (57/108) of those with concurrent extra-adrenal malignancy without metastatic disease and in 25% (27/109) in those with signs of metastatic disease. Conclusion. An adrenal lesion occurring in a patient with past malignancy has a high likelihood of representing a benign lesion, and even in patients with present signs of malignant disease at least one fourth to one half of such lesions are benign. Dedicated adrenal imaging including computed tomography attenuation measurements with wash-out characteristics, in addition to biochemical testing for adrenal dysfunction, is highly recommended in these cases, especially in patients without any other signs of metastatic spread.
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| 6. |
- Hammarstedt, Lilian, et al.
(författare)
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Adrenal lesions: variability in attenuation over time, between scanners, and between observers.
- 2013
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Ingår i: Acta radiologica (Stockholm, Sweden : 1987). - : SAGE Publications. - 1600-0455 .- 0284-1851. ; 54:7, s. 817-826
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundMeasurements of attenuation (in Hounsfield units [HU]) and contrast wash-out are widely used to characterize adrenal lesions as benign or indeterminate/malignant at computed tomography (CT). Clinical experience suggests that such measurements of adrenal lesions may vary over time and between observers, making evaluation difficult.PurposeTo investigate the change over time of adrenal lesion size, attenuation, and contrast wash-out at CT, to determine inter-observer variability, and to analyze other factors underlying the variability.Material and MethodsIn a cohort of patients, with or without malignant disease, undergoing CT, adrenal lesions were prospectively analyzed. Lesions with growth >20% or >5 mm over 6 months were excluded. Non-enhanced attenuation and contrast medium wash-out over 2-year follow-up were analyzed. An inter-observer analysis with five observers and a phantom study of eight different CT scanners were performed to assess measurement variability.ResultsMean adrenal lesion non-enhanced attenuation values decreased by 0.5 HU/year during follow-up. Using 10 HU or 40% relative wash-out as threshold values for benign versus indeterminate lesions, 27 (20%) and 39 (29%) of 136 lesions, respectively, would be reclassified at some occasion during follow-up. In the observer analysis 37 of 40 lesions demonstrated agreement between all observers, using established threshold values. The phantom study showed an intra-scanner variability of 1-3 HU, but an inter-scanner variability of up to 8 HU for water.ConclusionThe clinically widespread use of specific attenuation threshold values for characterizing adrenal lesions must be used with great caution, considering that multiple factors, related to patient, equipment, scanning technique, and observer influence the outcome.
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| 7. |
- Hammarstedt, Lilian
(författare)
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Incidentally detected adrenal lesions - radiological aspects
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Incidentally detected adrenal lesions (“adrenal incidentalomas”) have become a growing clinical problem due to increased and refined radiology methods. Autopsy studies show frequencies as high as 7-8% in the elderly. A large part of such lesions give no health problems but some can be related to hormone overproduction or malignant disease. Dedicated radiological imaging can often reveal whether the lesion is benign or malignant, based on e.g. its fat content and wash-out of contrast medium. Our first aim was to determine the frequency of adrenal lesions incidentally detected by radiological methods in a geographically defined region. Secondly, to characterize these lesions biochemically and radiologically in a 2-year follow-up study. Thirdly, the variability of adrenal lesion characterization was investigated. During 18 months all new cases of incidentally detected adrenal lesions were prospective reported from 19 radiology departments in Western Sweden. Included patients were examined with dedicated adrenal computed tomography (CT) and/or magnetic resonance imaging during 2 years follow-up. Biochemical and clinical examinations were performed at detection and after 2 years. To validate the frequency of submitted cases, a re-evaluation of 3.827 abdominal CT-examinations was performed. The characterization of adrenal lesions was validated by an interobserver analysis of 40 adrenal lesions and a phantom study of 8 different CT-machines. In total, 339 patients with adrenal lesions detected at CT were included. The re-evaluation showed that the CT frequency of adrenal lesions varied from 1.8 to 7.1% (mean 4.5%) between hospitals, while the initially reported mean frequency was 0.9%. Follow-up of patients with-out extra-adrenal malignant disease (n=226) revealed no primary adrenal malignancy. Fourteen patients (6.6%) were operated and benign hormone-producing tumours were verified in 3%. All were identified at first examination, and follow-up revealed no additional cases of hormone producing tumours. More than 80% of these patients had radiologically benign lesions. Benign adrenal lesions were found in 74% of patients with history of malignant disease, in 53% of those with concurrent malignancy and in 25% of those with metastatic disease. In patients with two or more adrenal CT-examinations performed over two years 20-25 % of adrenal lesions showed such variations in attenuation values that their classification as “benign” or “indeterminate” would change. Both interobserver analysis and phantom analysis showed some differences in attenuation measurements. Adrenal lesions detected at radiological examinations are common and frequency figures approach those reported at autopsy. Dedicated imaging and biochemical testing is highly recommended early after detection and further follow-up is recommended for lesions that still are indeterminate after this process. Follow-up should preferably be done with the same CT equipment, including a calibration instrument and the same observer to minimize observer and inter-scanner variability.
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| 8. |
- Muth, Andreas, 1974, et al.
(författare)
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Cohort study of patients with adrenal lesions discovered incidentally.
- 2011
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Ingår i: The British journal of surgery. - : Oxford University Press (OUP). - 1365-2168 .- 0007-1323. ; 98:10, s. 1383-91
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Tidskriftsartikel (refereegranskat)abstract
- This prospective cohort study investigated the incidence, clinical features and natural history of incidentally discovered adrenal mass lesions (adrenal incidentaloma, AI) in an unselected population undergoing radiological examination.
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| 9. |
- Muth, Andreas, 1974, et al.
(författare)
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Nationellt vårdprogram för adrenala incidentalom - Programmet har harmoniserats med europeiska riktlinjer – ger förenklad handläggning av patienter.
- 2017
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 114
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Tidskriftsartikel (refereegranskat)abstract
- Swedish guidelines for the management of adrenal incidentalomas Adrenal incidentalomas are seen in about five percent of abdominal CT examinations, and in most cases represent non-hormone-producing adrenocortical adenomas, but hormone-producing or malignant lesions occur. Revised Swedish guidelines for the evaluation and management of adrenal incidentalomas based on recently published European guidelines are presented. The importance of a thorough radiological, clinical and biochemical initial evaluation is emphasized. Long-term biochemical follow-up is not recommended and use of CT contrast medium »washout« calculation is omitted. No radiological evaluation or follow-up indicated for adrenal incidentalomas <1 cm size. For patients with diagnosed lipid rich adenomas (≤ 10 HU) 1-4 cm in size no radiological follow-up is suggested after initial evaluation.
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| 10. |
- Muth, Andreas, 1974, et al.
(författare)
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Patient-reported impacts of a conservative management programme for the clinically inapparent adrenal mass.
- 2013
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Ingår i: Endocrine. - : Springer Science and Business Media LLC. - 1559-0100 .- 1355-008X. ; 44:1, s. 228-236
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to assess patient-reported impacts and health-related quality of life (HRQL) of a 2-year follow-up programme in a large cohort of patients with stationary, non-functioning, adrenal incidentalomas (AIs) in western Sweden. 145 patients (mean age 68years, 62% females) with AI from a prospective study in western Sweden were studied. All had completed a 2-year follow-up programme by November 2007, without evidence of adrenal malignancy or hormone over-production. To evaluate patient-reported impacts and HRQL, an eight-item adrenal incidentaloma impact questionnaire was used retrospectively, together with the hospital anxiety and depression scale, and the short form-36. There were 111 patients (mean age 67years, 63% females) who responded to the questionnaire (response rate 77%). 77% reported that the AI diagnosis had caused them to be worried; however, fewer than 20% had thought about the lesion often during the follow-up programme, and only 3% had felt that it had a large impact on their current daily life. Only 4% stated that the follow-up programme had been a negative experience, nevertheless 10% reported a negative impact on their HRQL during the follow-up programme. Only 2% stated that release from follow-up caused worry to any degree. In total, 29% had possible anxiety, and 30% had possible depression, probably reflecting significant co-morbidity. Possible anxiety correlated with a more negative experience of the follow-up programme. In conclusion, the 2-year follow-up programme for patients with AI was well tolerated. Nonetheless, a small number remained worried throughout follow-up, suggesting the need for tailored counselling in individual patients to ameliorate negative impacts of follow-up.
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