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- Hawranek, Carolina, 1982-
(author)
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Someone has to tell them : exploring hereditary cancer risk disclosure in Sweden
- 2023
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Doctoral thesis (other academic/artistic)abstract
- Summary in EnglishBackground: An awareness of hereditary susceptibility for breast, ovarian and colorectal cancer in high-risk families enables targeted cancer prevention. A discovered hereditary risk in one family member (proband) may thus be important for several members of that family. Identified at-risk relatives can be offered surveillance to allow early detection or in some cases risk-reducing surgery to lower the risk of disease and premature death. Problem: The current clinical praxis with family-mediated risk disclosure leaves up to half of all at-risk relatives uninformed of their potential cancer risk. Complementary disclosure pathways have demonstrated promising results suggesting new opportunities to develop clinical management of hereditary cancer risk disclosure. However, concerns over legal liability, risk of inducing cancer worry and lack of robust outcome data from randomized trials among other factors, have hampered translation of emerging findings into clinical practice.Aim: This thesis explores perceptions and preferences on the disclosure of risk information concerning hereditary cancer syndromes in the general public and in patients. The work also estimates cancer worry levels in the Swedish population and explores willingness to participate in screening colonoscopy at different hypothetical levels of lifetime risk of colorectal cancer. Methods: Two quantitative and two qualitative studies were designed to address the aims. Data collection included focus groups, a population survey, and semi-structured patient interviews. Quantitative data was analyzed using descriptive statistics and groups were compared using tests and regression analysis. Interview data was analyzed with inductive qualitative content analysis of both manifest and latent content. Focus was placed on participants’ perceptions and preferences and patients’ management of risk disclosure as well as their interaction with genetic healthcare professionals.Results: Study I describes how lay people view the roles and responsibilities involved in risk disclosure. Respondents assumed genetic healthcare professionals (HCPs) would have a clear mandate in leading the risk disclosure process and wanted to be actively involved in shaping this process. They expected healthcare services to provide easy-to-understand, personalized information suitable for themselves and potential relatives. Findings from Study II show a strong public preference to share and receive risk information about hereditary cancer (90% and 89% respectively in a 10% cancer risk scenario). A majority wanted to receive information about a potential hereditary cancer risk from a healthcare professional (80%) and also preferred healthcare services to inform their at-risk relatives (58%). Preferred options for contact were by letter or telephone, followed by digital options. Study III presents novel data on cancer worry levels in a Swedish population-based sample (mean 9.46 of a total 24 on the 6-item cancer worry scale). Female respondents and those with children had higher cancer worry scores, and those with higher worry levels were also more inclined to participate in a screening colonoscopy. For each increasing risk level presented (5, 10 or 70% lifetime risk of colorectal cancer) more respondents reported interest to undergo colonoscopy. Study IV describes patient experiences of family disclosure, which is seen as difficult yet important, and often performed for the sake of others. Patients also describe the feeling unqualified in the role as proband, while others consider it a straightforward task which needs to be done. The patient data also illustrates the difficulties in communicating complex health information and patients’ struggles to navigate benefits and drawbacks of interacting with relatives. Patients also envisioned solutions to perceived barriers and outlined alternatives for healthcare services to better facilitate the risk disclosure process.Conclusion: Findings in this thesis indicate a missing link in the communication between proband, relative and healthcare regarding hereditary cancer risk information. The combined results suggest that risk disclosure would benefit from being more:Standardized – by increasing transparency about the risk disclosure process and harmonize disclosure options to guide probands and healthcare professional in the clinical setting.Systematic – by establishing follow up of risk disclosure as routine care and clearly define communication duties of healthcare professionals and probands early in the process.Situational – by tailoring professional support for risk disclosure and adapting the content and approach to the coping style, behavioral type and need of each family.Clinical implications: This thesis highlights the challenges of risk disclosure in families with increased risk of hereditary cancer and strengthens the argument for shifting towards more healthcare involvement in the process of informing at-risk relatives. The findings complement existing evidence on how hereditary cancer risk disclosure could develop further to better support proactive management of cancer risk in families affected by hereditary cancer.
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- Malmberg, Charlotte, et al.
(author)
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Antidepressant drugs and risk of developing glioma : a national registry-based case control study and a meta-analysis
- 2024
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In: American Journal of Epidemiology. - : Oxford University Press. - 0002-9262 .- 1476-6256.
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Journal article (peer-reviewed)abstract
- The aim of the present study was to investigate if use of antidepressants is related to the risk of developing lower (WHO grade 2-3) and higher grade (WHO grade 4) glioma. A registry based case-control study was performed using 1283 glioma cases and 6400 age-, sex- and geographically matched controls, diagnosed in Sweden 2009-2013. Conditional logistic regression was used to analyze whether Selective Serotonin Reuptake Inhibitors (SSRIs) or non-SSRIs were associated with the risk of developing lower- or higher-grade glioma in the study population. Our results show that use of antidepressant medication was not associated with the risk of developing glioma. We also performed a meta-analysis in which the dataset from the present study was combined with results from two previous epidemiological studies to answer the same questions. The meta-analysis showed a modest risk reduction of developing glioma in relation to antidepressant treatment (OR 0.90 [95% CI 0.83-0.97]), when all glioma subgroups and all forms of antidepressant medications were combined. In conclusion, it remains possible that antidepressants may have common monoaminergic mechanism(s) that reduce the risk of developing glioma.
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- Sjöström, Olof, et al.
(author)
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Disparities in colorectal cancer between Northern and SouthernSweden–a report from the new RISK North database
- 2018
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In: Acta Oncologica. - : Taylor & Francis. - 0284-186X .- 1651-226X. ; 57:12, s. 1622-1630
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Journal article (peer-reviewed)abstract
- Background: Geographic cancer health disparities have been reported in Sweden. The disparities are not fully understood, but may be attributed to differences in exposure to risk factors as well as differences in health care, socioeconomics and demography. The aim of this study was to describe the new nationwide population based RISK North database and its potential by analysing health disparities in colorectal cancer between Northern and Southern Sweden. Methods: Cancer-specific data from the National Cancer Quality Registers for colorectal, gastric and oesophageal cancer and brain tumours were linked to several nationwide registers hereby creating a new database–RISK North. To exemplify the potential of RISK North, we analyzed differences in colorectal cancer incidence, mortality and survival in relation to gender, age, cohabitation and education between Northern and Southern Sweden 2007–2013. Results: In colon cancer, the age-adjusted incidence per 100.000 was lower in Northern than Southern Sweden, 35.9 in the North vs. 41.1 in the South (p <.01); mortality rates were 11.0 vs. 12.2 (p <.01). For rectal cancer, incidence rates were 17.6 vs. 19.7 (p <.01) and mortality rates 5.33 vs. 5.89 (p =.07), respectively. The largest difference in incidence was demonstrated for colon cancer among individuals >79 years old (190. vs. 237, i.e., ∼20%). Survival in colon cancer was higher in Southern Sweden, HR 0.92 (0.87–0.98) adjusted for age, gender, co-habiting, education and m-stage at diagnosis. No difference in survival was seen for rectal cancer. Conclusions: The new RISK North database enabled analysis of cancer disparities between Northern and Southern Sweden. The incidence of colorectal cancer were lower in the North of Sweden whereas colon cancer survival was higher in the South. These differences can be further analysed utilising the RISK North database.
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- Sjöström, Olle, et al.
(author)
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Travel time to care does not affect survival for patients with colorectal cancer in northern Sweden : A data linkage study from the Risk North database
- 2020
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In: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 15:8
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Journal article (peer-reviewed)abstract
- INTRODUCTION: Numerous prior studies, even from countries with free access to care, have associated long travel time to care with poor survival in patients with colorectal cancer. METHODS: This is a data-linkage study of all 3718 patients with colorectal cancer, diagnosed between 2007 and 2013 in Northern Sweden, one of the most sparsely populated areas in Europe. Travel time to nearest hospital was calculated based on GPS coordinates and multivariable Cox regression was used to analyse possible associations between travel time and cause-specific survival. RESULTS: No association between travel time and survival was observed, either in univariable analysis (colon HR 1.00 [95% CI 0.998-1.003]; rectal HR 0.998; [95% CI 0.995-1.002]) or in multivariable Cox regression analysis (colon HR 0.999 [95% CI 0.997-1.002]; rectal HR 0.997 [95% CI 0.992-1.002]). CONCLUSIONS: In contrast to most other studies, no association between travel time and colorectal cancer survival was found; despite that longer travel time was associated with known risk factors for poorer outcome. In the Swedish health care setting, travel time does not appear to represent a barrier to care or to negatively influence outcomes.
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