Magnus Stenbeck

The Impact of Organized Mammography Service Screening on Breast Carcinoma Mortality in Seven Swedish Counties A Collaborative Evaluation

The evaluation of organized mammographic service screening programs is a major challenge in public health. In particular, there is a need to evaluate the effect of the screening program on the mortality of breast carcinoma, uncontaminated in the screening epoch by mortality from 1) cases diagnosed in the prescreening period and 2) cases diagnosed among unscreened women (i.e., nonattenders) after the initiation of organized screening.

KIDNEY DONORS LIVE LONGER

BACKGROUND A very important issue in living kidney donor transplantation is whether the donation is safe for the donor. The aim of this study was to examine survival and causes of death in kidney donors and to assess the renal function in those who had donated a kidney more than 20 years ago. METHODS A total of 459 living donor nephrectomies were performed in Stockholm from 1964 until the end of 1994. By using national registers, all 430 donors living in Sweden were traced. Donor survival was analysed using the Kaplan-Meier method. Expected survival was computed using the Hakulinens method and was based on national mortality rates. RESULTS Forty-one subjects had died between 15 months and 31 years after the donation. The mortality pattern was similar to that in the general population, the majority dying of cardiovascular diseases and malignancies. After 20 years of follow-up, 85% of the donors were alive, whereas the expected survival rate was 66%. Survival was thus 29% better in the donor group. One third of the donors (aged 46-91 years) who had donated >20 years ago had hypertension. There was a deterioration in the renal function with increasing age, similar to what is seen among normal healthy subjects. The average glomerular filtration rate in donors aged 75 years and over was 48 ml/min/1.73 m2. CONCLUSIONS To donate a kidney does not seem to constitute any long-term risk. The better survival among donors is probably due to the fact that only healthy persons are accepted for living kidney donation.

Health in Sweden : the National Public Health Report 2005.

Health in Sweden – The National Public Health Report 2005 : Scandinavian Journal of Public Health

Cancer Survival in Sweden 1960–1998 Developments Across Four Decades

This paper summarizes a comprehensive study of cancer survival in Sweden from 1960 to 1998. A total of 1 021 421 persons and 40 different cancer sites were included in the analyses. The main outcome measure is the relative survival rate (RSR) for different sites and follow-up times after diagnosis. The 10-year RSR for all sites combined has increased steadily—from 26.6% among men and 41.8% among women in the 1960s, to 44.6% (men) and 57.6% (women) in the 1990s. The expectation of life for a person diagnosed with cancer today is about 7 years longer than that of one diagnosed during the mid-1960s. About 3 years are gained due to changes in the relative distribution of various cancer types and about 4 years due to improved relative survival. During the 1990s substantial survival improvements were observed not only for uncommon types, such as testicular cancer, Hodgkins lymphoma and some other haematologic malignancies, but also for cancer of the rectum, kidney and malignant melanoma. Survival for breast and cervical cancer also improved during the 1990s, but not that for pancreatic, liver or lung cancer.

Male Genital Organs

Cancer of the prostate is by far the most common form of cancer among Swedish males. 5 278 new cases were reported to the Swedish Cancer Registry in 1991 (1). This comprised 25.6% of all new cases of male cancer reported in that year. The age-standardized incidence was 114.1 per 100 000 in 1991, an increase by 12 compared with 1990, and more than twice the 1961 rate of 54 per 100 000. Prostate cancer is more common in Sweden than in other parts of the world. Only the United States has a higher incidence, especially among blacks. Variation in diagnostic activity may partly explain international differences in incidence, although some evidence of a genuinely higher risk for Scandinavians living in the United States has been found (2-4). Prostate cancer relates more strongly to age than any other cancer form (3). 73% of the diagnosed patients were 70 years or older in 1991. Vitamin D deficiency, lack of sunlight, and high testosterone levels have been suggested as risk factors for the disease (2, 3, 5). There are strong ethnic and racial differences in incidence (2-4), a finding that may be related to racial differences in testosterone levels. A number of other suggested risk factors (e.g., dietary and sexual habits) are controversial (3), and the etiology and the reasons for the variable rate of progression of the disease remain essentially unknown (3, 4). The main initial diagnostic methods today include digital rectal examination (DRE), the serum prostate specific antigen test (PSA), fine needle biopsy and transrectal ultrasound (TRUS). The treatment for prostate cancer includes surgery, radiotherapy and endocrine therapy. Detection often occurs at an advanced stage and hence the treatment is often palliative. For localized disease it is not clear that radical surgery yields better average survival than watchful observation does.

Cancer patient survival in Sweden at the beginning of the third millennium--predictions using period analysis.

Estimates of cancer patient survival made using traditional, cohort-based, methods can be heavily influenced by the survival experience of patients diagnosed many years in the past and may not be particularly relevant to recently diagnosed patients. Period-based survival analysis has been shown to provide better predictions of survival for recently diagnosed patients and earlier detection of temporal trends in patient survival than cohort analysis. We aim to provide predictions of the long-term survival of recently diagnosed cancer patients using period analysis. The period estimates are compared with the latest available cohort-based estimates. Our results, based on period analysis for the years 2000–2002, suggest an improvement in survival for many forms of cancer during recent years. For all sites combined the 5-, 10-, 15-, and 20-year relative survival ratios were 62, 53, 48, and 47 for males and 67, 62, 60, and 59, for females. These estimates were 3–14 units higher than those obtained using the latest available cohorts with the respective lengths of follow-up. The interval-specific relative survival stabilised for males at 97 after 8 years of follow-up and for females at 98 after 7 years for both period and cohort analyses.

Avoidance of sun exposure is a risk factor for all-cause mortality: results from the Melanoma in Southern Sweden cohort

Sunlight exposure and fair skin are major determinants of human vitamin D production, but they are also risk factors for cutaneous malignant melanoma (MM). There is epidemiological evidence that all‐cause mortality is related to low vitamin D levels.

Is moist snuff use associated with excess risk of IHD or stroke? A longitudinal follow-up of snuff users in Sweden.

Background: The potential risks of Swedish moist snuff (snus) are debated and studies have shown diverging results. Aims: The aim of this study is to investigate whether there is any excess risk of ischaemic heart disease (IHD) and stroke from snuff use. Methods: The Swedish Survey of Living Conditions from 1988—89 was record-linked to the Swedish Cause of Death Register and the Swedish Hospital Discharge Register to investigate excess mortality and hospitalization from IHD and stroke. A Poisson regression model was used and incidence rate ratios (IRRs) for snuff and smoking were calculated controlling for age, physical activity, self-reported health, number of longstanding illnesses, residential area, and socioeconomic position. Results: Among snuff users there were no excess risks of mortality or hospitalization from IHD (IRR 0.8; 0.5—1.2,) or stroke (IRR 1.1; 0.7—1.8), but, as expected, clear excess risks were found for smokers (IRR 1.7; 1.4—2.1 for IHD, and IRR 1.4; 1.0—1.9 for stroke). Conclusions: This study has not shown any excess risk among users of snuff for IHD or stroke. If there is a risk associated with snuff it is evidently much lower than those associated with smoking.

The European data protection legislation and its consequences for public health monitoring: a plea for action

The Network of Competent Authorities (NCA) is one of the implementing structures of the Health Information and Knowledge Strand of the EU Public Health Programme 2003–08.1 The NCA became aware of problems in the field of European public health monitoring related to data protection legislation, and established in 2005, on a voluntary basis, a Work Group on Data Protection, consisting of six members of the NCA with a specific interest in the topic, and two staff members from the NCAs Scientific Assistance Office.2 The Work Group carried out an explorative survey among researchers in the European public health field, experts on health data protection and the national Data Protection Offices. This exercise resulted in a (non-exhaustive) overview of problems encountered in public health monitoring, and of major differences between national data protection systems regarding possibilities for using person identifiable health data for public health purposes. The major conclusions that can be drawn from this overview is that the legal possibilities for such usage differ to great extents between the Member States, and that this diversity can be traced back to the improper transposition of the EU Directive on Data Protection (Directive 95/46/EC).3 EU directives are addressed to the Member States, who are obliged to transpose the directive into national law. By now, all Member States indeed have transposed Directive 95/46/EC,4 though, as the results of the inventory of the Work Group showed, not in a harmonized way; for instance, Article 8 on the processing of sensitive data (e.g. health data), has not been fully transposed by all Member States. This …

Health in Sweden

1Centre for Epidemiology, National Board of Health and Welfare, SE-106 30 StockholmSweden. Tel:+46 8 5555 3000. Fax; +46 8 5555 3327. E-mail: gudrun.persson@sos.se, Etc., 2Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden. Tel:+46 8 517 779 71. E-mail: finn.diderichsen@socmed.ki.se, 3National Institute of Health, SE-103 52 Stockholm, Sweden. Tel:+46 8 5661 3515. E-mail: bosse.pettersson@fhi.se, 4Department of Public Health &Clinical Medicine, UmeaE university, SE-90 185 UmeaE , Sweden. Tel:+46 90 785 1209. E-mail. stig.wall@epiph.umu.se