Kravdal H.,University of Oslo |
Syse A.,Cancer Registry of Norway
BMC Public Health | Year: 2011
Background: Rates of all-cause and cause-specific mortality are higher among unmarried than married individuals. Cancer survival is also poorer in the unmarried population. Recently, some studies have found that the excess all-cause mortality of the unmarried has increased over time, and the same pattern has been shown for some specific causes of death. The objective of this study was to investigate whether there has been a similar change over time in marital status differences in cancer survival. Methods. Discrete-time hazard regression models for cancer deaths among more than 440 000 women and men diagnosed with cancer 1970-2007 at age 30-89 were estimated, using register data encompassing the entire Norwegian population. More than 200 000 cancer deaths during over 2 million person-years of exposure were analyzed. Results: The excess mortality of the never-married compared to the married has increased steadily for men, in particular the elderly. Among elderly women, the excess mortality of the never-married compared to the married has increased, and there are indications of an increasing excess mortality of the widowed. The excess mortality of divorced men and women, however, has been stable. Conclusions: There is no obvious explanation for the increasing disadvantage among the never-married. It could be due to a relatively poorer general health at time of diagnosis, either because of a more protective effect of partnership in a society that may have become less cohesive or because of more positive selection into marriage. Alternatively, it could be related to increasing differentials with respect to treatment. Today's complex cancer therapy regimens may be more difficult for never-married to follow, and health care interventions directed and adapted more specifically to the broad subgroup of never-married patients might be warranted. © 2011 Kravdal and Syse; licensee BioMed Central Ltd.
Ronning P.A.,University of Oslo |
Helseth E.,University of Oslo |
Meling T.R.,University of Oslo |
Johannesen T.B.,Cancer Registry of Norway
Neuro-Oncology | Year: 2012
The effect of temozolomide (TMZ) and radiotherapy (RT) in the treatment of glioblastoma multiforme (GBM) has been well documented in randomized controlled trials. Here we present our findings on the effect of TMZ added to RT at a population level. The Cancer Registry of Norway was searched for patients with a GBM diagnosis from January 1, 2000 to December 31, 2007. Subsequently, the prescriptions registered to these patients were obtained from the Norwegian Prescription Database. The data were analyzed according to era (pre-TMZ introduction or post-TMZ introduction) and according to treatment received. Furthermore, a matching procedure was utilized to reduce the bias between the RT 1 TMZ and RT alone treatments so that the effect of TMZ could be better scrutinized. We identified 1157 GBM patients. The median overall survival (OS), in months, was 8.3 (95% confidence interval: 7.6-9.0) and 10.1 (95% confidence interval: 9.1-11.0) in the pre-TMZ and TMZ eras, respectively (P <.001). By treatment, we found median OS for the control, RT alone, and RT + TMZ groups to be 2.5, 9.0, and 16.2 months, respectively (P <.001). Two-year survival was 0%, 4%, and 25%, respectively. The effect of age on TMZ effect was insignificant. In the matched group analysis, TMZ provided a 7.6-month OS benefit. Our population data reproduce the beneficial effect of TMZ from randomized controlled trials with a median OS of 16.2 months and 25% 2-year survival. © The Author(s) 2012.
Weir H.K.,Centers for Disease Control and Prevention |
Thompson T.D.,Centers for Disease Control and Prevention |
Soman A.,Northrop Grumman |
Moller B.,Cancer Registry of Norway |
Leadbetter S.,Centers for Disease Control and Prevention
Cancer | Year: 2015
BACKGROUND The overall age-standardized cancer incidence rate continues to decline whereas the number of cases diagnosed each year increases. Predicting cancer incidence can help to anticipate future resource needs, evaluate primary prevention strategies, and inform research. METHODS Surveillance, Epidemiology, and End Results data were used to estimate the number of cancers (all sites) resulting from changes in population risk, age, and size. The authors projected to 2020 nationwide age-standardized incidence rates and cases (including the top 23 cancers). RESULTS Since 1975, incident cases increased among white individuals, primarily caused by an aging white population, and among black individuals, primarily caused by an increasing black population. Between 2010 and 2020, it is expected that overall incidence rates (proxy for risk) will decrease slightly among black men and stabilize in other groups. By 2020, the authors predict annual cancer cases (all races, all sites) to increase among men by 24.1% (-3.2% risk and 27.3% age/growth) to >1 million cases, and by 20.6% among women (1.2% risk and 19.4% age/growth) to >900,000 cases. The largest increases are expected for melanoma (white individuals); cancers of the prostate, kidney, liver, and urinary bladder in males; and the lung, breast, uterus, and thyroid in females. CONCLUSIONS Overall, the authors predict cancer incidence rates/risk to stabilize for the majority of the population; however, they expect the number of cancer cases to increase by >20%. A greater emphasis on primary prevention and early detection is needed to counter the effect of an aging and growing population on the burden of cancer. © 2015 American Cancer Society.
Solheim O.,Norwegian University of Science and Technology |
Torsteinsen M.,Nordlandssykehuset |
Johannesen T.B.,Cancer Registry of Norway |
Jakola A.S.,Norwegian University of Science and Technology
Journal of Neurosurgery | Year: 2014
Object. It is assumed that the observed increase in brain tumor incidence may at least partially be explained by increased use of MRI. However, to date no direct estimate of this effect is available. The authors undertook this registry-based study to examine whether regional frequencies of cerebral MRI use correlate to regional incidence rates of intracranial tumors and survival of patients with these lesions. Methods. The authors used Norwegian national population registries from January 2002 through December 2007 to conduct this observational study. They obtained information on outpatient MRI scans in Norwegian counties and examined whether the annual regional rates of cerebral MRI scans correlated to regional age- and sex-adjusted brain tumor incidence rates. They also explored whether differences in cerebral MRI use were associated with survival and examined time trends in the study period. Results. Approximately 50,000 cerebral MRI scans are carried out annually in outpatient settings in Norway, and 6363 primary intracranial tumors were diagnosed in Norway during the study period. There was an overall positive correlation between the annual number of cerebral MRI scans per 100,000 capita and age- and sex-adjusted incidence rates of intracranial tumors in the various Norwegian counties (Spearman's rho = 0.35, p < 0.001). In a linear model, an increase in 1 MRI per 100,000 capita per year results in a 0.004 (95% CI 0.002-0.006) increase in diagnosed intracranial tumors per 100,000 capita per year (p < 0.001). Subgroup analysis showed a correlation between MRI use and the annual age- and sex-adjusted incidence rates of extraaxial tumors (p = 0.04, Spearman's rho = 0.28) but not intra-axial tumors (p = 0.394). Overall survival for unselected patients with intracranial tumors is longer with increasing number of cerebral MRI scans per capita in the county of residence at the time of the diagnosis (log rank, p = 0.029). However, after adjustment for year of diagnosis and catchment region of the Norwegian neurosurgical centers, the association between MRI scans per capita and overall survival was no longer statistically significant (p = 0.076). Conclusions. Presumably due to the incidental discovery of benign extraaxial tumors, regional differences in the use of cerebral MRI in outpatients affect observed incidence rates of intracranial tumors. ©AANS, 2014.
Kalager M.,Cancer Registry of Norway |
Kalager M.,Harvard University |
Zelen M.,Harvard University |
Zelen M.,Dana-Farber Cancer Institute |
And 5 more authors.
New England Journal of Medicine | Year: 2010
Background: A challenge in quantifying the effect of screening mammography on breast-cancer mortality is to provide valid comparison groups. The use of historical control subjects does not take into account chronologic trends associated with advances in breast-cancer awareness and treatment. Methods: The Norwegian breast-cancer screening program was started in 1996 and expanded geographically during the subsequent 9 years. Women between the ages of 50 and 69 years were offered screening mammography every 2 years. We compared the incidence-based rates of death from breast cancer in four groups: two groups of women who from 1996 through 2005 were living in counties with screening (screening group) or without screening (nonscreening group); and two historical-comparison groups that from 1986 through 1995 mirrored the current groups. Results: We analyzed data from 40,075 women with breast cancer. The rate of death was reduced by 7.2 deaths per 100,000 person-years in the screening group as compared with the historical screening group (rate ratio, 0.72; 95% confidence interval [CI], 0.63 to 0.81) and by 4.8 deaths per 100,000 person-years in the nonscreening group as compared with the historical nonscreening group (rate ratio, 0.82; 95% CI, 0.71 to 0.93; P<0.001 for both comparisons), for a relative reduction in mortality of 10% in the screening group (P = 0.13). Thus, the difference in the reduction in mortality between the current and historical groups that could be attributed to screening alone was 2.4 deaths per 100,000 person-years, or a third of the total reduction of 7.2 deaths. Conclusions: The availability of screening mammography was associated with a reduction in the rate of death from breast cancer, but the screening itself accounted for only about a third of the total reduction. (Funded by the Cancer Registry of Norway and the Research Council of Norway.) Copyright © 2010 Massachusetts Medical Society.
Strand T.-E.,Cancer Registry of Norway |
Bartnes K.,University of Tromsø |
Rostad H.,Cancer Registry of Norway
European Journal of Cardio-thoracic Surgery | Year: 2012
Objectives: Trends in lung cancer surgery may reveal potential for improvement and are important for planning by care providers. Methods: Using data from the Cancer Registry of Norway, we analysed the outcomes of lung cancer surgery during the periods of 1994-95, 2000-01 and 2006-07. The Cox regression model was carried out to identify the period effect on survival. Results: A total of 2201 patients were operated on. Surgery was centralized from 24 hospitals in the first two periods to 13 hospitals in the last. The resection rates varied from 6 to 31% across the counties. From the first to the last period, the national resection rate increased from 16 to 19% (Ptrend = 0.001), and the 1-year survival rate increased from 73 to 82%. The proportion of resected patients in pathological stage I-II decreased from 87 to 83% (Ptrend = 0.048), the proportion of pneumonectomies from 27 to 15% (Ptrend<0.001), and the rate of mortality within 30 days of the surgery from 4.8 to 3.0% (Ptrend = 0.072). In the first two periods, 31% of these early deaths were caused by complications directly related to the surgical technique, whereas, in the latter period, no deaths were directly related. The only unfavourable trend was the waiting time between the final diagnostic procedure and surgery, which increased from 29 to 40 days throughout the three periods (P < 0.001). Survival (excluding those who died within 30 days) was significantly improved in the last period (risk ratio (RR): 0.72 (P < 0.001)). Conclusions: Despite an increased surgical waiting time, important aspects of lung cancer surgery, including resection rates, have improved in recent years. © The Author 2012. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
News Article | October 17, 2016
Laboratory computer scientists and Norwegian researchers are collaborating to apply high performance computing (HPC) to the analysis of medical data to improve screening for cervical cancer. The convergence of high performance computing, big data and life science is enabling the development of personalized medicine, says Ghaleb Abdulla, Livermore lead on the collaboration with Norway and director of LLNL'sInstitute for Scientific Computing Research. "Delivering care tailored to the needs of the individual, rather than population averages, has the potential to transform the delivery of healthcare." Abdulla's team is partnering with the Cancer Registry of Norway(link is external) "to advance precision medicine" by developing "individually tailored prevention and treatment strategies." The partnership's ultimate goal is "to improve the outcome of women affected by cervical and breast cancers." Norway provides equal access to health care to all citizens and maintains registries of health histories. As a result, Norway brings an invaluable resource to the collaboration, a national database for some 1.8 million 'unique' Norwegian women's cervical cancer screening results covering 25 years (1991-2015). Aggressive screening programs against cancer, begun in 1995, are a key element of the Norwegian government's cancer control effort. "The cancer registry database is unique because it is not a sample, but includes almost all women in Norway," Abdulla says, noting the data base contains such information as patient identification, birthdate, diagnosis date, test type, stage, lab number, region and censor date. Initial efforts are focused on improving risk assessment and the resulting screening recommendations for individual women, he says. "We're working to personalize screenings by combining pattern recognition, machine learning and time-series statistics to analysis of the data." Access to 10.7 million individual records for 1.8 million patients over 25 years gives researchers the opportunity to test and validate their models against historical data, Abdulla said. The team is developing a flexible, extendable model that incorporates new data such as other biomolecular markers, genetics and lifestyle factors to individualize risk assessment, according to Abdulla. "We want to identify the optimal interval for screening each patient." Reliable assessment would allow women with increased risk of cervical cancer to receive more frequent screenings and those with less to receive fewer, improving health outcomes and making screening programs more cost effective, according to the project abstract. Medical researchers note that increasing the time between screenings for low risk women reduces the harm associated with false positive tests. Other members of the Livermore team are Amy Gryshuk of Physical and Life Sciences and Braden Soper, a computer scientist in Global Security. The partnership also has strong institutional support from Jim Brase, Computation deputy associate director for Science and Technology; David Rakestraw, S Program manager in Global Security; and Jason Paragas, Global Security, the Computation Directorate and Livermore Computing. Lawrence Livermore computing resources being used for the project include: Sierra, the 260-teraflop (trillion floating point operations per second) Dell system; Catalyst, the 150-teraflops first-of-a-kind big data cluster; and the Green Oasis Data Server, which supports large scale data storage and sharing. The collaboration has received international attention, most recently when it was referenced by Vice President Joe Biden in a Sept. 19 speech to the United Nations' Global Good Summit. Abdulla made successive presentations about the partnership, first to the Cancer Registry of Norway in Oslo, Sept. 13, and then the Nordic Life Sciences Days(link is external) conference in Stockholm, Sweden Sept. 14. On his return to the Lab, he presented Sept. 16 to a delegation of Norwegian members of parliament hosted by Bruce Warner, principal associate director for Global Security, at a meeting attended by Director Bill Goldstein. Tthe seeds of the partnership were sown at a 2014 i-GATE(link is external) workshop in Livermore when representatives from the Norwegian government approached Abdulla after hearing a presentation he made on data analysis. Together they wrote a proposal in July 2014. However, they had to address the absence of privacy and security protocols between the two countries for exchanging medical data, Abdulla says. Lab researchers were given access to the data in March of this year and early work shows promise. Currently the partnership's focus is on cervical cancer but the plan is to later include breast cancer as well, he says. "What we're doing is an example of how you start small and grow the collaboration." "The work we're doing now will open the door to other research opportunities," Abdulla says. "I'm passionate about this project. This research is about saving lives."
Syse A.,Cancer Registry of Norway |
Loge J.H.,Cancer Registry of Norway |
Lyngstad T.H.,Cancer Registry of Norway
Journal of Clinical Oncology | Year: 2010
Purpose: Cancer in children may profoundly affect parents' personal relationships in terms of psychological stress and an increased care burden. This could hypothetically elevate divorce rates. Few studies on divorce occurrence exist, so the effect of childhood cancers on parental divorce rates was explored. Patients and Methods: Data on the entire Norwegian married population, age 17 to 69 years, with children age 0 to 20 years in 1974 to 2001 (N = 977,928 couples) were retrieved from the Cancer Registry, the Central Population Register, the Directorate of Taxes, and population censuses. Divorce rates for 4,590 couples who were parenting a child with cancer were compared with those of otherwise similar couples by discrete-time hazard regression models. Results: Cancer in a child was not associated with an increased risk of parental divorce overall. An increased divorce rate was observed with Wilms tumor (odds ratio [OR], 1.52) but not with any of the other common childhood cancers. The child's age at diagnosis, time elapsed from diagnosis, and death from cancer did not influence divorce rates significantly. Increased divorce rates were observed for couples in whom the mothers had an education greater than high school level (OR, 1.16); the risk was particularly high shortly after diagnosis, for CNS cancers and Wilms tumors, for couples with children 0 to 9 years of age at diagnosis, and after a child's death. Conclusion: This large, registry-based study shows that cancer in children is not associated with an increased parental divorce rate, except with Wilms tumors. Couples in whom the wife is highly educated appear to face increased divorce rates after a child's cancer, and this may warrant additional study. © 2009 by American Society of Clinical Oncology.
Enerly E.,Cancer Registry of Norway |
Olofsson C.,Cancer Registry of Norway |
Nygard M.,Cancer Registry of Norway
Clinical Epidemiology | Year: 2013
Human papillomavirus (HPV) is the main cause of cervical cancer, and many countries now offer vaccination against HPV to girls by way of government-funded national immunization programs. Monitoring HPV prevalence in adolescents could offer a near-term biological measure of vaccine impact, and urine sampling may be an attractive large-scale method that could be used for this purpose. Our objective was to provide an overview of the literature on HPV DNA detection in urine samples, with an emphasis on adolescents. We searched the PubMed database using the terms "HPV" and "urine" and identified 21 female and 14 male study populations in which HPV prevalence in urine samples was reported, four of which included only asymptomatic female adolescents. We provide herein an overview of the recruitment setting, age, urine sampling procedure, lesion type, HPV assay, and HPV prevalence in urine samples and other urogenital samples for the studies included in this review. In female study populations, concordance for any HPV type and type-specific concordance in paired urine and cervical samples are provided in addition to sensitivity and specificity. We concluded that few studies on HPV prevalence in urine samples have been performed in asymptomatic female adolescent populations but that urine samples may be a useful alternative to cervical samples to monitor changes in HPV prevalence in females in the post-HPV vaccination era. However, care should be taken when extrapolating HPV findings from urine samples to the cervix. In males, urine samples do not seem to be optimal for monitoring HPV prevalence due to a low human genomic DNA content and HPV DNA detection rate compared to other urogenital sites. In each situation the costs and benefits of HPV DNA detection in urine compared to alternative monitoring options should be carefully considered. © 2013 Enerly et al, publisher and licensee Dove Medical Press Ltd.
Grimsrud T.K.,Cancer Registry of Norway |
Andersen A.,Cancer Registry of Norway
Scandinavian Journal of Work, Environment and Health | Year: 2012
Objectives Nickel compounds, inclusive of water-soluble salts, have been classified as human carcinogens by the International Agency for Research on Cancer (IARC). Nickel producers have disputed the classification of soluble nickel compounds for three decades with reference to an alleged absence of excess respiratory cancer among Canadian nickel-exposed electrolysis workers. We evaluated historical data from two electrolytic refineries in Ontario, both included in prominent Canadian reports on occupational nickel-related cancer. Methods For Port Colborne nickel refinery (PCNR) and Copper Cliff copper refinery (CCCR), we identified process descriptions, exposure estimates, and original reports on cancer mortality using reference lists, libraries, and state archives. The documents were written or published between 1930 and 1992. Results For PCNR, a 1977 US National Institute of Occupational Safety and Health criteria document demonstrated an excess nasal cancer risk among electrolysis workers independent of furnace exposure. PCNR studies published after 1980 excluded 26% of long-term refiners who died from respiratory cancer according to earlier reports, and 42% of the workers had unknown vital status at the end of follow-up, biasing the standardized observed-to-expected mortality ratios downwards, most pronounced in recent reports and for workers without pension or company benefits. CCCR reports did not adequately address soluble nickel exposure in the evaluation of an observed occupational lung cancer excess. Conclusions While acknowledging important contributions to the recognition of nickel carcinogenicity from highly exposed Canadian refiners, we conclude that the claimed absence of nickel-related respiratory cancer among electrolysis workers has resulted from an arbitrary overemphasis of biased and inconclusive findings.