Cancer Registry Of Norway Research Articles

Disability pension among patients with breast cancer: A Norwegian population-based controlled study.

9039 Background: Cancer is sometimes followed by permanently reduced work ability, which in Norway qualifies for disability pension when the reduction is permanently 50% or more. The aim of this study is to examine various aspects about the 13-year risk of receiving disability pension in women with breast cancer compared to that of matched cancer-free controls. Methods: Cases included 1,555 breast cancer patients registered in the Cancer Registry of Norway, diagnosed 1992-96 and aged 45 to 54 years. For each case a randomly sampled age matched control was identified. All women were followed until they received disability pension or were censored due to retirement (67 years), death or 13 year censoring. Hazard ratios for disability pension were estimated using the Cox proportional hazard model, after adjustment for socio-demographic variables at diagnosis. Results: During the observation period 42.4% of cases and 25.8% of controls got disability pension. Compared to controls, adjusted hazard rate for having disability pension was 2.4 times higher for cases (95%CI 2.1–2.7). Low income, low education, older age, being not married, having no children <18 years and living in rural areas at diagnosis were associated with increased hazard rates of disability pension. Compared to stage I cases, hazard ratios for disability pension were 1.3 (95%CI 1.1-1.5), 1.8 (95%CI 1.1-2.9) and 2.9 (95%CI 2.0-4.3) for stage II, III and IV cases, respectively. Cases receiving disability pension shortly after diagnosis (<3 years) had more advanced cancer, compared to cases receiving later disability pension (>3 years) (p<0.001). Among stage I cases 24% had disability pension within 3 years after diagnosis, compared to 40% for stage II and III, and 66% for stage IV cases. Disability pension was provided at a shorter time from diagnosis in patients with lower versus higher educational level (p<0.002). Conclusions: Survivors of breast cancer are at significantly increased and persistent risk of getting disability pension compared to matched controls. The risk increases with more advanced cancer. Time from diagnosis to disability pension is shorter among survivors with low income, low education and more advanced cancer.

Nationwide mammography screening registers: the best way to go for mortality evaluation – but there is no free lunch

R Ljung et al. focus on an important issue in a letter to the Editor in this issue of Acta Radiologica (1). Access to screening data and data quality represent a great challenge in many western European countries having a nationwide mammography screening program. Sweden has been a pioneer country in mammography screening. The Swedish randomized controlled trials started in the late 1970s, but screening was not nationwide until about 20 years later. Although Sweden has one of the oldest Cancer Registries (established in 1958), a national health data register and some regional databases of high quality as well as a personal identity number which makes linking from several databases possible: the lack of a centralized screening register has made a national mortality evaluation of screening mammography extremely difficult (1). The Norwegian Breast Cancer Screening Program (NBCSP) started as a pilot project in 1995–1996 and became nationwide in 2005. The program is managed by the Cancer Registry of Norway which was established in 1951. Since 1953 all cancers diagnosed in Norway must, by law, be reported to the Registry. Due to an 11-digit personal identification number given to all inhabitants, screening information for all women invited to the program can be linked to the national cancer database and the cause of death registry. Publications have shown that a nationwide evaluation is possible (2). The latest development in Norway has shown that a centralized well-working nationwide screening register is no guarantee for ongoing evaluation. After running the NBCSP for more than 10 years, the mere participation in the program was considered inadequate by the lawyers of the Norwegian Data Inspectorate and the implementation of informed consent was mandatory. The Inspectorate decided in March 2008 that all data on normal findings in the NBCSP without informed consent had to be deleted by the end of 2011. An appeal against this decision was rejected, and the consequence would be that all future scientific evaluations of theNBCSP from its early beginningwould be impossible.At the time ofwriting, theNorwegianMinistry of Health and Care Services is working on an amendment of the Cancer Registry regulation, and hopefully this will save the screening data. The Advisory Board of the NBCSP has for some years strongly recommended an update of the screening database for including the BI-RADS lexicon and the rating scales recommended by the European Guidelines. The Nordic countries have been reluctant to incorporate the BI-RADS lexicon into their practice, but standardized international descriptors and indicators are of utmost importance for comparison of screening programs. During the first years of the NBCSP the Cancer Registry of Norway was responsible for the quality assurance as well as financial aspects. Due to reorganization of the healthcare system in Norway some few years ago, the Regional Health Enterprise has the financial control of the NBCSP, and an update of the screening database is obviously more difficult than when one institution has the responsibility for all the screening activity. The Editor agrees with the authors (1) that the recent publication in the New England Journal of Medicine by M Kalager et al. (3) suffers from serious limitations and does not provide a thorough and complete evaluation of the screening program. The conclusion of this study is in contrast with results recently published on case-control evaluations of European mammography service screening programs (4). The publicity the article in N Engl J Med has been given internationally shows how important an ‘official’ mortality evaluation of the NBCSP would be. Such evaluations were scheduled for 2009 but were stopped due to the decision by the Norwegian Data Inspectorate. The problem in Sweden addressed by Ljung et al. (1) and the problems arising in Norway demonstrates a common challenge to the Nordic countries: implementation of screening and the establishment of screening databases does not represent a guarantee for proper evaluation. Continuous collaboration between healthcare providers (authorities) and screening institutions is mandatory in order to solve the challenges regarding quality assurance, updating databases, access to data for scientific purposes, and consequently the ability to present valid mortality evaluations of organized mammography screening.

Survival effect of implementing national treatment strategies for curatively resected colonic and rectal cancer

The surgical management of rectal cancer has changed substantially over the past decade. There are limited data on the long-term outcome of implementing systematic management strategies. Survival of a national cohort of patients treated surgically for colonic and rectal cancer over a 10-year interval was analysed. All 31 158 patients in Norway diagnosed with adenocarcinoma of the colon and rectum between 1994 and 2003 were identified from the Cancer Registry of Norway and the Norwegian Rectal Cancer Registry. Changes in 5-year relative survival were compared by age, stage and tumour location during the early and late years. The study population included 19 053 patients who had a curative resection. The relative 5-year survival rate significantly improved for both colonic cancer (73·8 versus 78·0 per cent; P < 0·001) and rectal cancer (72·1 versus 79·6 per cent; P < 0·001). The 5-year relative survival was significantly better for rectal than colonic cancer during the late period (P = 0·030). Improved 5-year relative survival was related to better outcomes in patients with positive lymph nodes (67·2 and 62·1 per cent for rectal and colonic cancer respectively; each P < 0·001 versus early period), but not for the subgroup aged over 75 years with lymph node-positive colonic cancer. In this national cohort, survival after curative surgery for colorectal cancer increased significantly after implementation of national management strategies. Improvements were most evident for rectal cancer and in lymph node-positive disease; they were less substantial for colonic cancer and elderly patients (over 75 years). Strategic treatment changes may be warranted for the latter group.

Health consumption in Sami-speaking municipalities with regard to cancer and radiotherapy

Objectives. The objective of this study was to document that the Sami people, constituting an ethnic minority in northern Norway, experience an equally available specialist health care service as the one offered to Norwegians in general. We aimed to use cancer and radiotherapy treatment as the instrument to clarify the situation.Study design. A retrospective registry-based study.Methods. The 8 municipalities included in the administration area of the Sami language law were matched with a control group of 11 municipalities. Population data (numbers, sex and age) were accessed from Statistics Norway. Data on cancer incidence, prevalence and survival during the 10-year time period 1999–2008 were derived from the Cancer Registry of Norway (CRN). Five years overall survival was calculated for patients diagnosed in the time period 1999–2003. Furthermore, data on radiotherapy (RT) and treatment intention were recorded for the time period 1999–2008.Results. The Sami-speaking municipalities had a significantly lower incidence of cancer. Breast (RR 0.82 [95% CI 0.76–0.89]) and lung cancer (females RR 0.55 [95% CI 0.52–0.58], males RR 0.64 [95% CI 0.60–0.68]) were significantly less frequent. The Sami group had experienced a significant increase (Sami 54.5% [95% CI 49.2–61.7], controls 24.1% [95% CI 21.7–26.5]) in the prevalence of cancer during the last 10 years. Five years overall survival was similar among both the Sami and control groups. In both groups, 28% of cancer patients underwent radiotherapy.Conclusions. The Sami in northern Norway had a lower risk of cancer but experienced the same use of radiotherapy in their cancer treatment as Norwegians in general.

Morbidity, life style and psychosocial situation in cancer survivors aged 60-69 years: results from The Nord-Trøndelag Health Study (The HUNT-II Study)

BackgroundDue to considerable health status differences in the elderly population, research limited to narrow age-spans might be an advantage. In this population-based controlled study we compare short-term (<5 years) (STS) and long-term (≥5 years) (LTS) cancer survivors and cancer-free controls aged 60-69 years from two Norwegian health registers; the Health Survey of North-Trøndelag County (HUNT-2 study) and the Cancer Registry of Norway (CRN). We examined possible factors associated with being cancer survivor.MethodsAmong 9,089 individuals aged 60-69 who participated in HUNT-2, 334 had been diagnosed with invasive primary cancer from 1 month to 42 years before HUNT-2 according to CRN and self-report. An overall random sample of controls without cancer five times larger than the sample of cases (N = 1,670) were drawn from the parent cohort.ResultsThe cancer sample comprised 128 STS and 206 LTS. For most variables no significant differences were observed between LTS and STS. LTS were significantly more women, and cases with gynaecological cancer, with physical impairment and more thyroid diseases compared to STS. When comparing all the survivors with controls, the survivors showed significantly higher rate of pensioning, decreased self-rated health, more physical impairment and thyroid diseases, daily use of medication and psychotropics and higher level of anxiety and Framingham Risk score. Multivariate logistic regression analysis showed that increasing age, being female, physical impairment and thyroid diseases all were significantly associated with being survivor versus controls.ConclusionSTS and LTS showed mostly similar situation. Compared to controls, the survivors reported somewhat poorer physical and mental health, but these differences were of doubtful clinical significance.

Cancer patients’ needs for rehabilitation services

Purpose. To examine cancer patients’ needs for rehabilitation services and factors associated with such needs, and secondly identify unmet needs for rehabilitation services and related factors. Material and methods. In 2008 persons aged 25–60 years, diagnosed in 2005/2006 with the ten most prevalent cancers in Norway were identified through the Cancer Registry of Norway. These patients were contacted by their treating hospital receiving a mailed questionnaire. Main outcomes for the present study were measured by two questions assessing a) needs for rehabilitation services and b) rehabilitation services offered/used. For each question seven services were listed; physical therapy, physical training, psychological counseling, consultations with social worker, occupational therapy, supportive group sessions and admittance to a convalescent home. The respondents then rated to what extent they had experienced needs and if they had been offered and used each service. Those who reported need for a service that not had been offered were defined as having unmet need. Associations between demographic, health-related and outcome variables were analyzed by multivariate logistic and linear regression analyses. Results. Among the 1 325 respondents, the mean age was 52 years and 70% were women. Sixty-three percent reported need for at least one rehabilitation service. Need for physical therapy was most frequently reported (43%), followed by physical training (34%), psychological counseling (27%), supportive group sessions (24%), admittance to a convalescent home (24%), consultation with social worker (19%) and occupational therapy (6%). Changes in employment status and ongoing or previous chemotherapy were associated with reporting needs for all rehabilitation services. Forty percent reported unmet needs, which most frequently was reported among persons living alone, who had changed their employment status, receiving or had received chemotherapy or reported comorbidities. Conclusions. The majority reported need for at least one rehabilitation service, and 40% reported unmet needs. Prospective studies are recommended in order to better understand needs for rehabilitation services, such as needs in relation to time since treatment, extent of disease and treatment intensity.

Template reporting matters—a nationwide study on histopathology reporting on colorectal carcinoma resections

Complete and accurate histopathology reports are fundamental in providing quality cancer care. The Cancer Registry of Norway and the Norwegian Society of Pathology have previously developed a national electronic template for histopathology reporting on colorectal carcinoma resection specimens. The present study was undertaken to investigate (1) whether quality routines in Norwegian pathology laboratories might affect completeness of such histopathology reports and (2) whether the national electronic template improves completeness of histopathology reports compared with other modes of reporting. A questionnaire on quality routines was sent to the 21 pathology laboratories in Norway. All histopathology reports on colorectal cancer submitted to the Cancer Registry for a 3-month period in the autumn of 2007 were then evaluated on the mode of reporting and the presence of 11 key parameters. Of the 20 laboratories that handled resection specimens, 16 had written guidelines on histopathology reporting. Of these, 4 used the national electronic template, 5 used checklists, 3 used locally developed electronic templates, whereas the remaining 4 had neither obligatory checklists nor templates. Of the 650 histopathology reports submitted to the Cancer Registry in the 3-month period, the national template had been used in 170 cases (26.2%), checklists/locally developed templates in 112 cases (17.2%), and free text in 368 cases (56.6%). Quality routines in the pathology laboratories clearly governed reporting practice and the completeness of the histopathology reports. Use of the national electronic template significantly improved (P < .05) the presence of the 11 key parameters compared with reporting by checklists, locally developed electronic templates, or free text.

Effect of Screening Mammography on Breast-Cancer Mortality in Norway

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. 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. 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. 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.)

C-reactive protein; a potential marker of second cancer and cardiovascular disease in testicular cancer survivors?

Introduction C-reactive protein (CRP) is a marker of cardiovascular disease (CVD). There is conflicting evidence regarding CRP as a marker of future cancer. We studied whether CRP predicts CVD and consecutive cancer in testicular cancer survivors (TCSs). Patients and methods During 1998–2001, 586 TCSs with a high sensitivity CRP ⩽10 mg/L were identified median 11 (4–21) years after treatment (FU-1). A second follow-up survey (FU-2) was conducted median 8 (6–9) years after FU-1. At FU-2 we obtained information about post-FU-1 CVD (cardiovascular death, nonfatal myocardial infarction, stroke, revascularisation or heart failure). Information about post-FU-1 non-germ cell cancer and cardiovascular death in all patients were retrieved from the Cancer Registry of Norway. Results After FU-1 31 (5.3%) of 586 patients developed non-germ cell cancer (excluding localised prostate cancer), while 28 (4.9%) developed CVD. Cox regression analyses showed that patients with CRP ⩾1.5 mg/L had 2.21 (95% CI 1.04–4.70) times higher risk of developing non-germ cell cancer and 2.79 (95% CI 1.22–6.34) times higher risk for CVD compared to patients with CRP <1.5 mg/L at FU-1. Conclusion In long-term TCSs, CRP may serve as a potential marker of cardiovascular events and a second cancer.

Strength and weakness of the new TNM classification for lung cancer

The article by Strand et al. 1 on the evaluation of the new tumour, node, metastasis (TNM) classification and staging system for lung cancer raises important questions on the validity of the classification and its therapeutic implications in clinical practice. The authors analysed a population-based series of 1,885 patients who underwent operation for lung cancer and who were registered at the Cancer Registry of Norway from 2001 to 2005. They pathologically classified these tumours according to the 6th 2 and 7th 3 editions of the TNM classification to assess their prognostic capacity, and found that the 7th edition did not improve the overall predictive ability of the staging system. Moreover, based on the current indications of therapy, nearly one-fifth of the patients could be offered different treatment options because of the rearrangement of some TNM subsets in different stages. Whether this different treatment will result in an improved prognosis is unknown. Regarding the prognostic capacity of the 7th edition of the TNM classification, the authors' results contradict those of the International Association for the Study of Lung Cancer (IASLC), whose database of >100,000 patients collected worldwide was used to revise the 6th edition of the classification 4, and those of others whose patient series have validated most of the changes introduced in the 7th edition. Soon after the publication of the recommended changes for the new edition, independent groups validated them based on their own data or on data from registries. Zell et al. 5 and Ou and Zell 6, 7 found that the proposed changes better reflected survival for advanced bronchioloalveolar carcinoma and for small cell lung cancer, and validated the revisions of the T4 and M descriptors, respectively. …

Trends in incidence of ductal carcinoma in situ: The effect of a population-based screening programme

Background The incidence of ductal carcinoma in situ (DCIS) has increased substantially in the western world in recent decades. The aim of this study was to investigate the incidence according to grade distribution, age, and implementation of a population-based screening programme. Methods Cases of primary pure DCIS ( n = 3167) were obtained from the Cancer Registry of Norway. Poisson regression was used to estimate trends in incidence. Results Age-adjusted incidence of DCIS increased from 4 to 11 per 100 000 women-years from 1993 to 2007, in parallel with the implementation of screening. Higher incidence was observed among prevalent (IRR 3.3) and subsequent (IRR 2.8) invited women compared with those not invited. The proportion of DCIS among breast malignancies increased throughout the period, most markedly in the age range of screening. Conclusion The increased proportion of DCIS during the study period is probably due to improved diagnostics resulting from the implementation of population-based screening.

Risk of metachronous contralateral testicular germ cell tumor (met-TGCT) among 7,248 Norwegian patients (1953-2007).

1579 Background: The aims were to identify the overall incidence and risk of developing a met-TGCT, and compare the risk between patients treated before and after 1980 (cisplatinum-based chemotherapy became available for newly diagnosed TGCT patients in Norway). Our hypothesis was that the risk of TCGT would be reduced for patients diagnosed after 1980, at least for subgroups of patients, due to a protective effect of cisplatinum. Methods: The study included 7,248 men with unilateral TGCT (seminoma: 3,999, nonseminoma: 3,249) recorded in the Cancer Registry of Norway. Allowing for competing risk, 10- and 20-year cumulative incidence (cum. inc.) and adjusted hazard ratios (HR) were estimated for different subgroups, and the diagnostic periods 1953-1979 (I) and 1980-2007 (II). After 1980, 20-25% of all men (1987) with initially localized TGCT, and nearly all men (570) with metastatic TGCT, received cisplatinum. Results: 175 men were diagnosed with met-TGCT. Period I: 38 met-TGCT, 10- and 20-year cumulative incidence 1.3% (0.9-1.9) and 1.9% (1.4-2.6). Period II: 137 met-TGCT, 10- and 20-year cumulative incidence 2.7% (2.2-3.2) and 3.9% (3.3-4.7). Conclusions: Comparing the two periods, there has been a two-fold increase in the incidence of unilateral TGCT, and the cumulative incidence of met-TGCT has doubled. Increasing age reduced the risk in both periods, but more so in period I. In period II, the risk of met-TGCT was halved for patients with metastatic disease compared to patients with localized disease, whereas the protective effect of extent of disease lacked significance for period I. These findings support our hypothesis that cisplatinum reduced the risk of TGCT for patients diagnosed after 1980, at least for those with metastatic TGCT. First TGCC: 1953-1979 1980-2007 10-year cum.inc. Comp.risk reg. 10-year cum.inc. Comp.risk reg. % 95%CI HR 95%CI % 95%CI HR 95%CI Age < 30 years 2.7 1.6-4.2 Ref 3.7 2.8-4.7 Ref ≥30 years 0.7 0.4-1.3 0.2 0.1-0.4 2.0 1.5-2.6 0.5 0.3-0.7 Histology Seminoma 1.2 0.7-2.0 Ref 1.5 0.8-2.6 Ref Nonseminoma 2.8 2.2-3.6 0.8 0.4-1.8 2.5 1.9-3.3 0.9 0.6-1.2 Extent of disease Localized 1.3 0.8-2.1 Ref 3.2 2.6-4.0 Ref Metastatic 1.4 0.7-2.6 0.7 0.3-1.4 1.6 1.0-2.4 0.5 0.3-0.8 No significant financial relationships to disclose.

Potentially Curative Radiotherapy for Non–Small-Cell Lung Cancer in Norway: A Population-Based Study of Survival

The efficacy of curative irradiation in the treatment of non-small-cell lung cancer patients is considered limited. The purpose of this study was to evaluate long-term survival in a population-based approach. Cases of non-small-cell lung cancer diagnosed from 1993 to 2001 were identified in the Cancer Registry of Norway. Electronic linkage with national data from the hospitals' radiotherapy verification systems identified those who received potentially curative doses (≥ 50 Gy). Hospital records were reviewed for all patients. A total of 497 patients (336 men) were identified with a radiation dose of ≥ 50 Gy delivered to the lung region. Of these, 41% received 60 Gy or more. The majority (70%) of patients included had advanced stage disease: 24% Stage IIIA and 46% Stage IIIB. The overall 1-, 3-, and 5-year observed survival rates were 53%, 16%, and 9%, respectively. Multivariable analyses identified stage and chemotherapy, but not radiation dose, as significant independent prognostic variables for survival. However, 68% of patients treated with chemotherapy participated in prospective studies with inclusion criteria that excluded patients with less favorable prognostic factors, leading to a selection bias. The number of fractions and the radiation doses varied widely among different hospitals. The long-term prognosis after radiation therapy is poor. More sophisticated, targeted, and uniform delivery of radiation therapy is needed. The apparent benefit of chemotherapy may in part be due to selection of patients with more favorable prognostic factors for this therapy.

Activity of daily living problems in older cancer survivors: a population-based controlled study

The ability to perform activities of daily living (ADL) is a crucial factor for independent functioning and living at home. This population-based cross-sectional study examines ADL problems in older cancer survivors compared with an age-matched cancer-free control group. According to both The Cancer Registry of Norway and self-report, 911 individuals > or =70 years had invasive cancer among the participants of The Health Study of Nord-Trøndelag County (HUNT-2) 1995-7. Three age- and gender-matched cancer-free controls for each cancer survivor were drawn from HUNT-2 (N = 2733). Personal- and Instrumental-ADL (P-ADL and I-ADL) problems were self-rated. P-ADL problems addressed activities such as personal hygiene, dressing and eating, while I-ADL problems concerned household activities, managing finances, shopping and administration of medication. Associations among relevant independent variables and P- and I-ADL problems were examined with both descriptive and multivariate statistics. P-ADL problems were present in 10% of the cancer survivors and 8% of the controls (P = 0.02). Correspondingly, 38% of the cancer survivors had I-ADL problems versus 32% of the controls (P < 0.001). Older cancer survivors with co-morbidity showed significantly higher rates of P-ADL and I-ADL problems compared with controls with co-morbidity (14% versus 9%, P = 0.01, and 47% versus 39%, P = 0.02). Cancer survivors with co-morbidity had significantly more P-ADL and I-ADL problems than survivors without co-morbidity (14% versus 8%, P = 0.01 and 47% versus 32%, P < 0.001). This study showed higher incidence of ADL problems among a population of older cancer survivors compared with cancer-free controls. Somatic co-morbidity further increased the prevalence of both P- and I-ADL problems in the cancer survivors. Primary healthcare providers should pay attention to and assess ADL problems in older cancer survivors.

Abstract 877: Impact of histology and gender on lung cancer survival: a population based study

Abstract Purpose: The magnitude of the lung cancer epidemic combined with a change in proportion of gender and histological subtypes underscore the need to identify survival trends with a focus on underlying gender and histology variations as to better target prevention, screening, research and treatment efforts. Materials and Methods: We present complete national data on 40,118 lung cancer cases prospectively collected in The Cancer Registry of Norway the last 20 years (1988-2007). One and 5-year overall relative survival rates (RSR) were computed with 95% confidence intervals (CI) for each of the four successive 5-year periods of diagnosis stratified by gender, histological subgroups, age and stage. Results: A significant increase in overall 5-year RSR from the first to last 5-year period was observed for both men and women, in women from 10.1% (95% CI: 8.8% − 11.4%) to 15.4% (95% CI: 14% − 16.9%), and in men from 7.9% (95% CI: 7.1% − 8.7%) to 11.6% (95% CI: 10.5% − 12.8%). Five-year RSR were significantly higher for women than for men in all periods. Also 1-year RSR increased significantly, in women from 30.6% (95% CI: 28.7% − 32.5%) in 1988-1992 to 40.9% (95% CI: 39.5% − 42.4) in 2003-2007. In men, the corresponding rates were 28.2% (95% CI: 27%-29.4%) and 35.3% (95% CI: 34.2%-36.5%), respectively. Five-year RSR were lowest in patients diagnosed with small cell carcinoma, with no significant survival improvement over time in either gender, whereas in adenocarcinoma in women, and squamous cell carcinomas in both genders long-term relative survival rates improved significantly. Women diagnosed with adenocarcinoma had significantly higher 5-year RSR compared to men the three last 5-year periods studied. This gender difference was not significant in other histological subtypes. In both men and women, increasing age was associated with decreasing 1- and 5-year RSR. In women, a significant improvement in 5-year RSR was observed in all age groups from 50-79 years over the 20-year period. Women with localized disease at time of diagnosis had significantly better 5-year relative survival compared to men with localized disease throughout the period studied. In 2003-2007, 5-year RSR for localized disease were 51.8% (95% CI: 46.5%-56.8%) in women and 40.9% (95% CI: 36.1%-45.9%) in men. Conclusion: These complete national data highlight important prognostic characteristics of the lung cancer epidemic in Norway that presumably can be extrapolated to most developed countries. Improvements in short-term survival rates and modest but statistically significant improvements in long-term survival rates are encouraging; however long-time survival still remains poor. The apparent gender differences in survival should be a focus of further research. Note: This abstract was not presented at the AACR 101st Annual Meeting 2010 because the presenter was unable to attend. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 877.

Extrathymic malignancies in thymoma patients with and without myasthenia gravis

Objective The influence of myasthenia gravis (MG) on risk of cancer is uncertain. Using nationwide, comprehensive data, we investigated the association between MG and occurrence of extrathymic malignancies in thymoma patients, and also assessed the risk of consecutive extrathymic malignancies after thymoma diagnosis. Methods Two hundred twelve thymoma patients were identified at the Cancer Registry of Norway between 1969 and 2005. Records on all extrathymic malignancies for these patients were supplied from the Registry's database. Comparisons were made between MG and non-MG patients and between thymoma patients and the general population. Results The frequency of extrathymic malignancies was similar in MG and non-MG thymoma patients, and so was the survival after thymoma diagnosis. Extrathymic malignancies occurred in 10% of thymoma patients within 10 years following the thymoma diagnosis. Thymoma patients had a significantly increased risk of developing an extrathymic malignancy compared to the general population. This was not linked to any specific kind of cancer. Thymoma morphology was not a significant predictor for an increased risk of consecutive cancer. Conclusions The immunological process underlying MG does not influence the risk of cancer in thymoma patients. Thymoma patients have a significantly increased risk of extrathymic malignancies. This is an intrinsic effect, being unaffected by a coexisting autoimmune disease such as MG and not specific for any type of cancer. Screening for extrathymic malignancies in thymoma patients is probably not recommendable, but clinicians should be aware of the high rate of extrathymic malignancies occurring in thymoma patients.

Blood pressure and risk of prostate cancer: cohort Norway (CONOR)

Some studies suggest that raised blood pressure may increase prostate cancer risk. We investigated associations of blood pressure with prostate cancer within the CONOR collaborative cohorts of Norway. Between 1994 and 2003, 82,098 men from ten population-based cohorts in Norway completed standardised questionnaires and physical examinations, including resting blood pressure. The unique 11-digit identification number of Norwegian citizens allowed linkage with the Cancer Registry of Norway. A total of 78,768 (96%) men who were cancer-free at baseline and average age of 50.3 years (standard deviation, SD: 15.2) were followed up for a mean of 9.15 years. 11.4% of these men used antihypertensive drugs at baseline. During follow-up (1994-2006), 1,974 incident prostate cancers were diagnosed. We found a 4% (95% confidence interval, CI = 0-9%) increased risk of prostate cancer per one SD (18.3 mmHg) increase in systolic blood pressure and similar findings for diastolic blood pressure (hazard ratio, HR: 1.05 per SD; 95% CI = 1.01-1.10). The association was stronger for advanced (HR: 1.16 per SD increase in systolic blood pressure; 95% CI = 1.05-1.27) compared with localised (1.01; 0.95-1.08) prostate cancer (p for heterogeneity in hazard ratios = 0.02). Raised blood pressure was associated with an increased risk of prostate cancer, particularly advanced cancers at diagnosis. Understanding the mechanisms underlying these findings may provide biological insights into prostate carcinogenesis. Even if the association was causal, our data suggest that raised blood pressure would account for only 3% of prostate cancers, so the public health impact of this association may be limited.

Kartlegging av kreftrisiko og årsakspesifikk dødelighet blant ansatte i norsk offshorevirksomhet

ENGLISH SUMMARYStrand LÅ. Cancer risk and cause-specific mortality among workers in the Norwegian offshoreoil industry. Nor J Epidemiol 2001; 11 (2): 137-142.The Cancer Registry of Norway has, in collaboration with the Norwegian oil industry association, started aproject investigating cancer risk and cause-specific mortality among workers in the Norwegian offshore oilindustry. The project started in 1996 by identifying the 61,300 present and former workers on the platformson the Norwegian continental shelf. The main contributors to the crew lists were oil companies, contractingcompanies, labour unions, safety training schools, and the national archives of Norway. In 1998 a selfadministeredquestionnaire was distributed by mail to the 57,000 workers alive and living in Norway. Thequestionnaire included questions on offshore job history, other occupations, leisure activities, and life-stylefactors such as smoking, alcohol consumption and nutrition.The study design of the project is a prospective cohort study, where cancer incidence and mortalityamong the exposed (the offshore workers) will be compared with the non-exposed (the general population).Factors known to cause cancer and other diseases in other industries are probably present in the offshorework environment. The offshore workers may also be exposed to harmful agents more or less specific forthe work on the platforms, such as crude oil, gas, and drilling mud. Intense work periods and long leaveperiods, a diet rich in fat and calories, cheap tobacco, a ban on alcohol consumption on the platform, andworry about helicopter flights and platform safety are also factors that may influence the workers' health.The overall response rate was 62%. The collected material will constitute a basis for research in thecoming decades. With regular intervals the cohort will be linked to the cancer database in the CancerRegistry and the Cause of Death Registry at Statistics Norway.Because they are a highly selected group, the offshore workers as a whole will probably be as healthy asthe general population, yet excesses in cancer incidence and certain causes of death among the most exposedworkers (i.e., maintenance workers, drilling personnel, welders, painters and cleaners) are expected.

Screening for prostatakreft i Norge

ENGLISH SUMMARYFosså SD, Høisæter PÅ. Screening for prostate cancer in Norway. Nor J Epidemiol 2001; 11 (2): 147-152.Background Results Conclusion . Population-based PSA screening can not be recommended in Norway. PSA-based opportunisticscreening should be substantially reduced. If an asymptomatic man persistently requires PSAtesting, the responsible doctor has to inform him about the potential disadvantages as well as the potentialbenefits associated with opportunistic screening, diagnosis and treatment of prostate cancer. PSAscreeningshould be considered as a public health care strategy, depending on the results of the ERPCS.. The rate of opportunistic screening in Norway in elderly men was about 7% in 1999 but isincreasing, with significant differences between the counties. The current health care strategy is to limitopportunistic screening to a minimum, as the effectiveness of this task is unproven. Reduction of mortalitycan only be achieved by the early diagnosis and treatment of “clinically important” prostatecancer. The identification of these cases remains problematic in clinical routine. Data from the CancerRegistry of Norway, and knowledge about prostate cancer tumour biology and epidemiology leavedoubt whether the aim of the ERPCS can be reached in 2008: The Norwegian Urological Cancer Grouphas therefore not recommended Norway's participation in the ERPCS.. PSA-based opportunistic screening for prostate cancer is increasing throughout theworld, and also in Norway. The mortality reducing effectiveness of population-based PSA screeninghas, however, so far not been proven and it is currently addressed by a European randomised trial(ERPCS). This trial aims to demonstrate a 20% reduction of the prostate cancer-related mortality rate inthe year 2008 in men who have had regular PSA analysis and, if possible, curatively intended treatmentof a newly diagnosed prostate cancer.

Fractal analysis of time series in epidemiology: Is there information hidden in the noise?

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