Jon P Fryzek

Aarhus University Hospital, Århus, Central Jutland, Denmark

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Publications (104)422.09 Total impact

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    ABSTRACT: Background: The myelodysplastic sydromes (MDS) are a heterogeneous group of hematopoietic disorders which have poor overall survival. As its incidence in the general population is only 4.6 out of 100,000, there is a paucity of epidemiological studies on the disorders. We combined three data sets from Pennsylvania, Ohio and New York to study determinants of outcome. Methods: De-identified patient and clinical data for 1192 incident cases of MDS from three sites were collected non-concurrently, from 1990-2010. All patients were followed from the date of diagnosis to transformation to Acute Myeloid Leukemia (AML), death, or end of the study period (2010). The median of the population baseline blood parameters was used to create cut offs for analyses for hemoglobin levels, neutrophil count, and platelet count. Clinical cutoff values were also utilized. Descriptive and survival analyses were performed. Results: The study population was 90.5% White, 60.6% male, and ever smokers in 57.8% of cases. Mean age at diagnosis was 68 years. Males were significantly more likely to be ever smokers than females (p<.0001); a significantly higher proportion of non-White patients was observed among males compared with females. Factors significantly associated with survival at multivariate analysis were being female [HR adj: 0.79 (95% CI: 0.66-0.95)], and having a neutrophil count > 1.8 x 109/L, the median value for this sample [HR adj: 0.75 (0.6-0.93)]. Conclusions: Among MDS patients, females and patients with higher neutrophil counts have better survival than males or patients with lower neutrophil counts, respectively, and this may reflect differences in the biology of the disease, or in environmental exposure.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Workers engaged in the production of Portland cement may come into contact with potential occupational hazards, but existing epidemiological studies show wide variation in risk estimates for cancer incidence and mortality in relation to cement exposure. This report identified studies of cement workers and associations with cancer incidence and mortality in a systematic review and meta-analysis. A systematic review according to the PRISMA guidelines was conducted to identify studies of Portland cement workers and cancer outcomes. Meta-analyses were performed using random effects models for all cancers combined and for each cancer site with three or more reported measures of risk. A total of 26 studies were included in the review (14 occupational cohort studies and 12 case-control studies). Overall, the meta-relative risks did not provide convincing evidence for increased risks of any cancers in relation to cement exposure. Meta-SMR and 95% CIs were 0.94 (0.76 to 1.16) for six studies reporting all cancers combined, 0.93 (0.62 to 1.39) for seven studies reporting on lung cancer, 1.07 (0.72 to 1.59) for five studies reporting on stomach cancer, and 1.05 (0.79 to 1.40) for four studies reporting on colorectal cancer. Meta-relative risks for cancer incidence were similarly null for all sites with the exception of colorectal cancer which had a borderline statistically significant elevated risk (SIR=1.38, 95% CI 1.02 to 1.88). Overall, the meta-relative risks calculated across 26 published studies do not provide evidence of increased risks for cancer in relation to cement exposure.
    Occupational and environmental medicine. 08/2014;
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    ABSTRACT: Mastocytosis is a heterogeneous group of diseases characterized by abnormal proliferation of mast cells. Systemic mastocytosis (SM), in which abnormal mast cells are present in tissues beyond the skin, is divided into seven subcategories with varying degrees of severity and prognosis. Very little is known about the epidemiology of SM and its subcategories. This retrospective cohort study of 548 adults with SM diagnosed 1997–2010 was constructed using linked Danish national health registries. The most common subtype of mastocytosis was indolent SM (including urticaria pigmentosa) (n = 450; 82%), followed by SM with subtype unknown (n = 61; 11%), SM with associated clonal haematological non-mast cell lineage disease (n = 24; 4%), aggressive SM (n = 8; 2%), and mast cell leukaemia (n = 5; 1%). The incidence rate for SM (all subtypes including urticaria pigmentosa) was 0·89 per 100 000 per year. Cumulative incidence was 12·46 per 100 000, and the 14-year limited-duration prevalence as of 1 January, 2011 was 9·59 per 100 000. This nationwide cohort from Denmark is the first population-based epidemiological study of mastocytosis. In this cohort of patients aged 15 years and older, SM was found to be overall relatively rare with notable variation by subtype for patient characteristics, survival and epidemiological measures.
    British Journal of Haematology 04/2014; · 4.94 Impact Factor
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    ABSTRACT: ABSTRACT Myelofibrosis (MF), polycythemia vera (PV) and essential thrombocythemia (ET) may lead to bone marrow fibrosis. Because the disease course of ET and PV are long and the disease course of MF may be fatal, HRU associated costs of these neoplasms is especially important to understand. We used a large US health insurance claim database to describe the costs of these diseases. Compared to age-gender matched comparisons without MPN, all aspects of health care resource utilization (HRU) that we examined, including inpatient, outpatient and emergency room visits and pharmacy, as well as overall healthcare expenditures are significantly higher in MF, PV and ET patients (e.g., MF total costs=$54,168 vs. $10,203; PV=$14,903 vs. $7,913; ET=$29,553 vs. $8,026) than matched comparisons. In order to reduce the burden of illness associated with these diseases, continued efforts in the development of more efficacious treatments for these disorders are needed.
    Leukemia & lymphoma 01/2014; · 2.61 Impact Factor
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    ABSTRACT: Primary myelofibrosis (PMF), essential thrombocythemia (ET), and polycythemia vera (PV) are BCR ABL negative myeloproliferative neoplasms (MPN). Published epidemiology data are scarce and multiple sources are needed in order to assess the disease burden. We assembled the most recent information available on the incidence and prevalence of MF, ET and PV by conducting a structured and exhaustive literature review of the published peer-reviewed literature in EMBASE and by reviewing online documentation from disease registries and relevant health registries in European countries. The search was restricted to human studies written in English or French and published between January 1, 2000 and December 6, 2012. Eleven articles identified from EMBASE, three online hematology or oncology registries and two web-based databases or reports were used to summarize epidemiological estimates for MF, PV and ET. The incidence rate of MF ranged from 0.1 per 100,000 per year to 1 per 100,000 per year. Among the various registries, the incidence of PV ranged from 0.4 per 100,000 per year to 2.8 per 100,000 per year while the literature estimated the range of PV incidence to be 0.68 per 100,000 to 2.6 per 100,000 per year. The estimated incidence of ET was between 0.38 per 100,000 per year and 1.7 per 100,000 per year. While a few studies reported on the MPNs' prevalences, it is difficult to compare them as various types of prevalence were calculated (point prevalence versus period prevalence) and standardization was made according to different populations (e.g., the world population, the European population). There is a wide variation in both prevalence and incidence estimates observed across European data sources. Carefully designed studies, with standardized definitions of MPNs and complete ascertainment of patients including both primary and secondary MF, should be conducted so that estimates of the population aimed to receive novel treatments for these neoplasms is better understood in order to assist public health planning and provide valuable information about the burden of illness to policy makers, funding agencies, resource planners, healthcare insurers, and pharmaceutical manufacturers. This article is protected by copyright. All rights reserved.
    European Journal Of Haematology 12/2013; · 2.55 Impact Factor
  • Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 11/2013; 55(11):1378. · 1.88 Impact Factor
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    ABSTRACT: Evaluate whether childhood cancer incidence is associated with counties with hydraulic fracturing (HF). We compared cancer incidence in children in Pennsylvania counties before and after HF drilling began, using standardized incidence ratios (SIRs) and 95% confidence intervals (CIs). The total number of cancers observed was close to expected both before drilling began (SIR = 0.94; 95% CI, 0.90 to 0.99) and after drilling (SIR = 1.02; 95% CI, 0.98 to 1.07) for counties with oil and natural gas wells. Analyses for childhood leukemia were also unremarkable (SIR for leukemia before drilling = 0.97 [95% CI, 0.88 to 1.06]; SIR for leukemia after drilling = 1.01 [95% CI, 0.92 to 1.11]). A slightly elevated SIR was found for central nervous system tumors after drilling (SIR = 1.13; 95% CI, 1.02 to 1.25). This was because of a slight excess in those counties with the fewest number of wells. This study offers comfort concerning health effects of HF on childhood cancers.
    Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 07/2013; 55(7):796-801. · 1.88 Impact Factor
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    ABSTRACT: X-linked hypohidrotic ectodermal dysplasia (XLHED) is characterized by hypohidrosis, sparse hair, and teeth abnormalities. Infants with XLHED have an increased risk of death by hyperpyrexia. XLHED is the most common form of hypohidrotic ectodermal dysplasia (HED); however, no population-based prevalence estimates are available. We aimed to: 1) estimate the prevalence of XLHED in the Danish population per January 1, 2011; 2) identify the most frequent age at time of diagnosis; and 3) quantify the most frequent clinical feature associated with XLHED. MATERIALS AND METHODS: We conducted a nationwide cross-sectional study (1995-2010). We leveraged national medical registries and data from clinical departments to categorize XLHED cases into three groups: 1) Molecularly-confirmed XLHED; 2) Clinically-diagnosed HED (registered with ICD-10 Q82.4); and 3) Possible HED (registered with sufficient clinical features based on a clinical algorithm that we designed). RESULTS: We identified 90 molecularly-confirmed XLHED, 146 clinically-diagnosed HED, and 988 possible HED cases between 1995 and 2010 (total n= 1224). The prevalence was 21.9 per 100,000 overall and 1.6 per 100,000 when restricting to molecularly-confirmed XLHED cases. The most frequent age at time of XLHED diagnosis occurred between the ages of 11-18 years. Teeth abnormalities occurred in 79% of all cases and 52% of molecularly-confirmed cases as a primary clinical marker. CONCLUSION: We present the first ever population-based prevalence estimates of XLHED and suggest that the prevalence of XLHED may be higher than previously estimated. Diagnosis occurs most frequently during adolescence and teeth abnormalities were the most frequent clinical marker of XLHED.
    European journal of medical genetics 02/2013; · 1.57 Impact Factor
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    ABSTRACT: Skeletal-related events (SREs) among women with breast cancer may be associated with considerable use of health-care resources. We characterized inpatient and outpatient hospital visits in a national population-based cohort of Danish women with SREs secondary to breast cancer and bone metastases. We identified first-time breast cancer patients with bone metastases from 2003 through 2009 who had a subsequent SRE (defined as pathologic fracture, spinal cord compression, radiation therapy, or surgery to bone). Hospital visits included the number of inpatient hospitalizations, length of stay, number of hospital outpatient clinic visits, and emergency room visits. The number of hospital visits was assessed for a pre-SRE period (90 days prior to the diagnostic period), a diagnostic period (14 days prior to the SRE), and a post-SRE period (90 days after the SRE). Patients who experienced more than one SRE during the 90-day post-SRE period were defined as having multiple SREs and were followed until 90 days after the last SRE. We identified 569 women with SREs secondary to breast cancer with bone metastases. The majority of women had multiple SREs (73.1%). A total of 20.9% and 33.4% of women with single and multiple SREs died in the post-SRE period, respectively. SREs were associated with a large number of hospital visits in the diagnostic period, irrespective of the number and type of SREs. Women with multiple SREs generally had a higher number of visits compared to those with a single SRE in the post-SRE period, eg, median length of hospitalization was 5 days (interquartile range 0-15) for women with a single SRE and 13 days (interquartile range 4-30) for women with multiple SREs. SREs secondary to breast cancer and bone metastases were associated with substantial use of hospital resources.
    Clinical Epidemiology 01/2013; 5:97-103.
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    ABSTRACT: Immune thrombocytopenia (ITP) is a chronic, immune-mediated disease characterized by a transient or long-lasting decrease in platelet counts. ITP is associated with numerous serious clinical consequences. Discussed here are clinical aspects of ITP, the humanistic and economic burden of ITP, and current treatment options with a focus on romiplostim, a thrombopoietin (TPO) receptor agonist. The aim of this review is to provide decision-makers with the background information necessary to evaluate the value of romiplostim. PubMed was searched for relevant, English-language papers published from January 2006 through November 2011 relating to the epidemiology and treatment options of chronic ITP, and, focusing on the TPO mimetic romiplostim, patient-reported outcomes (PRO) and economic burden. Recent select conference abstracts were also reviewed. The initial clinical management of ITP (e.g., corticosteroids, immunoglobulins) is often associated with adverse events and recommended for short-term use only. Splenectomy, a potentially curative second-line treatment, is associated with increased risks of bleeding and infection, and patients often require additional long-term drug intervention. ITP and its sequelae are associated with a substantial burden on patients' health-related quality-of-life (HRQoL) and increased medical costs. Use of TPO receptor agonists in ITP patients may represent a more efficient use of healthcare resources than existing therapies. While this literature review is not a systematic review, e.g., it considers only approved therapies and published literature written in English, it provides a comprehensive overview of the clinical, humanistic, and economic factors that should be considered in treating ITP, particularly with new agents such as romiplostim. Among the limited number of safe and effective therapies currently available for chronic ITP, highly effective and well-tolerated medications such as romiplostim may reduce the healthcare resource utilization associated with ITP while improving patients' HRQoL.
    Journal of Medical Economics 04/2012; 15(5):956-76.
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    ABSTRACT: The compilation of comprehensive, worldwide epidemiologic data can inform hypotheses on cancer etiology and guide future drug development. These statistics are reported by a multitude of sources using varying methods; thus, compiling a complete database of these statistics is a challenge. To this end, this paper examined the usefulness of a novel, multisource approach-extracting data from the peer-reviewed literature, online reports, and query systems from cancer registries and health agencies and directly contacting cancer registry personnel-for building a comprehensive, multinational epidemiologic cancer database. The major B-cell malignancies were chosen as the cancer subtype to test this approach largely because their epidemiology has not been well characterized in the peer-reviewed literature. We found that a multisource approach yields a more comprehensive epidemiologic database than what would have been possible with the use of literature searches alone. In addition, our paper revealed that cancer registries vary considerably in their methodology, comprehensiveness, and ability to gather information on specific B-cell malignancy subtypes. Collectively, this paper demonstrates the feasibility and value of a multisource approach to gathering epidemiologic data.
    ISRN oncology. 01/2012; 2012:129713.
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    ABSTRACT: Cancer patients may be at increased risk of acute kidney injury, but evidence is limited. We assembled a cohort of incident cancer patients diagnosed within a population-based hospital setting in Northern Denmark (population:~1.2 million) between 1999 and 2006. Patients were followed up to five years for acute kidney injury, identified using creatinine measurements recorded in a laboratory database covering the study area. Acute kidney injury was defined according to recent consensus criteria as a 50% increase in creatinine level. We computed incidence rate, 1-year, and 5-year risks of acute kidney injury, accounting for competing risk from death. Acute kidney injury incidence was compared between cancers using a Cox regression model adjusted for important confounders. Among 37,267 incident cancer patients with a creatinine measurement, 9613 (25.8%) developed acute kidney injury during 77,376 person-years. The incidence was 258 (95%CI: 252-264) per 1000 person-years the first year after cancer diagnosis decreasing to 43 (95%CI: 41-44) thereafter. The 1-year risk was 17.5% (95%CI: 17.1-17.9%), and the 5-year risk was 27.0% (95%CI: 26.5-27.5%). We observed the highest 1-year risk in patients with kidney cancer [44.0% (95%CI: 40.5-47.5)], liver cancer [33.0% (95%CI: 28.2-37.8%)], or multiple myeloma [31.8% (95%CI: 27.3-36.3%)]. Similar results were observed after adjustment for confounders. Both overall and for most specific cancer sites, risks were higher among patients with distant metastases at cancer diagnosis. Acute kidney injury is a common complication in cancer patients, particularly in patients with kidney cancer, liver cancer, or multiple myeloma.
    European Journal of Internal Medicine 08/2011; 22(4):399-406. · 2.30 Impact Factor
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    ABSTRACT: Bone lesions as a consequence of bone metastases in breast cancer patients can increase risk for skeletal-related events (SREs) (i.e., radiation to the bone, a pathological or osteoporotic fracture event, hypercalcemia, spinal cord compression, or surgery to the bone). The mortality risk for breast cancer patients with SREs subsequent to bone metastases is unclear. We assessed this relationship in a large, population-based cohort of breast cancer patients in Denmark. We identified 35,912 newly diagnosed breast cancer patients from January 1, 1999 to December 31, 2007 in the Danish National Patient Registry (DNPR) and followed them through April 1, 2008. Information on stage and treatment was obtained from the Danish Cancer Registry. We used the Kaplan-Meier method to estimate survival, and Cox's regression analysis to estimate the mortality rate ratio (MRR) by the presence of bone metastases with and without SREs, adjusting for age and comorbidity. The 5-year survival was 75.8% for breast cancer patients without bone metastases, 8.3% for patients with bone metastases, and 2.5% for those with both bone metastases and SREs. The adjusted MRR was 10.5 [95% confidence interval (CI) 9.5-11.6] for breast cancer patients with bone metastases, and 14.4 (95% CI 13.1-15.8) for those with bone metastases and SREs, compared with breast cancer patients with no bone metastases but possibly other sites of metastases. A similar pattern persisted when analyses were stratified by stage or treatment. Breast cancer patients with bone metastases and SREs have a poor prognosis compared to those with and without bone metastases regardless of cancer treatment or stage of disease at diagnosis.
    Breast Cancer Research and Treatment 04/2011; 129(2):495-503. · 4.47 Impact Factor
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    ABSTRACT: The side-effects associated with androgen deprivation therapy (ADT) include weight gain, dyslipidemia, and insulin resistance. As cataracts have been linked to these metabolic abnormalities, an increased risk of cataract may be another adverse consequence of ADT use. Using data from the Surveillance, Epidemiology and End Results-Medicare database, we estimated risk of cataract associated with ADT among 65,852 prostate-cancer patients. ADT treatment was defined as at least one dose of a gonadotropin-releasing hormone agonist or orchiectomy within 6 months after prostate cancer diagnosis. The outcome measure was a first claim of cataract diagnosis identified in Medicare claim files. Cox regression was used to estimate hazard ratios (HR) for the effects of ADT treatment, controlling for confounders. Gonadotropin-releasing hormone agonist use was associated with a modest increase in cataract incidence (HR 1.09, 95% confidence interval 1.06-1.12). Orchiectomy was also associated with an increased risk of cataract among men with no history of cataract prior to prostate cancer diagnosis (HR 1.26, 95% confidence interval 1.07-1.47). In the first systematic investigation of the association between ADT and cataract, our results suggest an elevation in the incidence of cataract among ADT users. Further study, preferably prospective in design, is needed to provide additional evidence to support or refute these findings.
    Annals of epidemiology 03/2011; 21(3):156-63. · 2.95 Impact Factor
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    ABSTRACT: The myelodysplastic syndromes (MDS) are a collection of hematologic disorders that affect older adults, and whose baseline characteristics and risk factors for evolution to acute myeloid leukemia (AML) and death have not been completely defined. We analyzed a large unselected cohort of 214 patients with MDS from the University of Pittsburgh Network Cancer Registry in Western Pennsylvania. Patients' follow-up was 22 months, at the end of which 72.9% of patients were dead. Overall, the 36-month survival rate was 19.0% (95% CI: 14.0-24.5%); 22.4% (95% CI: 16.4-29.0%) for patients with lower-risk MDS; and 5.0% (95% CI: 0.1-14.8%) for patients with higher-risk MDS (p = 0.0007). During follow-up, 32.9% of the patients developed AML. Family history of cancer and having  ≥5% blasts at diagnosis were statistically significant predictors for progression to AML. A higher risk of death also was associated with age >70 years and previous diagnosis of another cancer. More than three cycles of chemotherapy sessions and a platelet count of ≥50 × 10(3)/mm(3) were inversely associated with death. This study suggests the need to incorporate laboratory results such as percentage blasts and platelet counts as well as epidemiologic data on family history of cancer in future outcome studies on MDS.
    Leukemia & lymphoma 02/2011; 52(2):265-72. · 2.61 Impact Factor
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    ABSTRACT: We conducted a nationwide cohort study of adult Danish patients with primary chronic immune thrombocytopenia (cITP) to examine selected patient and clinical characteristics as predictors for splenectomy. We analyzed data from the Danish National Patient Registry and patient medical records from 1996 to 2007. Using Cox regression analyses, we calculated incidence rate ratios (IRRs) and associated 95% confidence intervals (CI) for splenectomy. We included 371 adult cITP patients. Of these, 87 patients (23%) underwent a splenectomy during a median of 3.6 years of follow-up. The majority (84%) of cITP patients who underwent splenectomy had splenectomy within the first year after cITP diagnosis. Predictors for splenectomy included age ≤ 75 years (adjusted 1-year IRR = 6.79 (95% CI, 2.10-21.90)) at least one platelet count ≤ 30 × 10(9)/L (i.e., high disease activity; adjusted 1-year IRR = 2.67 (95% CI, 1.37-5.22)) during follow-up and year of cITP diagnosis in early period (1996-2001; adjusted 1 year IRR = 2.37 (95% CI, 1.46-3.85)). Presence of chronic comorbidity was associated with lower rates of splenectomy (adjusted 1 year IRR = 0.58 (95% CI, 0.33-1.05)). Our findings suggest that high disease activity and absence of chronic comorbidity may be associated with higher rates of splenectomy, and that contraindications for splenectomy (i.e., patients' perceived frailty) cause the physicians to use the procedure cautiously.
    Annals of Hematology 02/2011; 90(2):207-12. · 2.87 Impact Factor
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    ABSTRACT: Cancer patients receiving chemotherapy are at increased risk of anemia. We conducted a population-based historical cohort study in newly diagnosed cancer patients with chemotherapy-associated anemia in order to characterize red blood cell transfusion (RBCT) use. This study evaluated cancer patients diagnosed between January 1, 1998 and December 31, 2003 using Danish National Patient Registry data. Patients were receiving chemotherapy and had a hemoglobin level ≤10.9 g/dL during the 4 months following cancer diagnosis. We characterized patterns of RBCT use and inpatient and outpatient hospitalization for transfusion. Adjusted Poisson regression models were used to evaluate the likelihood of RBCT, estimated by relative risk (RR), based on demographic and clinical factors. Women constituted 58% of 1782 patients studied; the median age was 58 years. Two-thirds (67%) had solid tumors; 67% had stage III or IV disease at diagnosis. Overall, 713 (40%) patients received an RBCT within 120 days of cancer diagnosis, of which 94% were administered in the inpatient setting; 84% of these patients required subsequent transfusions. The median (Q1, Q3) pretransfusion hemoglobin level was 9.0 (8.4, 9.8) g/dL. Patients aged <20 years were more likely to receive an RBCT than older patients (RR 1.89; 95% confidence interval [CI] 1.44-2.49). Compared with stage IV disease, those with stage II or III disease had a lower likelihood of RBCT (stage II: RR 0.52, 95% CI: 0.37-0.72; stage III: RR 0.68, 95% CI: 0.55-0.83). Patients diagnosed with breast cancer were less likely to receive an RBCT than patients with hematologic cancers (RR 0.34, 95% CI: 0.21-0.55). In this study, 40% of cancer patients with chemotherapy-associated anemia in Western Denmark received an RBCT, usually in the inpatient setting; of these, most required subsequent transfusions. Younger age increased the likelihood of receiving an RBCT, and earlier stage or breast cancer decreased RBCT likelihood.
    Clinical Epidemiology 01/2011; 3:91-9.
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    ABSTRACT: Breast cancer (BrCa) is the most commonly diagnosed cancer among women in the industrialized world. More than half of women presenting with metastatic BrCa develop bone metastases. Bone metastases increase the risk of skeletal-related events (SREs), defined as pathological fractures, spinal cord compression, bone pain requiring palliative radiotherapy, and orthopaedic surgery. Both bone metastases and SREs are associated with unfavorable prognosis and greatly affect quality of life. Few epidemiological data exist on SREs after primary diagnosis of BrCa and subsequent bone metastasis. We therefore estimated the incidence of bone metastases and SREs in newly-diagnosed BrCa patients in Denmark from 1999 through 2007. We estimated the overall and annual incidence of bone metastases and SREs in newly-diagnosed breast cancer patients in Denmark from January 1, 1999 to December 31, 2007 using the Danish National Patient Registry (DNPR), which covers all Danish hospitals. We estimated the cumulative incidence of bone metastases and SREs and associated 95% confidence intervals (CI) using the Kaplan-Meier method. Of the 35,912 BrCa patients, 178 (0.5%) presented with bone metastases at the time of primary breast cancer diagnosis, and of these, 77 (43.2%) developed an SRE during follow up. A total of 1,272 of 35,690 (3.6%) BrCa patients without bone metastases at diagnosis developed bone metastases during a median follow-up time of 3.4 years. Among these patients, 590 (46.4%) subsequently developed an SRE during a median follow-up time of 0.7 years. Incidence rates of bone metastases were highest the first year after the primary BrCa diagnosis, particularly among patients with advanced BrCa at diagnosis. Similarly, incidence rates of a first SRE was highest the first year after first diagnosis of a bone metastasis. The high incidence of SREs following the first year after first diagnosis of a bone metastasis underscores the need for early BrCa detection and research on effective treatments to delay the onset of SREs.
    BMC Cancer 01/2011; 11:29. · 3.33 Impact Factor
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    ABSTRACT: Myelodysplastic syndromes (MDS) incidence is unclear because of historical lack of population-based registration and possibly because of underdiagnosis. We conducted a study to evaluate completeness of MDS registration in the Seattle-Puget Sound region of the Surveillance, Epidemiology, and End Results (SEER) program-which has reported the highest rates among the SEER registries since mandatory reporting of MDS began in 2001. We identified incident MDS cases of any age that occurred within a nonprofit healthcare system in western Washington State in 2005 or 2006 through the local SEER registry or by relevant diagnostic code followed by medical chart review to classify these patients as unlikely, possible, or definite/probable MDS. We calculated age-standardized incidence rates for all identified MDS cases and for case groups based on identification method, and we summarized medical histories of the MDS patients. MDS incidence in our study population was estimated as 7.0 per 100,000 person-years in 2005-2006 when combining MDS cases identified by SEER and definite/probable cases identified by chart review, which was similar to the rate of 6.9 reported by our local SEER registry. The addition of possible MDS cases identified from chart review increased the rate to 10.2 per 100,000. MDS patients frequently had previous cancer diagnoses (25%) and comorbidities such as high blood pressure and diabetes. Our investigation suggests that although reporting of confirmed MDS diagnoses in our region appears complete, MDS incidence is likely underestimated because of omission of cases who are symptomatic but do not receive definitive diagnoses.
    American Journal of Hematology 10/2010; 85(10):765-70. · 4.00 Impact Factor
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    ABSTRACT: Venous thromboembolism (VTE) frequently complicates cancer. Data on tumour-specific VTE predictors are limited, but may inform strategies to prevent thrombosis. We computed incidence rates (IRs) with 95% confidence intervals (CIs) for VTE hospitalisation in a cohort of cancer patients (n=57,591) and in a comparison general-population cohort (n=287,476) in Denmark. The subjects entered the study in 1997-2005, and the follow-up continued through 2006. Using Cox proportional-hazards regression, we estimated relative risks (RRs) for VTE predictors, while adjusting for comorbidity. Throughout the follow-up, VTE IR was higher among the cancer patients (IR=8.0, 95% CI=7.6-8.5) than the general population (IR=4.7, 95% CI=4.3-5.1), particularly in the first year after cancer diagnosis (IR=15.0, 95% CI=13.8-16.2, vs IR=8.6, 95% CI=7.6-9.9). Incidence rates of VTE were highest in patients with pancreas (IR=40.9, 95% CI=29.5-56.7), brain (IR=17.7, 95% CI=11.3-27.8) or liver (IR=20.4, 95% CI=9.2-45.3) tumours, multiple myeloma (IR=22.6, 95% CI=15.4-33.2) and among patients with advanced-stage cancers (IR=27.7, 95% CI=24.0-32.0) or those who received chemotherapy or no/symptomatic treatment. The adjusted RR (aRR) for VTE was highest among patients with pancreas (aRR=16.3, 95% CI=8.1-32.6) or brain cancer (aRR=19.8 95% CI=7.1-55.2), multiple myeloma (aRR=46.1, 95% CI=13.1-162.0) and among patients receiving chemotherapy, either alone (aRR=18.5, 95% CI=11.9-28.7) or in combination treatments (aRR=16.2, 95% CI=12.0-21.7). Risk of VTE is higher among cancer patients than in the general population. Predictors of VTE include recency of cancer diagnosis, cancer site, stage and the type of cancer-directed treatment.
    British Journal of Cancer 09/2010; 103(7):947-53. · 5.08 Impact Factor

Publication Stats

2k Citations
422.09 Total Impact Points

Institutions

  • 2006–2013
    • Aarhus University Hospital
      • Department of Clinical Epidemiology
      Århus, Central Jutland, Denmark
    • Vanderbilt University
      Nashville, Michigan, United States
  • 2010–2012
    • Amgen
      • Center for Observational Research
      Thousand Oaks, California, United States
  • 2011
    • State University of New York Downstate Medical Center
      Brooklyn, New York, United States
  • 2009
    • University of Pittsburgh
      • Department of Epidemiology
      Pittsburgh, PA, United States
  • 2008
    • Region Hovedstaden
      Hillerød, Capital Region, Denmark
  • 2007
    • Wayne State University
      Detroit, Michigan, United States
  • 2006–2007
    • University of Michigan
      • Department of Environmental Health Sciences
      Ann Arbor, Michigan, United States
  • 2002–2006
    • Karolinska Institutet
      • Institutionen för medicinsk epidemiologi och biostatistik
      Solna, Stockholm, Sweden
  • 2001–2006
    • Danish Cancer Society
      København, Capital Region, Denmark
  • 2000–2006
    • Epidemiology International, Inc.
      Maryland, United States
  • 1997–1998
    • University of Nebraska Medical Center
      Omaha, Nebraska, United States