Anna L V Johansson

Karolinska Institutet, Solna, Stockholm, Sweden

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Publications (51)344.31 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Malignant melanoma (MM) is one of the most common malignancies in young women. It remains debated whether a MM diagnosed during pregnancy or lactation has a worse prognosis. We sought to examine mortality in women with pregnancy-associated MM (PAMM) (diagnosed during pregnancy and up to 2-years postpartum). This was a population-based cohort study based on information retrieved from the Swedish Cancer and Multi-Generation Registers. Hazard ratios with 95% confidence intervals adjusted for age, period, education, parity, and tumor location were estimated. In total, 6857 women and girls aged 15 to 44 years with a diagnosis of cutaneous MM between 1963 and 2009 were identified. Of these, 1019 cases were classified as PAMM. The cause-specific mortality did not differ between PAMM and MM not diagnosed near childbirth (adjusted hazard ratio 1.09, 95% confidence interval 0.83-1.42). Information on stage at diagnosis was available only for a subset of patients Overall, the cause-specific mortality in women and girls with PAMM did not differ from that in women and girls with non-PAMM. The current findings do not provide evidence of an adverse prognostic influence of pregnancy or a recent birth. Copyright © 2014 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.
    Journal of the American Academy of Dermatology 10/2014; · 4.91 Impact Factor
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    ABSTRACT: Quantitative knowledge of the long-term human papillomavirus (HPV) type-specific risks for high-grade cervical intraepithelial neoplasias (CIN2 and CIN3) is useful for estimating the effect of elimination of specific HPV types and clinical benefits of screening for specific HPV types. We estimated HPV type-specific risks for CIN2 and CIN3 using a randomized primary HPV screening trial followed up for 14.6 years using comprehensive, nationwide registers. Poisson regression estimated cumulative incidences, population attributable proportions (PAR) and incidence rate ratios (IRRs) of high-grade lesions by baseline HPV type, with censoring at date of first CIN2/3 or last registered cytology. Multivariate analysis adjusted for co-infections. IRRs were highest during the first screening round, but continued to be high throughout follow-up (IRRs for CIN3 associated with high-risk (HR) HPV positivity were 226.9, 49.3, 17.7 and 10.3 during the first, second and third screening round and for >9 years of follow-up, respectively). Increased long-term risks were found particularly for HPV types 16, 18 and 31 and for CIN3+ risks. HPV16/18/31/33 had 14-year cumulative incidences for CIN3+ above 28%, HPV35/45/52/58 had 14 year risks between 14-18% and HPV39/51/56/59/66/68 had risks <10%.HPV16 contributed to the greatest proportion of CIN2+ (first round PAR 36%), followed by types 31, 52, 45 and 58 (7%-11%). HPV16/18/31/33/45/52/58 together contributed 73.9% of CIN2+ lesions and all HR types contributed 86.9%.In summary, we found substantial differences in risks for CIN2 and CIN3 between different oncogenic HPV types. These differences may be relevant for both clinical management and design of preventive strategies. © 2014 Wiley Periodicals, Inc.
    International Journal of Cancer 07/2014; · 6.20 Impact Factor
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    ABSTRACT: Human papillomavirus (HPV) infections result in a significant burden of low-grade cervical lesions. Between 1997 and 2000, our randomized trial of primary HPV screening enrolled 12,527 women participating in population-based screening. Women between 32 and 38 years of age (median: 34, interquartile range: 33-37) were randomized to HPV and cytology double testing (intervention arm, n=6257 enrolled, n=5888 followed-up) or to cytology, with samples frozen for future HPV testing (control arm, n=6270 enrolled, n=5795 followed-up). We estimated the HPV type-specific, long-term absolute risks (AR) and population attributable proportions (PAR) for cytological diagnoses of atypical squamous cells of undetermined significance (ASCUS) or low-grade squamous intraepithelial lesion (LSIL) and for histopathologically diagnosed cervical intraepithelial neoplasia grade 1 (CIN1).. The women were followed using comprehensive, nationwide register-based follow-up. During a mean follow-up time of 11.07 years, 886 ASCUS and LSIL lesions were detected, 448 in the intervention arm and 438 in the control arm. Poisson regression estimated the incidence rate ratios (IRRs) of low-grade lesions by HPV type. The IRRs were strongly dependent on follow-up time. The IRRs for ASCUS/LSIL associated with high-risk HPV positivity were 18.6 (95% CI: 14.9-23.4) during the first screening round, 4.1 (95% CI: 2.8-6.2) during the second, 2.6 (95% CI: 1.7-4.1) during the third and 1.1 (95% CI: 0.7-1.8) for >9 years of follow-up, with similar declines seen for the individual types. Type 16 contributed consistently to the greatest proportion of ASCUS, LSIL, and CIN1 risk in the population (first screening round PAR: ASCUS: 15.5% (95% CI: 9.7-21.9), LSIL: 14.7% (95% CI: 8.0-20.9), and CIN1: 13.4% (95% CI: 3.2-22.5)), followed by type 31 (8.4% (95% CI: 4.2-12.5) for ASCUS to 17.3% (95% CI: 6.8-26.6) for CIN1). In summary, most ASCUS/LSIL lesions associated with HPV infection are caused by new HPV infections and most lesions are found during the first screening round. © 2014 Wiley Periodicals, Inc.
    International Journal of Cancer 05/2014; · 6.20 Impact Factor
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    ABSTRACT: To assess whether the increased sensitivity of screening for human papillomavirus (HPV) may represent overdiagnosis and to compare the long term duration of protective effect against cervical intraepithelial neoplasia grade 2 or worse (CIN2+) in HPV based and cytology based screening. 13 year follow-up of the Swedescreen randomised controlled trial of primary HPV screening. Organised cervical screening programme in Sweden. 12 527 women aged 32-38 attending organised screening were enrolled and randomised to HPV and cytology double testing (intervention arm, n=6257) or to cytology only, with samples frozen for future HPV testing (control arm, n=6270). Cumulative incidence of CIN2+ and CIN3+ (Kaplan Meier curves). Longitudinal test characteristics were calculated for cytology only, HPV testing only, and cytology and HPV testing combined, adjusting for censoring. The increased detection of CIN2+ in the intervention arm decreased over time. After six years, the cumulative incidence of CIN3+ was similar in both trial arms, and after 11 years the cumulative incidence of CIN2+ became similar in both arms. The longitudinal sensitivity of cytology for CIN2+ in the control arm at three years was similar to the sensitivity of HPV testing in the intervention arm at five years of follow-up: 85.94% (95% confidence interval 76.85% to 91.84%) v 86.40% (79.21% to 91.37%). The sensitivity of HPV screening for CIN3+after five years was 89.34% (80.10% to 94.58%) and for cytology after three years was 92.02% (80.59% to 96.97%). Over long term follow-up, the cumulative incidence of CIN2+ was the same for HPV screening and for cytology, implying that the increased sensitivity of HPV screening for CIN2+ reflects earlier detection rather than overdiagnosis. The low long term risks of CIN3+ among women who tested negative in HPV screening, support screening intervals of five years for such women. Clinicaltrials.gov NCT00479375.
    BMJ (online) 01/2014; 348:g130. · 17.22 Impact Factor
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    ABSTRACT: Background:Metastatic breast cancer is a severe condition without curative treatment. How relative and absolute risk of distant metastasis varies over time since diagnosis, as a function of treatment, age and tumour characteristics, has not been studied in detail.Methods:A total of 9514 women under the age of 75 when diagnosed with breast cancer in Stockholm and Gotland regions during 1990-2006 were followed up for metastasis (mean follow-up=5.7 years). Time-dependent development of distant metastasis was analysed using flexible parametric survival models and presented as hazard ratio (HR) and cumulative risk.Results:A total of 995 (10.4%) patients developed distant metastasis; the most common sites were skeleton (32.5%) and multiple sites (28.3%). Women younger than 50 years at diagnosis, with lymph node-positive, oestrogen receptor (ER)-negative, >20 mm tumours and treated only locally, had the highest risk of distant metastasis (0-5 years' cumulative risk =0.55; 95% confidence interval (CI): 0.47-0.64). Women older than 50 years at diagnosis, with ER-positive, lymph node-negative and 20-mm tumours, had the same and lowest cumulative risk of developing metastasis 0-5 and 5-10 years (cumulative risk=0.03; 95% CI: 0.02-0.04). In the period of 5-10 years after diagnosis, women with ER-positive, lymph node-positive and >20-mm tumours were at highest risk of distant recurrence. Women with ER-negative tumours showed a decline in risk during this period.Conclusion:Our data show no support for discontinuation at 5 years of clinical follow-up in breast cancer patients and suggest further investigation on differential clinical follow-up for different subgroups of patients.British Journal of Cancer advance online publication, 16 January 2014; doi:10.1038/bjc.2014.5 www.bjcancer.com.
    British Journal of Cancer 01/2014; · 5.08 Impact Factor
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    ABSTRACT: Background: Familial aggregation has been shown for Alzheimer's disease (AD) and Parkinson's disease (PD) separately, and it has been hypothesized that these diseases also coaggregate in families. Methods: The authors investigated familial coaggregation of AD and PD by conducting a systematic review and meta-analysis. PubMed was searched for relevant studies published through the end of October 2012. Three independent investigators screened publications and extracted data. Relative risk estimates of AD risk associated with family history of PD or parkinsonism, or PD risk associated with family history of AD or dementia, were summarized into metaestimates using random effects models. Heterogeneity and publication bias were tested using Higgins' and Egger's tests, respectively. Results: We included 16 studies in the review, with 14 included in any meta-analysis. AD risk associated with family history of PD yielded a summary hazard ratio of 1.18 (95% CI: 1.00-1.39) based on 5 reconstructed cohort studies and a summary odds ratio (OR) of 1.40 (95% CI: 0.92-2.12) based on 7 case-control studies. PD risk associated with family history of AD yielded a summary OR of 0.75 (95% CI: 0.49-1.16) based on 3 studies. There was no significant heterogeneity among studies, nor significant publication bias. Conclusions: There may be familial coaggregation of AD and PD, although the association was modest and only apparent when studying AD risk associated with family history of PD. © 2013 S. Karger AG, Basel.
    Neuroepidemiology 11/2013; 42(2):69-80. · 2.37 Impact Factor
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    ABSTRACT: To investigate the contribution of shared familial risk to the co-occurrence of dementia and parkinsonism by studying familial co-aggregation of Alzheimer's disease (AD) and Parkinson's disease (PD). Using Swedish population-based registers we constructed two cohorts; a first-degree relative cohort of persons born 1932-1960 (n = 2,775,332) and a spouse cohort of persons born 1890-1960 (n = 4,736,006). Study persons were followed up between 1969 and 2009 in the National Patient and Cause of Death Registers. We modeled the association between incidence of disease and having at least one affected relative using Cox proportional hazard regression that estimated hazard ratios (HRs) with 95 % confidence intervals (CIs) adjusted for age, sex and number of relatives. Within each disorder; dementia, AD, parkinsonian disorders and PD, there was a strong association between risk of disease and having at least one affected sibling or parent. There was also a modest shared familial risk between the diseases; risk of parkinsonian disorders was associated with having a sibling with AD (HR 1.35, 95 % CI 1.11-1.65) and risk of dementia was associated with having a sibling with PD (HR 1.20, 95 % CI 1.02-1.41). There were no meaningful familial risks among spouses. The risk of co-occurring dementia in PD was considerably increased (HR 2.83, 95 % CI 2.76-2.89). There is strong familial aggregation within dementia, AD, parkinsonian disorders and PD, and modest familial co-aggregation between dementia and parkinsonism. Thus, co-occurrence of dementia and parkinsonism is not primarily caused by shared familial risk between AD and PD.
    European Journal of Epidemiology 11/2013; · 5.12 Impact Factor
  • European Urology 05/2013; · 10.48 Impact Factor
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    ABSTRACT: Converging evidence indicates that women with pregnancy-associated breast cancer (PABC) have increased mortality compared to women with breast cancer not diagnosed near pregnancy (non-PABC). Our aim was to investigate if the stage distribution differs between PABC and non-PABC and if stage at diagnosis can explain the poorer prognosis observed among women with PABC. We identified 3,282 breast cancers in women aged 15-44 years at diagnosis for whom staging data (tumor size, nodal involvement, metastasis) were available in the Swedish Cancer Register between 2002 and 2009. Information on reproductive history and vital status was obtained from the Multi-Generation Register and the Cause of Death Register. PABC was defined as breast cancers diagnosed during pregnancy and up to 2 years after delivery (n = 317). Non-PABC was defined as cases diagnosed before pregnancy or more than 2 years postpartum. Stage distributions were compared between PABC and non-PABC, and mortality rates were modeled using Cox regression. Compared to women with non-PABC, the mortality was almost 50 % higher in women with PABC [unadjusted hazard ratio (HR) 1.47 (95 % CI 1.04-2.08)], a difference which was reduced after adjustment for age and calendar year of diagnosis [HR 1.27 (95 % CI 0.88-1.83)]. Although advanced stage of breast cancer at diagnosis was more common among PABC than among non-PABC, further adjustment for stage only slightly reduced the HR [1.22 (95 % CI 0.84-1.78)]. The difference in mortality between PABC and non-PABC was more pronounced among women above 35 years and among women with PABC diagnosed within 1 year postpartum. Age, rather than stage at diagnosis, appears to act as the principal driver of the increased mortality observed in women with PABC. However, these findings do not preclude an untoward influence on mortality by pregnancy-associated factors affecting tumor aggressiveness and progression.
    Breast Cancer Research and Treatment 04/2013; · 4.47 Impact Factor
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    ABSTRACT: BACKGROUND: The incidence of bladder cancer (BCa) is substantially lower in women than in men, a difference that cannot be fully explained by established risk factors. Several studies suggest that hormonal and reproductive factors play a role in the development of BCa. OBJECTIVE: To examine possible associations between patterns of childbearing and the risk of BCa. DESIGN, SETTING, AND PARTICIPANTS: This cohort study encompassed >2 million women for whom information on reproductive history and BCa incidence was retrieved from Swedish population-based registers. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Incidence rate ratios (IRRs) of BCa were estimated using Cox proportional hazards modelling. The exposures under investigation were parity and age at first birth, adjusted for education and history of chronic obstructive lung disease (COLD). RESULTS AND LIMITATIONS: Among 2 009 811 women in the cohort, 2860 incident cases of BCa were identified. Parous women had lower incidence of BCa compared with nulliparous women (adjusted IRR: 0.80; 95% confidence interval [CI], 0.72-0.89). Moreover, the incidence was 15% lower in women with two children and 24% lower in women with three or more children compared with uniparous women. Compared with women aged 20-24 at first childbirth, the incidence was elevated in women with a first birth before age 20 (adjusted IRR: 1.16; 95% CI, 1.05-1.29). The risk of BCa was elevated in women with low education and among women with a history of COLD. Absence of data on menstrual history, use of exogenous hormones, and smoking was a limitation of the study. CONCLUSIONS: The incidence of BCa decreased with increasing parity and older age at first birth. Although smoking habits may partly explain some of the associations, our findings provide support for yet-to-be-identified protective mechanisms associated with childbearing, possibly mediated by hormonal or structural changes following pregnancy.
    European Urology 01/2013; · 10.48 Impact Factor
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    ABSTRACT: To improve confounder adjustments, observational studies are often matched on potential confounders. While matched case-control studies are common and well covered in the literature, our focus here is on matched cohort studies, which are less common and sparsely discussed in the literature. Matched data also arise naturally in twin studies, as a cohort of exposure-discordant twins can be viewed as being matched on a large number of potential confounders. The analysis of twin studies will be given special attention. We give an overview of various analysis methods for matched cohort studies with binary exposures and binary outcomes. In particular, our aim is to answer the following questions: (1) What are the target parameters in the common analysis methods? (2) What are the underlying assumptions in these methods? (3) How do the methods compare in terms of statistical power?
    Statistical Science 10/2012; 27(2012). · 2.24 Impact Factor
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    ABSTRACT: Swedish population-based national health registers are widely used data sources in epidemiological research. Register-based diagnoses of Parkinson's disease have not been validated against clinical information. Parkinson's disease (PD) and other parkinsonian disorder diagnoses were ascertained in two registers, i.e. the National Patient Register (NPR) and the Cause of Death Register (CDR). Diagnoses were validated in terms of accuracy (positive predictive value) and sensitivity against data from a population-based study of PD in 1998-2004 that screened more than 35,000 persons and identified 194 cases of parkinsonian disorders including 132 PD cases (the gold standard for the purposes of this study). Accuracy for any parkinsonian disorder diagnoses was 88.0% in the NPR and 94.4% in the CDR. Accuracy of PD diagnoses was 70.8% in the NPR and 66.7% in the CDR. Misclassification between differential parkinsonian diagnoses was common. The accuracy of PD diagnoses in the NPR improved to 83.0% by restricting the definition to primary diagnoses only. The sensitivity of PD diagnoses in the NPR and CDR combined was 83.1%, with a mean time to detection of 6.9 years. Population-based national health registers are valid data sources in epidemiological studies of PD or parkinsonian disorder etiology but are less suitable in studies of incidence or prevalence.
    Neuroepidemiology 03/2012; 38(3):186-93. · 2.37 Impact Factor
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    ABSTRACT: It is unclear whether estrogen receptor (ER)-status of first primary breast cancer is associated with risk of metachronous (non-simultaneous) contralateral breast cancer (CBC), and to what extent endocrine therapy affects this association. We studied the effect of ER-status of the first cancer on the risk of CBC overall, and for different ER-subtypes of CBC, using a large, population-based cohort. The cohort consisted of all women diagnosed with breast cancer in the Stockholm region 1976-2005; 25715 patients, of whom 940 suffered CBC. The relative risk was analyzed mainly using standardized incidence ratios (SIR). WOMEN WITH BREAST CANCER HAD A DOUBLED RISK OF CBC COMPARED TO THE RISK OF BREAST CANCER IN THE GENERAL FEMALE POPULATION (SIR: 2.22 [2.08-2.36]), for women with a previous ER-positive cancer: SIR = 2.30 (95% CI:2.11-2.50) and for women with a previous ER-negative cancer: SIR = 2.17 (95% CI:1.82-2.55). The relative risk of ER-positive and ER-negative CBC was very similar for women with ER-positive first cancer (SIR = 2.02 [95%CI: 1.80-2.27] and SIR = 1.89 [95%CI: 1.46-2.41] respectively) while for patients with ER-negative first cancer the relative risk was significantly different (SIR = 1.27 [95% CI:0.94-1.68] for ER-positive CBC and SIR = 4.96 [95%CI:3.67-6.56] for ER-negative CBC). Patients with ER-positive first cancer who received hormone therapy still had a significantly higher risk of CBC than the risk of breast cancer for the general female population (SIR = 1.74 [95% CI:1.47-2.03]). The risk of CBC for a breast cancer patient is increased to about two-fold, compared to the risk of breast cancer in the general female population. This excess risk decreases, but does not disappear, with adjuvant endocrine therapy. Patients with ER-positive first cancers have an increased risk for CBC of both ER subtypes, while patients with ER-negative first cancer have a specifically increased risk of ER-negative CBC.
    PLoS ONE 01/2012; 7(10):e46535. · 3.53 Impact Factor
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    ABSTRACT: The proportion of women living with a diagnosis of breast cancer in developed countries is increasing. Because breast cancer-specific deaths decrease with time since diagnosis, it is important to assess the burden of other causes of death in women diagnosed with breast cancer. Different causes of death within 10 years from diagnosis were assessed in 12,850 women younger than 75 years of age with stage 1 to 3 breast cancer diagnosed in Stockholm and Gotland regions 1990 to 2006. Flexible parametric survival models were used to estimate hazard ratios over time since diagnosis by tumor characteristics and age at diagnosis. The proportion of deaths attributed to breast cancer ranged from 95.0% among women younger than age 45 years at diagnosis to 44.5% among women age 65 to 74 years. The proportions of circulatory system-specific deaths and deaths resulting from other causes increased with older age at diagnosis. Patients with one to three positive lymph nodes were more likely to die as a result of breast cancer during the first 10 years of follow-up compared with women without positive lymph nodes. Women with estrogen receptor (ER) -positive tumors had the same risk of dying as a result of breast cancer 5 years after diagnosis compared with women with ER-negative tumors. Lymph node negativity is an important long-term predictor of more favorable prognosis. The nature of the relationship between ER status and risk of dying as a result of breast cancer after 5 years of follow-up requires further investigation. Circulatory system diseases are an important cause of death, especially in women diagnosed with breast cancer at an older age.
    Journal of Clinical Oncology 09/2011; 29(30):4014-21. · 18.04 Impact Factor
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    ABSTRACT: This study aims to determine the risk of pelvic organ prolapse (POP) and stress urinary incontinence (SUI) surgery related to mode of hysterectomy focusing on vaginal hysterectomy. We performed a nationwide cohort study. Women exposed to hysterectomy on benign indications (n = 118,601) were compared to women unexposed to hysterectomy (n = 579,200). The outcome was defined as first occurrence of POP or SUI surgery. Hazard ratios (HRs) were calculated with 95% confidence intervals (CIs) using Cox proportional-hazards models. The greatest risks of POP (HR 4.9, 95% CI 3.4-6.9) or SUI surgery (HR 6.3, 95% CI 4.4-9.1) were observed subsequent to vaginal hysterectomy for pelvic organ prolapse. Having a vaginal hysterectomy for other reasons also significantly increased the risks of POP and SUI surgery compared to other modes of hysterectomy. Hysterectomy in general, in particular vaginal hysterectomy, was associated with an increased risk for subsequent POP and SUI surgery.
    International Urogynecology Journal 08/2011; 23(1):43-8. · 2.17 Impact Factor
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    ABSTRACT: Because of a continued trend toward postponed childbearing, the incidence of pregnancy-associated breast cancer (PABC) is likely to increase. This study investigated the mortality in women with PABC in relation to when the tumor was detected (during pregnancy, different postpartum periods) and by time since diagnosis, compared with women with non-PABC. A population-based cohort study of 15,721 Swedish women diagnosed with breast cancer between ages 15 to 44 years, of whom 1,110 (7%) had a PABC (diagnosed during or within two years after pregnancy). Information on outcome and potential confounders was obtained from population-based health registers. Mortality rates and HRs with 95% CIs were estimated. Women with PABC had higher mortality compared with women with non-PABC diagnosed at the same age and calendar period. Among women with PABC, 46% died within 15 years after diagnosis, whereas 34% died among non-PABC patients. The mortality in both groups peaked at around two years after diagnosis, with the highest peak occurring in women diagnosed 4 to 6 months after delivery (HR = 3.8, 95% CI: 2.4-5.9). An increased mortality among women with PABC remained until 10 years after diagnosis. Women with PABC had a poorer prognosis compared with women with breast cancer and no recent birth. The mortality increase was most pronounced in the subgroup of women diagnosed shortly after delivery. An increased awareness among clinicians may help reduce the mortality in women with PABC, for example, by avoiding undue delays in diagnosis and treatment.
    Cancer Epidemiology Biomarkers &amp Prevention 08/2011; 20(9):1865-72. · 4.56 Impact Factor
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    ABSTRACT: Several occupations and occupational exposures have been investigated for associations with Parkinson's disease. Common findings are increased risk associated with pesticide exposure and no association between Parkinson's disease and welding. We explored the association between a broad range of possible occupational risk factors and Parkinson's disease as well as Parkinson's disease plus other forms of Parkinsonism (referred to as Parkinsonian disorders), using prospectively collected data in the population-based Swedish Twin Registry. A cohort of 14,169 Swedish men was followed for up to 43 years. We identified 234 Parkinsonian disorder cases including 204 Parkinson's disease cases with complete data. We assessed exposure to 14 chemical and biological compounds through a job exposure matrix. Hazard ratios (HR) with 95% confidence intervals (CI) adjusted for age, smoking, and education were used to estimate the relative risk of disease associated with exposure. Exposure to inorganic dust was associated with increased risk of Parkinson's disease and Parkinsonian disorders, HR 1.6 (95% CI 1.1-2.4) and 1.5 (1.0-2.2) respectively. There was no association between Parkinson's disease or Parkinsonian disorders and occupational exposure to pesticides, welding smoke, metal dust, wood dust, animal handling, stone and concrete dust, chrome and nickel dust, quartz dust, organic dust, oil, asbestos, organic solvents and irritating gas. Inorganic dust should be explored further as a potential risk factor for Parkinson's disease. Occupational exposure to pesticides and twelve other compounds explored in this study may not be associated with risk of Parkinson's disease in Swedish men.
    Parkinsonism & Related Disorders 07/2011; 17(9):677-82. · 3.27 Impact Factor
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    ABSTRACT: To examine temporal trends in the incidence of hydatidiform mole (HM) in relation to maternal age, the occurrence of choriocarcinoma in women with a history of HM and the extent of underreporting of HM to the Swedish Cancer Register (SCR). Women registered with a diagnosis of HM were identified in the Swedish Cancer Register and the Swedish Inpatient Register (IPR). Record linkage to the Medical Birth Register provided information to assess the incidence of HM. We identified 3 844 unique cases of HM in the SCR and in the IPR combined between 1973 and 2004, yielding an incidence of 1.2 per 1 000 deliveries. The incidence of HM increased during the period under study. The highest incidence was observed in women below 20 and above 39 years of age. Of all registered cases of choriocarcinoma, 37% occurred in women with a previous history of HM. The risk of choriocarcinoma following HM was 1.3%, compared to 0.005% in women without a previous molar diagnosis. The records of the Cancer Register included 83.2% of all identified cases of HM. The incidence of HM in Sweden has increased over time, and is characterized by a bimodal pattern with distinctive peaks in the youngest and oldest women of reproductive age. More than one third of all women registered with choriocarcinoma had a previous diagnosis of HM. Despite mandatory reporting, there was evidence of underreporting of HM to the SCR that remained virtually unchanged over calendar time.
    Acta oncologica (Stockholm, Sweden) 04/2011; 50(3):367-72. · 2.27 Impact Factor
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    ABSTRACT: The treatment for transsexualism is sex reassignment, including hormonal treatment and surgery aimed at making the person's body as congruent with the opposite sex as possible. There is a dearth of long term, follow-up studies after sex reassignment. To estimate mortality, morbidity, and criminal rate after surgical sex reassignment of transsexual persons. A population-based matched cohort study. Sweden, 1973-2003. All 324 sex-reassigned persons (191 male-to-females, 133 female-to-males) in Sweden, 1973-2003. Random population controls (10:1) were matched by birth year and birth sex or reassigned (final) sex, respectively. Hazard ratios (HR) with 95% confidence intervals (CI) for mortality and psychiatric morbidity were obtained with Cox regression models, which were adjusted for immigrant status and psychiatric morbidity prior to sex reassignment (adjusted HR [aHR]). The overall mortality for sex-reassigned persons was higher during follow-up (aHR 2.8; 95% CI 1.8-4.3) than for controls of the same birth sex, particularly death from suicide (aHR 19.1; 95% CI 5.8-62.9). Sex-reassigned persons also had an increased risk for suicide attempts (aHR 4.9; 95% CI 2.9-8.5) and psychiatric inpatient care (aHR 2.8; 95% CI 2.0-3.9). Comparisons with controls matched on reassigned sex yielded similar results. Female-to-males, but not male-to-females, had a higher risk for criminal convictions than their respective birth sex controls. Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity than the general population. Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric and somatic care after sex reassignment for this patient group.
    PLoS ONE 01/2011; 6(2):e16885. · 3.53 Impact Factor
  • European Journal of Cancer - EUR J CANCER. 01/2011; 47.

Publication Stats

1k Citations
344.31 Total Impact Points

Institutions

  • 2000–2014
    • Karolinska Institutet
      • Institutionen för medicinsk epidemiologi och biostatistik
      Solna, Stockholm, Sweden
  • 2011
    • Södersjukhuset
      Tukholma, Stockholm, Sweden
    • University of Massachusetts Medical School
      Worcester, Massachusetts, United States