Eero Pukkala

Tampere University | UTA · Faculty of Social Sciences

The cancer profile of veterinarians has received little research attention, despite the profession potentially being exposed to a wide range of known and suspected carcinogens. In this large-scale cohort study, we assessed cancer incidence in veterinarians in Denmark, Finland, Iceland, Norway, and Sweden, across more than 40 years (1961–2005). The...

Purpose Evaluate the occupational variation in incidence of oropharyngeal cancer (OPC). Methods We calculated standardized incidence ratios (SIRs) of OPC in occupational categories in the Nordic countries relative to the entire national populations. The data covered 6155 OPC cases. Results Among men high risk of OPC was observed, among else, in w...

Introduction: While certain occupations, such as agriculture and fishery, have been associated with an increased risk of lip cancer, the occupational risk profile of lip cancer and its change over time remain poorly known. This study aims to evaluate the incidence of lip cancer across different occupations in the Nordic countries. Methods: The N...

Objective Incidence and causes of primary adrenal insufficiency (PAI) have not been comprehensively studied in children. Our objective was to describe the epidemiology and to assess causes of PAI in Finnish children. Design A population-based descriptive study of PAI in Finnish patients aged 0-20 years. Methods Diagnoses referring to adrenal insu...

Study question: Are genetic disorders and congenital malformations associated with premature ovarian insufficiency (POI)? Summary answer: A wide range of genetic disorder and congenital malformation diagnoses are associated with POI, especially early onset POI. What is known already: POI is known to be associated with some genetic disorders, s...

Background: Long-term Helicobacter pylori infection increases the risk of gastric malignancies. Since the symptoms for H. pylori gastritis, as well as for several malignancies, may be nonexisting or highly unspecific, even H. pylori-positive subjects with underlying malignancies may receive eradication therapy. The aim was to assess the incidence...

Introduction: The long-term risk of cancer among first-degree relatives of ovarian cancer patients, especially their offspring, is of apparent clinical importance. Risks caused by known inherited factors such as BRCA1 or BRCA2 pathogenic variants are well established, but these account for only about 15% of ovarian cancer cases. Less is known abou...

Colorectal cancer (CRC) is a leading cause of mortality worldwide. We conducted a genome-wide association study meta-analysis of 100,204 CRC cases and 154,587 controls of European and east Asian ancestry, identifying 205 independent risk associations, of which 50 were unreported. We performed integrative genomic, transcriptomic and methylomic analy...

Background The COVID-19 pandemic strained healthcare workers but the individual challenges varied in relation to actual work and changes in work. We investigated changes in healthcare workers’ mental health under prolonging COVID-19 pandemic conditions, and heterogeneity in the mental-health trajectories. Methods A monthly survey over a full year...

As colorectal cancer (CRC) is largely due to modifiable lifestyle habits, the awareness on its risk factors is highly important. Dietary fatty acids have been linked to CRC risk. We explored the association between dietary trans fatty acids (TFAs) intake and CRC risk. We analyzed 865 CRC cases (434 in colon and 404 in rectum) and 3206 controls of t...

Background The aim of this study was to estimate occupational risk variation in the incidence of nasopharyngeal cancer (NPC) in a large population-based cohort of the Nordic Occupational Cancer (NOCCA) study. Methods This study is based on a cohort of almost 15 million persons from Denmark, Finland, Iceland, Norway and Sweden, with 2898 nasopharyn...

The evolving trends in colorectal cancer (CRC) as one of the most common malignancies worldwide, have likely been influenced by the implementation of screening programs and changes in lifestyle habits. Changing lifestyle, including the shift in diet composition with higher fat, sugar, and animal-source foods intake, led to an increasing burden of C...

Police work may expose officers to various circumstances that have potential for increasing their risk of cancer, including traffic‐related air pollution, night shift work, and radiation from radars. In this study, we examined the incidence of cancer among Nordic male and female police officers. We utilize data from the Nordic Occupational Cancer (...

Background Globally, lung cancer is the most frequent occupational cancer, but the risk associated with the occupations or occupational environment in Iran is not clear. We aimed to assess occupations with the risk of lung cancer. Methods We used the IROPICAN nationwide case–control study data including 658 incident lung cancer cases and 3477 cont...

Objective We assessed the association between parental prenatal exposures in wood-related jobs and risk of testicular germ cell tumours (TGCT) in offspring. Methods NORD-TEST, a registry-based case–control study in Sweden, Finland and Norway, included 8112 TGCT cases diagnosed at ages 14–49 years between 1978 and 2012 with no history of prior canc...

Opium use was recently classified as a human carcinogen for lung cancer by the International Agency for Research on Cancer. We conducted a large, multicentre case‐control study evaluating the association between opium use and the risk of lung cancer. We recruited 627 cases and 3477 controls from May 2017 to July 2020. We used unconditional logistic...

Background: There is evidence of an inverse association between yoghurt intake and risk of colorectal cancer (CRC). We aimed at investigating the association between the intake of yoghurt and other dairy foods consumed in Iran and CRC risk. Methods: Our analysis included 4070 subjects within the IROPICAN (Iran Study of Opium and Cancer) study. D...

Background Exposure to extremely low frequency magnetic fields (ELF-MFs) and electric shocks is a common occupational risk factor in many workplaces. Recent investigations have highlighted a possible association between such exposures and lymphoma risk. This study was carried out to further explore the association between occupational exposure to E...

Risk of colorectal cancer (CRC) increases in relatives of patients with CRC. The extent to which this is attributable to genetic predisposition or shared environment is unclear. We explored this question using nationwide cohorts from Denmark, Finland and Sweden. From 1977 to 2013, we identified 359 879 individuals with a CRC diagnosis and 2 258 870...

Purpose This case–control study assesses the independent roles of reproductive history, postmenopausal hormonal therapy (HT), socioeconomic status (SES), and occupational physical activity on the risk of breast cancer (BC). Methods Odds ratios (OR) were estimated from conditional logistic multivariate regression model in a data set of 19,253 Finni...

Background: The aim of this study was to estimate occupational risk variation in the incidence of nasopharyngeal cancer (NPC) in a large population-based cohort of the Nordic Occupational Cancer (NOCCA) study. Methods: This study is based on a cohort of almost 15 million persons from Denmark, Finland, Iceland, Norway and Sweden, with 2898 nasophary...

Objectives Animal bioassays have demonstrated convincing evidence of the potential carcinogenicity to humans of titanium dioxide (TiO 2 ), but limitations in cohort studies have been identified, among which is the healthy worker survivor effect (HWSE). We aimed to address this bias in a pooled study of four cohorts of TiO 2 workers. Methods We rea...

Background The rates and routes of Helicobacter pylori transmission, in a high prevalent country like Iran, with gastric cancer as the leading cause of male cancer mortality is of essence. Here, we have studied the H. pylori-associated risk factors and the likelihood of interspousal transmission. Methods In a cohort of 686 young prewed couples, qu...

Background: Bladder cancer (BC) is the 10th most common type of cancer worldwide and the fourth most common type of cancer in Iran. Opium use is considered as one of the risk factors for BC. We aim to assess the association between various parameters of opium use, which in Iran is mainly ingested or smoked in various forms, and the risk of BC. Me...

Background: While the excess in lung cancer risk among lower socioeconomic status individuals has been widely described, the magnitude of this association across lung cancer subtypes, as well as histotype-related long-term incidence trends, are inconclusively reported. Aims: We explored the variation in the incidence of the three main lung cance...

STUDY QUESTION What is the incidence of premature ovarian insufficiency (POI), has the incidence of POI changed over time, and what is the risk of POI among relatives of POI women? SUMMARY ANSWER The incidence of POI increased among females aged 15–19 years from 2007 onwards and decreased in older age groups, and among relatives of women with POI...

Background Human papillomavirus (HPV) vaccination protects against HPV, a necessary risk factor for cervical cancer. We now report results from population-based follow-up of randomised cohorts that vaccination provides HPV-type-specific protection against invasive cancer. Methods Individually and/or cluster randomised cohorts of HPV-vaccinated and...

Purpose: To investigate changes in healthcare workers’ mental-health under prolonging Covid-19 pandemic conditions.Methods: A monthly survey over a full year was conducted for employees of the HUS Helsinki University Hospital (n = 4804) between 4th June 2020 to 28th May 2021. Pandemic-related potentially traumatic events (PTEs), work characteristic...

Military pilots undergo rigorous selection compared with civilian professional pilots because of different operational requirements. There are no studies of military pilots’ subsequent civil aviation careers and fatal pilot aviation accidents. This study focuses on Vietnam War (VW) pilots and subsequent fatal aviation accidents in the U.S from 1965...

IntroductionA small number of adverse events of seizure in patients using desloratadine (DL) have been reported. The European Medicines Agency requested a post-authorization safety study to investigate whether there is an association between DL exposure and seizure.Objective The aim was to study the association between DL exposure and incidence of...

Introduction Styrene is genotoxic, an animal carcinogen, associated with lymphohematopoietic malignancies in humans, and classified as a group 2A carcinogen by the IARC. Objective To combine and harmonize existing cohorts of reinforced plastics industry workers with the aim to study exposure-response relations for styrene and subtypes of lymphohem...

Introduction We conducted a community-randomized trial (NCTBLINDED) in Finland to assess gender-neutral and girls-only vaccination strategies with the AS04-adjuvanted human papillomavirus (HPV)-16/18 (AS04-HPV-16/18)vaccine. Methods Girls and boys (12−15 years) were invited. We randomized 33 communities (1:1:1 ratio): Arm A: 90% of randomly select...

Background Cholangiocarcinoma (CCA) is a cancer arising from the intra- and extrahepatic bile ducts. The early stages are often asymptomatic, CCA is frequently diagnosed in an advanced stage and the prognosis of CCA is often dismal. Objective Our objective was to estimate the incidence of CCA in Finland and to identify risk factors for CCA, with a...

Objective Adult-type ovarian granulosa cell tumors (AGCTs) are hormonally active neoplasms with limited epidemiological data available. We evaluated the effect of parity and postmenopausal hormone therapy (HT) use on the risk of AGCT in a population-based case-control setting. Methods We identified all women diagnosed with AGCT during 1994–2015 (n...

Background Endometriosis is associated with increased risk of clear cell ovarian cancer and has even suggested being an etiological factor for this cancer. Association between endometriosis and extraovarian clear cell cancers is unclear. This study aimed to assess the association between surgically diagnosed endometriosis and risk of extraovarian c...

Background There are studies suggesting that participation in musical activities may protect from cancer. On the other hand, some musicians have a lifestyle that might increase the risk of cancer. The objective of this study was to assess the cancer pattern of musicians in four Nordic countries. Material and methods This study combines census and...

Numerous epidemiological studies published over the past two decades have provided further evidence of an association between socioeconomic status and incidence of all of the most common cancers in European countries. We summarise their main conclusions and add some further insights and references.

Lack of social contacts has been associated with an increased risk of cancer mortality, but it is not known whether living alone increases the risk of cancer incidence or case fatality. We examined the association between living alone with cancer incidence, case-fatality and all-cause mortality in eight most common cancers. All patients with their...

Background Parity is known to have a protective effect as regards ovarian cancer, but its effect on the different histological subtypes of ovarian cancer is not well known. The impact of parity on the incidence of ovarian cancer subtypes was studied. Material and methods All Finnish women diagnosed 1994–2013 with ovarian cancer for the first time...

Ovarian cancer (OC) has a poor prognosis. Hypertension may be a prognostic factor for OC, but it is unclear whether antihypertensive (anti-HT) drug use of modifies OC prognosis. We performed a population-based analysis assessing the effect of anti-HT drug use on OC mortality. A cohort of 12,122 women identified from the Finnish Cancer Registry with...

This study aims to assess mortality from causes other than breast cancer among women with breast cancer with focus on indications of joint aetiology. Data on female breast cancer patients were obtained from the Finnish Cancer Registry and their underlying causes of death in 54 categories from the Statistics Finland. Standardized mortality ratios (S...

Introduction A majority of the Finnish COVID-19 pandemic patients have been cared for in the HUS Helsinki University Hospital since March 2020. Objectives June 2020 baseline results of an ongoing prospective cohort study are reported. Methods An electronic survey was created to assess potentially traumatic COVID-19 pandemic related events (PTEs)...

Background The increased risk of malignancies in coeliac disease is well recognised, but data on incidence and predisposing factors are scarce. Our aim was to determine cancer incidence and its prognostic factors in coeliac disease during a long‐term follow‐up. Methods The study cohort comprised all (n=1460) coeliac patients diagnosed in Tampere U...

Background The aim was to examine the hypothesis that antireflux surgery with fundoplication improves long-term survival compared with antireflux medication in patients with reflux oesophagitis or Barrett’s oesophagus. Method Individuals aged between 18 and 70 years with reflux oesophagitis or Barrett’s oesophagus (intestinal metaplasia) documente...

The COVID-19 pandemic has caused an unequally distributed extra workload to hospital personnel and first reports have indicated that especially front-line health care personnel are psychologically challenged. A majority of the Finnish COVID-19 patients are cared for in the Helsinki University Hospital district. The psychological distress of the Hel...

Background: The International Agency for Research on Cancer (IARC) recently classified opium use as a Group 1 carcinogen. However, much remains to be studied on the relation between opium and cancer. We designed the Iranian Opium and Cancer (IROPICAN) study to further investigate the association of opium use and cancers of the head and neck, bladd...

Extremely low frequency (ELF) magnetic fields (MF) have been classified as possibly carcinogenic. This classification was mainly based on studies indicating increased risk of leukemia in children living near power lines. Increased risks of adult hematological malignancies and brain tumors have also been reported, but the results are mixed. We asses...

Background and aims Absolute rates and risk factors of short-term outcomes after antireflux surgery remain largely unknown. We aimed to clarify absolute risks and risk factors for poor 90-day outcomes of primary laparoscopic and secondary antireflux surgery. Methods This population-based cohort study included patients who had primary laparoscopic...

Background: Bladder cancer (BC) is the 10th most common type of cancer worldwide and the 4th most common type of cancer in Iran. Opium use is considered as one of the risk factors for BC. We aim to assess the association between various parameters of opium use, which in Iran is mainly ingested or smoked in various formats, and the risk of BC. Meth...

Even 30 years after the accident, an association between breast cancer incidence and ionizing radiation exposure from Chernobyl fallout remains uncertain. We studied breast cancer incidence in the most contaminated regions of Belarus (Gomel and Mogilev) and Ukraine (Kyiv, Zhytomyr and Chernihiv) before (1978‐1986) and after (1987‐2016) the accident...

In March 2020, strict measures took place in Finland to limit the COVID-19 pandemic. Majority of Finnish COVID-19 patients have been located in southern Finland and consequently cared for at the Hospital District of Helsinki and Uusimaa (HUS) Helsinki University Hospital. During the pandemic, HUS personnel's psychological symptoms are followed via...

The incidence pattern of lichen planus (LP) and LP-related mortality are unknown. The aim of this study was to assess these factors, based on Finnish nationwide registry data including 13,378 women with LP diagnosed during 1969 to 2012. The incidence rate for LP in 2003 to 2012 was 28 per 100,000 woman-years age-adjusted to the European Standard Po...

Objective: The aim of this study was to clarify whether antireflux surgery prevents laryngeal and pharyngeal squamous cell carcinoma. Summary background data: Gastroesophageal reflux disease (GERD) seems to increase the risk of laryngeal and pharyngeal squamous cell carcinoma. Methods: All-Nordic (Denmark, Finland, Iceland, Norway, and Sweden)...

PurposeObesity increases the risk of several cancers, but the influence of bariatric surgery on the risk of individual obesity-related cancers is unclear. This study aimed to assess the impact of bariatric surgery on cancer risk in a multi-national setting.Materials and Methods This cohort study included all adults with an obesity diagnosis identif...

Introduction Airway micro-aspiration might contribute to the proposed associations between gastroesophageal reflux disease (GERD) and some lung diseases, including lung cancer. This study aimed to examine the hypothesis that antireflux surgery decreases the risk of small cell carcinoma, squamous cell carcinoma and adenocarcinoma of the lung differe...

On March 2020 strict measures took place in Finland to limit the COVID -19 pandemic. A majority of the Finnish COVID -19 –patients have been located in the southern Finland and consequently cared for in the HUS Helsinki University Hospital. During the ongoing pandemic, HUS personnel’s psychological symptoms are followed via an electronic survey, wh...

Background: Breast cancer (BCa) incidence has been associated with hypertension which might worsen disease prognosis but few nationwide studies have investigated the association between antihypertensive drug use and BCa prognosis. Methods: A cohort of 73,170 women diagnosed with BCa during 1995-2013 identified from the Finnish Cancer Registry wa...

Background: Kidney transplant recipients (KTRs) have an increased cancer risk compared to the general population, but absolute risks that better reflect the clinical impact of cancer are seldom estimated. Methods: All KTRs in Sweden, Norway, Denmark and Finland, with a first transplantation between 1995-2011, were identified through national reg...

Scant evidence exists to support the association of opium use with head and neck cancer, limited to the larynx and oral cavity. In a multicenter case-control study -Iran Opium and Cancer study (IROPICAN), we recruited 633 cases of head and neck squamous cell carcinoma (HNSCC) (254 lip and oral cavity, 54 pharynx, 327 larynx, and 28 other sub-sites...

Objective: To identify risk factors for suicide after bariatric surgery. Summary background data: Bariatric surgery reduces obesity-related mortality. However, it is for unclear reasons is associated with an increased risk of suicide. Methods: This population-based cohort study included patients having undergone bariatric surgery in 1982 to 20...

Background The age‐adjusted incidence of cutaneous melanoma (CM) in the Nordic countries has increased during the last 60 years. Few prospective population‐based studies estimated the occupational variation in CM risk over time. Objective To determine occupational variation in CM risk. Methods Historical prospective cohort study with 45‐year foll...

It has been suggested that the association between self-reported occupational noise exposure and vestibular schwannoma (VS) found in several studies, represents recall bias. Therefore, we aim to study the relation in a large case-control study using occupational noise measurements. We performed a case-control study from Sweden of 1913 VS cases diag...

Background: Bariatric surgery carries a risk of severe postoperative complications, sometimes leading to reinterventions or even death. The incidence and risk factors for reintervention and death within 90 days after bariatric surgery are unclear, and were examined in this study. Methods: This population-based cohort study included all patients...

Context Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) is an autoimmune endocrinopathy with severe and unpredictable course. The impact of APECED on mortality has not been determined. Objective To assess overall and cause-specific mortality of patients with APECED. Design and Setting: A follow-up study of Finnish patients...

Supplementary material to Vänskä et al. Vaccination With Moderate Coverage Eradicates Oncogenic Human Papillomaviruses if a Gender-Neutral Strategy Is Applied

Objective: To assess the incidence of lichen sclerosus (LS) in women and all-cause and cause-specific mortality of women with LS. Design: Population-based descriptive study. Setting: Finland. Population: All Finnish women, including 7,790 women diagnosed with LS during 1969-2012. Methods: Information gathered from the national Hospital Dis...

Background: With improved survival among women with breast cancer, the risk of dying from causes other than breast cancer has increased. Emerging studies suggest the possibility of shared modifiable risk factors between some of the causes of death among breast cancer patients and the occurrence of breast cancer. This study is aimed at understanding...

During the twentieth century, register data have become increasingly important for the identification and quantification of occupational cancer risks and thereby for occupational cancer control. Registers can provide rapid access to information on occupation, exposure, death, disease, and a number of potential confounders, for cohorts, cases, and r...

Background: Evidence suggests that among some occupational groups, there is an elevated risk of kidney cancer. This might, however, derive from a difference in smoking habits across occupational groups. The objective of this study was to determine smoking-adjusted occupational variation in the incidence of kidney cancer in Nordic males. Material an...

Purpose: Published epidemiological studies on the association between finasteride use and the risk of male breast cancer have been inconclusive due to methodological limitations including a few male breast cancer cases included. Determinants of male breast cancer have been studied, but it remains unexplored whether these are also related to finast...