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Damber, Lena
Publications (10 of 21) Show all publications
Lubin, J. H., Adams, M. J., Shore, R., Holmberg, E., Schneider, A. B., Hawkins, M. M., . . . Veiga, L. H. S. (2017). Thyroid Cancer Following Childhood Low-Dose Radiation Exposure: A Pooled Analysis of Nine Cohorts. Journal of Clinical Endocrinology and Metabolism, 102(7), 2575-2583
Open this publication in new window or tab >>Thyroid Cancer Following Childhood Low-Dose Radiation Exposure: A Pooled Analysis of Nine Cohorts
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2017 (English)In: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, E-ISSN 1945-7197, Vol. 102, no 7, p. 2575-2583Article in journal (Refereed) Published
Abstract [en]

Context: The increased use of diagnostic and therapeutic procedures that involve radiation raises concerns about radiation effects, particularly in children and the radiosensitive thyroid gland.

Objectives: Evaluation of relative risk (RR) trends for thyroid radiation doses <0.2 gray (Gy); evidence of a threshold dose; and possible modifiers of the dose-response, e.g., sex, age at exposure, time since exposure.

Design and Setting: Pooled data from nine cohort studies of childhood external radiation exposure and thyroid cancer with individualized dose estimates, ≥1000 irradiated subjects or ≥10 thyroid cancer cases, with data limited to individuals receiving doses <0.2 Gy.

Participants: Cohorts included the following: childhood cancer survivors (n = 2); children treated for benign diseases (n = 6); and children who survived the atomic bombings in Japan (n = 1). There were 252 cases and 2,588,559 person-years in irradiated individuals and 142 cases and 1,865,957 person-years in nonirradiated individuals.

Intervention: There were no interventions.

Main Outcome Measure: Incident thyroid cancers.

Results: For both <0.2 and <0.1 Gy, RRs increased with thyroid dose (P < 0.01), without significant departure from linearity (P = 0.77 and P = 0.66, respectively). Estimates of threshold dose ranged from 0.0 to 0.03 Gy, with an upper 95% confidence bound of 0.04 Gy. The increasing dose–response trend persisted >45 years after exposure, was greater at younger age at exposure and younger attained age, and was similar by sex and number of treatments.

Conclusions: Our analyses reaffirmed linearity of the dose response as the most plausible relationship for “as low as reasonably achievable” assessments for pediatric low-dose radiation-associated thyroid cancer risk.

National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-138041 (URN)10.1210/jc.2016-3529 (DOI)000405621600055 ()
Available from: 2017-08-14 Created: 2017-08-14 Last updated: 2018-06-09Bibliographically approved
Björ, O., Jonsson, H., Damber, L., Burström, L. & Nilsson, T. (2016). Is outdoor work associated with elevated rates of cerebrovascular disease mortality?: a cohort study based on iron-ore mining. Journal of Occupational Medicine and Toxicology, 11, Article ID 40.
Open this publication in new window or tab >>Is outdoor work associated with elevated rates of cerebrovascular disease mortality?: a cohort study based on iron-ore mining
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2016 (English)In: Journal of Occupational Medicine and Toxicology, ISSN 1745-6673, E-ISSN 1745-6673, Vol. 11, article id 40Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: A cohort study that examined iron ore mining found negative associations between cumulative working time employed underground and several outcomes, including mortality of cerebrovascular diseases. In this cohort study, and using the same group of miners, we examined whether work in an outdoor environment could explain elevated cerebrovascular disease rates.

METHODS: This study was based on a Swedish iron ore mining cohort consisting of 13,000 workers. Poisson regression models were used to generate smoothed estimates of standardized mortality ratios and adjusted rate ratios, both models by cumulative exposure time in outdoor work.

RESULTS: The adjusted rate ratio between employment classified as outdoor work ≥25 years and outdoor work 0-4 years was 1.62 (95 % CI 1.07-2.42). The subgroup underground work ≥15 years deviated most in occurrence of cerebrovascular disease mortality compared with the external reference population: SMR (0.70 (95 % CI 0.56-0.85)).

CONCLUSIONS: Employment in outdoor environments was associated with elevated rates of cerebrovascular disease mortality. In contrast, work in tempered underground employment was associated with a protecting effect.

Keywords
Poisson regression, Occupation, Standardized mortality ratio, Mortality, Cohort study, Mining
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-125120 (URN)10.1186/s12995-016-0131-8 (DOI)000384698600001 ()27570536 (PubMedID)
Available from: 2016-09-06 Created: 2016-09-06 Last updated: 2018-06-07Bibliographically approved
Veiga, L. H. S., Holmberg, E., Anderson, H., Pottern, L., Sadetzki, S., Adams, M. J., . . . Lubin, J. H. (2016). Thyroid Cancer after Childhood Exposure to External Radiation: An Updated Pooled Analysis of 12 Studies. Radiation Research, 185(5), 473-484
Open this publication in new window or tab >>Thyroid Cancer after Childhood Exposure to External Radiation: An Updated Pooled Analysis of 12 Studies
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2016 (English)In: Radiation Research, ISSN 0033-7587, E-ISSN 1938-5404, Vol. 185, no 5, p. 473-484Article in journal (Refereed) Published
Abstract [en]

Studies have causally linked external thyroid radiation exposure in childhood with thyroid cancer. In 1995, investigators conducted relative risk analyses of pooled data from seven epidemiologic studies. Doses were mostly <10 Gy, although childhood cancer therapies can result in thyroid doses >50 Gy. We pooled data from 12 studies of thyroid cancer patients who were exposed to radiation in childhood (ages <20 years), more than doubling the data, including 1,070 (927 exposed) thyroid cancers and 5.3 million (3.4 million exposed) person-years. Relative risks increased supralinearly through 2-4 Gy, leveled off between 10-30 Gy and declined thereafter, remaining significantly elevated above 50 Gy. There was a significant relative risk trend for doses <0.10 Gy (P < 0.01), with no departure from linearity (P = 0.36). We observed radiogenic effects for both papillary and nonpapillary tumors. Estimates of excess relative risk per Gy (ERR/Gy) were homogeneous by sex (P = 0.35) and number of radiation treatments (P = 0.84) and increased with decreasing age at the time of exposure. The ERR/Gy estimate was significant within ten years of radiation exposure, 2.76 (95% CI, 0.94-4.98), based on 42 exposed cases, and remained elevated 50 years and more after exposure. Finally, exposure to chemotherapy was significantly associated with thyroid cancer, with results supporting a nonsynergistic (additive) association with radiation.

National Category
Radiology, Nuclear Medicine and Medical Imaging Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-122578 (URN)10.1667/RR14213.1 (DOI)000376755000004 ()27128740 (PubMedID)
Available from: 2016-06-20 Created: 2016-06-20 Last updated: 2018-06-07Bibliographically approved
Björ, O., Damber, L., Jonsson, H. & Nilsson, T. (2015). A comparison between standard methods and structural nested modelling when bias from a healthy worker survivor effect is suspected: an iron-ore mining cohort study. Occupational and Environmental Medicine, 72(7), 536-542
Open this publication in new window or tab >>A comparison between standard methods and structural nested modelling when bias from a healthy worker survivor effect is suspected: an iron-ore mining cohort study
2015 (English)In: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926, Vol. 72, no 7, p. 536-542Article in journal (Refereed) Published
Abstract [en]

Objectives Iron-ore miners are exposed to extremely dusty and physically arduous work environments. The demanding activities of mining select healthier workers with longer work histories (ie, the Healthy Worker Survivor Effect (HWSE)), and could have a reversing effect on the exposure-response association. The objective of this study was to evaluate an iron-ore mining cohort to determine whether the effect of respirable dust was confounded by the presence of an HWSE. Methods When an HWSE exists, standard modelling methods, such as Cox regression analysis, produce biased results. We compared results from g-estimation of accelerated failure-time modelling adjusted for HWSE with corresponding unadjusted Cox regression modelling results. Results For all-cause mortality when adjusting for the HWSE, cumulative exposure from respirable dust was associated with a 6% decrease of life expectancy if exposed >= 15 years, compared with never being exposed. Respirable dust continued to be associated with mortality after censoring outcomes known to be associated with dust when adjusting for the HWSE. In contrast, results based on Cox regression analysis did not support that an association was present. Conclusions The adjustment for the HWSE made a difference when estimating the risk of mortality from respirable dust. The results of this study, therefore, support the recommendation that standard methods of analysis should be complemented with structural modelling analysis techniques, such as g-estimation of accelerated failure-time modelling, to adjust for the HWSE.

Keywords
Cox regression, occupation, standardized incidence ratio, standardized mortality ratio
National Category
Occupational Health and Environmental Health
Research subject
Occupational and Environmental Medicine
Identifiers
urn:nbn:se:umu:diva-81789 (URN)10.1136/oemed-2014-102251 (DOI)000356298200012 ()
Note

Originally published in manuscript form with the title A comparison between standard methods and structural nested modeling when adjusting for the healthy worker survivor effect. 

Available from: 2013-10-22 Created: 2013-10-22 Last updated: 2018-06-08Bibliographically approved
Stattin, P., Sandin, F., Ortqvist, D., Damber, L., Holmberg, E., Cederberg, H. & Lambe, M. (2014). ONLINE REPORT IN REAL TIME FROM THE NATIONAL PROSTATE CANCER REGISTER (NPCR) OF SWEDEN, A NEW AND EFFICIENT TOOL FOR QUALITY ASSURANCE. BMJ Quality and Safety, 23(4), 350-350
Open this publication in new window or tab >>ONLINE REPORT IN REAL TIME FROM THE NATIONAL PROSTATE CANCER REGISTER (NPCR) OF SWEDEN, A NEW AND EFFICIENT TOOL FOR QUALITY ASSURANCE
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2014 (English)In: BMJ Quality and Safety, ISSN 2044-5415, E-ISSN 2044-5423, Vol. 23, no 4, p. 350-350Article in journal, Meeting abstract (Other academic) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-88271 (URN)10.1136/bmjqs-2014-002893.6 (DOI)000333002700019 ()
Available from: 2014-05-05 Created: 2014-04-29 Last updated: 2018-06-07Bibliographically approved
Björ, O., Jonsson, H., Damber, L., Wahlström, J. & Nilsson, T. (2013). Reduced mortality rates in a cohort of long-term underground iron-ore miners. American Journal of Industrial Medicine, 56(5), 531-540
Open this publication in new window or tab >>Reduced mortality rates in a cohort of long-term underground iron-ore miners
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2013 (English)In: American Journal of Industrial Medicine, ISSN 0271-3586, E-ISSN 1097-0274, Vol. 56, no 5, p. 531-540Article in journal, Editorial material (Refereed) Published
Abstract [en]

Background Historically, working in iron-ore mines has been associated with an increased risk of lung cancer and silicosis. However, studies on other causes of mortality are inconsistent and in the case of cancer incidence, sparse. The aim of this study was to examine the association between iron-ore mining, mortality and cancer incidence.

Methods A 54-year cohort study on iron-ore miners from mines in northern Sweden was carried out comprising 13,000 workers. Standardized rate ratios were calculated comparing the disease frequency, mortality, and cancer incidence with that of the general population of northern Sweden. Poisson regression was used to evaluate the association between the durations of employment and underground work, and outcome.

Results Underground mining was associated with a significant decrease in adjusted mortality rate ratios for cerebrovascular and digestive system diseases, and stroke. For several outcomes, elevated standardized rate ratios were observed among blue-collar workers relative to the reference population. However, only the incidence of lung cancer increased with employment time underground (P<0.001).

Conclusions Long-term iron-ore mining underground was associated with lower rates regarding several health outcomes. This is possibly explained by factors related to actual job activities, environmental exposure, or the selection of healthier workers for long-term underground employment.

Am. J. Ind. Med. 56:531540, 2013. (c) 2013 Wiley Periodicals, Inc.

Keywords
mining, occupational disease, occupational exposure, cancer incidence, mortality
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-71076 (URN)10.1002/ajim.22168 (DOI)000317684400005 ()
Available from: 2013-06-17 Created: 2013-05-20 Last updated: 2018-06-08Bibliographically approved
Jörgren, F., Johansson, R., Damber, L. & Lindmark, G. (2013). Validity of the Swedish Rectal Cancer Registry for patients treated with major abdominal surgery between 1995 and 1997. Acta Oncologica, 52(8), 1707-1714
Open this publication in new window or tab >>Validity of the Swedish Rectal Cancer Registry for patients treated with major abdominal surgery between 1995 and 1997
2013 (English)In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 52, no 8, p. 1707-1714Article in journal (Refereed) Published
Abstract [en]

Background. Founded in 1995, the Swedish Rectal Cancer Registry (SRCR) is frequently used for rectal cancer research. However, the validity of the registry has not been extensively studied. This study aims to validate a large amount of registry data to assess SRCR quality.

Material and methods. The study comprises 906 patients treated with major abdominal surgery registered in the SRCR between 1995 and 1997. SRCR data for 14 variables were scrutinized for validity against the medical records. Kappa's and Kendall's correlation coefficients for agreement between SRCR data and medical records data were calculated for 13 variables.

Results. For 11 variables, concerning the tumor, neoadjuvant therapy, the surgical procedure, local radicality and TNM stage, data were missing in 5% or less of the registrations; for the remaining three variables, anastomotic leakage, local and distant recurrence, data were missing in 13-38%. For the variables surgery performed or not and type of surgical procedure, no data were missing. Erroneous registrations were found in less than 10% of all variables; for the variables preoperative chemotherapy and surgery performed or not, all registrations were correct. For the variables concerning neoadjuvant therapy, local radicality according to the surgeon as well as the pathologist and distant metastasis, the false-positive or- negative registrations were equally distributed, and for the variables rectal washout, rectal perforation, anastomotic leakage and local recurrence there was a discrepancy in distribution. The correlation coefficient for 12 variables ranged from 0.82 to 1.00, and was 0.78 for the remaining variable.

Conclusion. The validity of the SRCR was good for the initial three registry years. Thus, research based on SRCR data is reliable from the beginning of the registry's use.

Place, publisher, year, edition, pages
Informa Healthcare, 2013
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-82792 (URN)10.3109/0284186X.2013.805886 (DOI)000325526300017 ()
Available from: 2013-11-12 Created: 2013-11-11 Last updated: 2018-06-08Bibliographically approved
Veiga, L. H. S., Lubin, J. H., Anderson, H., de Vathaire, F., Tucker, M., Bhatti, P., . . . Ron, E. (2012). A Pooled Analysis of Thyroid Cancer Incidence Following Radiotherapy for Childhood Cancer. Radiation Research, 178(4), 365-376
Open this publication in new window or tab >>A Pooled Analysis of Thyroid Cancer Incidence Following Radiotherapy for Childhood Cancer
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2012 (English)In: Radiation Research, ISSN 0033-7587, E-ISSN 1938-5404, Vol. 178, no 4, p. 365-376Article in journal (Refereed) Published
Abstract [en]

Childhood cancer five-year survival now exceeds 70-80%. Childhood exposure to radiation is a known thyroid carcinogen; however, data are limited for the evaluation of radiation dose-response at high doses, modifiers of the dose-response relationship and joint effects of radiotherapy and chemotherapy. To address these issues, we pooled two cohort and two nested case-control studies of childhood cancer survivors including 16,757 patients, with 187 developing primary thyroid cancer. Relative risks (RR) with 95% confidence intervals (CI) for thyroid cancer by treatment with alkylating agents, anthracyclines or bleomycin were 3.25 (0.9-14.9), 4.5 (1.4-17.8) and 3.2 (0.8-10.4), respectively, in patients without radiotherapy, and declined with greater radiation dose (RR trends, P = 0.02, 0.12 and 0.01, respectively). Radiation dose-related RRs increased approximately linearly for <10 Gy, leveled off at 10-15-fold for 10-30 Gy and then declined, but remained elevated for doses >50 Gy. The fitted RR at 10 Gy was 13.7 (95% CI: 8.0-24.0). Dose-related excess RRs increased with decreasing age at exposure (P < 0.01), but did not vary with attained age or time-since-exposure, remaining elevated 25+ years after exposure. Gender and number of treatments did not modify radiation effects. Thyroid cancer risks remained elevated many decades following radiotherapy, highlighting the need for continued follow up of childhood cancer survivors. (C) 2012 by Radiation Research Society

Place, publisher, year, edition, pages
Lawrence: Radiation Research Society, 2012
National Category
Radiology, Nuclear Medicine and Medical Imaging Biophysics
Identifiers
urn:nbn:se:umu:diva-61569 (URN)10.1667/RR2889.1 (DOI)000309791000013 ()
Available from: 2012-11-28 Created: 2012-11-20 Last updated: 2018-06-08Bibliographically approved
Jorgren, F., Johansson, R., Damber, L. & Lindmark, G. (2011). Anastomotic leakage after surgery for rectal cancer: a risk factor for local recurrence, distant metastasis and reduced cancer-specific survival?. Colorectal Disease, 13(3), 272-283
Open this publication in new window or tab >>Anastomotic leakage after surgery for rectal cancer: a risk factor for local recurrence, distant metastasis and reduced cancer-specific survival?
2011 (English)In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 13, no 3, p. 272-283Article in journal (Refereed) Published
Abstract [en]

Aim The impact of anastomic leakage (AL) on the oncological outcome after anterior resection (AR) for rectal cancer is still controversial. We explored the impact of AL regarding local recurrence (LR), distant metastasis and overall recurrence (OAR). Overall and cancer-specific survival was analysed. Method Patients undergoing AR for rectal cancer with a registered AL between 1995 and 1997 and a control group were identified in the Swedish Rectal Cancer Registry. The medical records were retrieved for additional data and validation. Differences in the oncological outcome at 5-year follow-up were analysed with multivariate methods. Results After validation, 114 patients with AL and 136 control patients with locally radical surgery for tumours in tumour-node-metastasis stages I-III were analysed. There was no difference detected between patients with AL and control patients regarding rates of LR [8% (9 of 114) vs 9% (12 of 136); P = 0.97], distant metastasis [18% (20 of 114) vs 23% (31 of 136); P = 0.37] and OAR [19% (22 of 114) vs 28% (38 of 136); P = 0.15]. The 5-year cancer-specific survival was almost 80% in both groups. In multivariate analysis, AL was not a risk factor of LR, distant metastasis or OAR and had no impact on 5-year overall or 5-year cancer-specific survival. Irrespective of the occurrence of AL, preoperative radiotherapy (P = 0.055) and rectal washout (P = 0.046) reduced the LR rate, but did not influence survival. Conclusion Anastomotic leakage was not proved to be a risk factor of worse oncological outcome. Hence, additional adjuvant treatment or extended follow-up on the basis of the occurrence of AL after AR might not be justified.

Keywords
Rectal neoplasm, anterior resection, anastomosis, neoplasm recurrence, neoplasm metastasis, survival rate
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-104492 (URN)10.1111/j.1463-1318.2009.02136.x (DOI)000287317000010 ()19912285 (PubMedID)
Available from: 2015-06-12 Created: 2015-06-11 Last updated: 2018-06-07Bibliographically approved
Bergdahl, I. A., Jonsson, H., Eriksson, K., Damber, L. & Järvholm, B. (2010). Lung cancer and exposure to quartz and diesel exhaust in Swedish iron ore miners with concurrent exposure to radon. Occupational and Environmental Medicine, 67(8), 513-518
Open this publication in new window or tab >>Lung cancer and exposure to quartz and diesel exhaust in Swedish iron ore miners with concurrent exposure to radon
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2010 (English)In: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926, Vol. 67, no 8, p. 513-518Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Studies of underground miners have documented an increased risk of lung cancer mainly linked to radon exposure but possibly influenced by other concurrent exposures. METHODS: A cohort study was carried out in 8321 iron ore miners with low exposure to radon, employed in 1923-1998 and followed up for lung cancer in 1958-2000. Historical exposures to radon, crystalline silica and diesel exhaust were assessed. Data including exposure to radon, quartz and diesel exhaust from another mine with higher exposure to radon were reanalysed. RESULTS: Miners had increased risk for lung cancer (SIR 1.48 (95% CI 1.22 to 1.78), based on 112 cases during 227,000 person-years). The increased risk could not be explained by exposure to radon or diesel exhaust but was associated with exposure to crystalline silica: SIR 0.96 (0.53 to 1.62), 1.45 (1.10 to 1.87), 1.99 (1.31 to 2.90) and 1.77 (0.92 to 3.10) in groups with exposure to 0, 0-2, 2-5 and >5 mg years/m3, respectively. Reanalysis of data from the other mine indicated that quartz was a possible confounder in the analysis of relationship between radon and lung cancer. In the highest radon exposed group, the point estimate for the RR decreased from 5.65 to 3.90 when adjusting for concurrent exposure to quartz. CONCLUSIONS: Crystalline silica, a known carcinogen, probably affects lung cancer risk in iron ore miners. The main implication of the results is for interpretation of the dose-response curve for radon and lung cancer in underground iron ore miners. Since exposure to radon and quartz is often correlated, quartz exposure can be an important confounder.

Identifiers
urn:nbn:se:umu:diva-36825 (URN)10.1136/oem.2009.047456 (DOI)000280116200004 ()20519746 (PubMedID)
Available from: 2010-10-12 Created: 2010-10-12 Last updated: 2018-06-08Bibliographically approved
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