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Jonsson, Håkan
Publications (10 of 96) Show all publications
Jonsson, H., Andersson, A., Mao, Z. & Nyström, L. (2024). Age-specific differences in tumour characteristics between screen-detected and non-screen-detected breast cancers in women aged 40–74 at diagnosis in Sweden from 2008 to 2017. Journal of Medical Screening
Open this publication in new window or tab >>Age-specific differences in tumour characteristics between screen-detected and non-screen-detected breast cancers in women aged 40–74 at diagnosis in Sweden from 2008 to 2017
2024 (English)In: Journal of Medical Screening, ISSN 0969-1413, E-ISSN 1475-5793Article in journal (Refereed) Epub ahead of print
Abstract [en]

Objective:  To analyze differences between screen-detected and non-screen-detected invasive breast cancers by tumour characteristics and age at diagnosis in the nationwide population-based mammography screening program in Sweden.

Methods:  Data were retrieved from the National Quality Register for Breast Cancer for 2008-2017. Logistic regression analysis was used to estimate the likelihood for a tumour to be screen-detected by tumour characteristics and age group at diagnosis.

Results:  In total there were 51,429 invasive breast cancers in the target age group for mammography screening of 40-74 years. Likelihood of screen detection decreased with larger tumour size, lymph node metastases, higher histological grade and distant metastasis. Odds ratios (ORs) for negative oestrogen (ER) and progesterone (PgR) were 0.41 and 0.57; for positive HER2, 0.62; for Ki-67 high versus low, 0.49. Molecular sub-types had OR of 0.56, 0.40 and 0.28, respectively, for luminal B-like, HER2-positive and triple negative versus luminal A-like. Adjusting for tumour size (T), lymph node status (N), age, year and county at diagnosis slightly elevated the ORs. Statistically significant interactions between tumour characteristics and age were found (p < 0.05) except for ER and PgR. The age group 40-49 deviated most from the other age groups.

Conclusions:  Our study demonstrates that screen-detected invasive breast cancers had more favourable tumour characteristics than non-screen-detected after adjusting for age, year and county of diagnosis, and even after adjusting for T and N. The trend towards favourable tumour characteristics was less pronounced in the 40-49 age group compared to the other age groups, except for ER and PgR.

Place, publisher, year, edition, pages
Sage Publications, 2024
Keywords
Breast cancer, detection mode, mammography, screening program, tumour characteristics
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-222415 (URN)10.1177/09691413241237616 (DOI)38454634 (PubMedID)2-s2.0-85187110390 (Scopus ID)
Funder
Cancerforskningsfonden i Norrland
Available from: 2024-03-22 Created: 2024-03-22 Last updated: 2024-03-22
Blom, J., Saraste, D., Törnberg, S. & Jonsson, H. (2024). Routine fecal occult blood screening and colorectal cancer mortality in Sweden. JAMA Network Open, 7(2), Article ID e240516.
Open this publication in new window or tab >>Routine fecal occult blood screening and colorectal cancer mortality in Sweden
2024 (English)In: JAMA Network Open, E-ISSN 2574-3805, Vol. 7, no 2, article id e240516Article in journal (Refereed) Published
Abstract [en]

Importance: Population-based colorectal cancer (CRC) screening programs are implemented worldwide, but there are difficulties evaluating their effectiveness. The magnitude of routine CRC screening effectiveness regarding cancer-specific mortality is unclear.

Objective: To evaluate cancer-specific mortality associated with early vs late or no invitation for routine CRC screening using fecal occult blood testing.

Design, Setting, and Participants: This prospective cohort study was performed in the region of Stockholm-Gotland, Sweden, between January 1, 2008, and December 31, 2021. All individuals of the target population of screening born from 1938 to 1954 were included. Data were analyzed from December 12, 2022, to June 25, 2023.

Exposures: Individuals were invited early (2008-2012), late (2013-2015), or not at all to screening with biennial guaiac-based fecal occult blood test. The early invitation group was considered the exposure group and the late or no invitation group was considered the control group.

Main Outcomes and Measures: The main outcome was cancer-specific mortality, defined as CRC registered in the Cancer Register with CRC as underlying cause of death in the Cause of Death Register. Excess mortality was calculated as all-cause deaths among the individuals with CRC subtracted from the expected number of deaths had they not had CRC. Poisson regression analysis based on deaths and person-years was used to estimated mortality rate ratio (RR) with 95% CIs, adjusted for follow-up years and attained age.

Results: In total, 379 448 individuals (193 436 [51.0%] female) were invited for CRC screening, including 203 670 individuals in the exposure group and 175 778 in the control group. The mean screening participation rate was 63.3%, and there was a maximum of 14 years follow-up. There were 834 CRC deaths in 2 190 589 person-years in the exposure group, compared with 889 CRC deaths in 2 249 939 person-years in the control group. Individuals who underwent early CRC screening had reduced adjusted risk of CRC mortality (RR, 0.86; 95% CI, 0.78-0.95) and excess mortality (RR, 0.84; 95% CI, 0.75-0.93).

Conclusions and Relevance: This prospective cohort study of routine screening with fecal occult blood testing found a 14% decrease in CRC mortality associated with screening. The true association of screening with reduced mortality is expected to be higher due to some coexistence of testing in the control group and CRC deaths diagnosed more than 2 years after screening.

Place, publisher, year, edition, pages
American Medical Association (AMA), 2024
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-222354 (URN)10.1001/jamanetworkopen.2024.0516 (DOI)38411959 (PubMedID)2-s2.0-85186749576 (Scopus ID)
Funder
Swedish Cancer Society, 21 1389Swedish Research Council, 2021-03139Region Stockholm, FoUI-961412
Available from: 2024-03-15 Created: 2024-03-15 Last updated: 2024-03-15Bibliographically approved
Sun, S., Jonsson, H., Sahlen, K.-G., Andén, M., Beckman, L. & Fransson, P. (2023). Is ultra-hypo-fractionated radiotherapy more cost-effective relative to conventional fractionation in treatment of prostate cancer? A cost–utility analysis alongside a randomized HYPO-RT-PC trial. European Journal of Health Economics, 24, 237-246
Open this publication in new window or tab >>Is ultra-hypo-fractionated radiotherapy more cost-effective relative to conventional fractionation in treatment of prostate cancer? A cost–utility analysis alongside a randomized HYPO-RT-PC trial
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2023 (English)In: European Journal of Health Economics, ISSN 1618-7598, E-ISSN 1618-7601, Vol. 24, p. 237-246Article in journal (Refereed) Published
Abstract [en]

Background: Economic evidence for comparing low fraction with ultra-hypo fractionated (UHF) radiation therapy in the treatment of intermediate-to-high-risk prostate cancer (PC) is lacking, especially in Europe. This study presents an economic evaluation performed alongside an ongoing clinical trial.

Aim: To investigate up to 6 years’ follow-up whether conventional fractionation (CF, 78.0 Gy in 39 fractions, 5 days per week for 8 weeks) is more cost-effective than UHF (42.7 Gy in 7 fractions, 3 days per week for 2.5 weeks inclusive of 2 weekends) radiotherapy in treatment for patients with intermediate-to-high-risk PC.

Method: HYPO-RT-PC trial is an open-label, randomized, multicenter (10 in Sweden; 2 in Denmark) phase-3 trial. Patients from Sweden (CF 434; UHF 445) were included in this study. The trial database was linked to the National Patient Registry (NPR). Costs for inpatient/non-primary outpatient care for each episode were retrieved. For calculating Quality-adjusted life years (QALYs), the EORTC QLQ-C30 questionnaire was mapped to the EQ-5D-3L index. Multivariable regression analyses were used to compare the difference in costs and QALYs, adjusting for age and baseline costs, and health status. The confidence interval for the difference in costs, QALYs and incremental cost-effectiveness ratio effectiveness ratio (ICER) was estimated by the bootstrap percentile method.

Results: No significant differences were found in ICER between the two arms after 6 years of follow-up.

Conclusion: The current study did not support that the ultra-hypo-fractionated treatment was more cost-effective than the conventional fraction treatment up to the sixth year of the trial.

Place, publisher, year, edition, pages
Springer, 2023
Keywords
Cost–utility analysis, Prostate cancer, Within-trial economic evaluation, Radiotherapy, Intermediate-to-highrisk cancer
National Category
Cancer and Oncology
Research subject
Radiography; Economics
Identifiers
urn:nbn:se:umu:diva-194827 (URN)10.1007/s10198-022-01467-5 (DOI)000797784900001 ()35587847 (PubMedID)2-s2.0-85130499893 (Scopus ID)
Funder
Prostatacancerförbundet
Available from: 2022-05-19 Created: 2022-05-19 Last updated: 2023-07-13Bibliographically approved
Jonsson, S., Jonsson, H., Lundin, E., Häggström, C. & Idahl, A. (2023). Pelvic inflammatory disease and risk of epithelial ovarian cancer: a national population-based case-control study in Sweden. American Journal of Obstetrics and Gynecology, 230(1), 75.e1-75.e15
Open this publication in new window or tab >>Pelvic inflammatory disease and risk of epithelial ovarian cancer: a national population-based case-control study in Sweden
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2023 (English)In: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 230, no 1, p. 75.e1-75.e15Article in journal (Refereed) Published
Abstract [en]

Background: Epithelial ovarian cancer is an insidious disease, and women are often diagnosed when the disease is beyond curative treatment. Accordingly, identifying modifiable risk factors is of paramount importance. Inflammation predisposes an individual to cancer in various organs, but whether pelvic inflammatory disease is associated with an increased risk of epithelial ovarian cancer has not been fully determined.

Objective: This study aimed to investigate a possible association between clinically verified pelvic inflammatory disease and the risk of epithelial ovarian cancer.

Study Design: In this national population-based case-control study, all women in Sweden diagnosed with epithelial ovarian cancer between 1999 and 2020 and 10 controls for each were identified, matched for age and residential district. Using several Swedish nationwide registers, data on previous pelvic inflammatory disease and potential confounding factors (age, parity, educational level, and previous gynecologic surgery) were retrieved. Adjusted odds ratios and 95% confidence intervals were estimated using conditional logistic regression. Histotype-specific analyses were performed for the subgroup of women diagnosed with epithelial ovarian cancer between 2015 and 2020. Moreover, hormonal contraceptives and menopausal hormone therapy were adjusted in addition to the aforementioned confounders.

Results: This study included 15,072 women with epithelial ovarian cancer and 141,322 controls. Most women (9102 [60.4%]) had serous carcinoma. In a subgroup of cases diagnosed between 2015 and 2020, high-grade serous carcinoma (2319 [60.0%]) was identified. A total of 168 cases (1.1%) and 1270 controls (0.9%) were diagnosed with pelvic inflammatory disease. Previous pelvic inflammatory disease was associated with an increased risk of epithelial ovarian cancer (adjusted odds ratio, 1.39; 95% confidence interval, 1.17–1.66) and serous carcinoma (adjusted odds ratio, 1.46; 95% confidence interval, 1.18–1.80) for the entire study population. For the subgroup of women diagnosed in 2015–2020, pelvic inflammatory disease was associated with high-grade serous carcinoma (adjusted odds ratio, 1.43; 95% confidence interval, 1.01–2.04). The odds ratios of the other histotypes were as follows: endometrioid (adjusted odds ratio, 0.13; 95% confidence interval, 0.02–1.06), mucinous (adjusted odds ratio, 1.55; 95% confidence interval, 0.56–4.29), and clear cell carcinoma (adjusted odds ratio, 2.30; 95% confidence interval, 0.90–5.86). A dose-response relationship was observed between the number of pelvic inflammatory disease episodes and the risk of epithelial ovarian cancer (Ptrend<.001).

Conclusion: A history of pelvic inflammatory disease is associated with an increased risk of epithelial ovarian cancer and a dose-response relationship is evident. Histotype-specific analyses show an association with increased risk of serous epithelial ovarian cancer and high-grade serous carcinoma and potentially also with clear cell carcinoma, but there is no significant association with other histotypes. Infection and inflammation of the upper reproductive tract might have serious long-term consequences, including epithelial ovarian cancer.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
epithelial ovarian cancer, high-grade serous carcinoma, ovarian cancer, pelvic inflammatory disease, population-based case-control study
National Category
Obstetrics, Gynecology and Reproductive Medicine Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-216205 (URN)10.1016/j.ajog.2023.09.094 (DOI)37778677 (PubMedID)2-s2.0-85175294490 (Scopus ID)
Available from: 2023-11-06 Created: 2023-11-06 Last updated: 2024-01-05Bibliographically approved
Morian, H., Härgestam, M., Hultin, M., Jonsson, H., Jonsson, K., Nordahl Amorøe, T. & Creutzfeldt, J. (2023). Reliability and validity testing of team emergency assessment measure in a distributed team context. Frontiers in Psychology, 14, Article ID 1110306.
Open this publication in new window or tab >>Reliability and validity testing of team emergency assessment measure in a distributed team context
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2023 (English)In: Frontiers in Psychology, E-ISSN 1664-1078, Vol. 14, article id 1110306Article in journal (Refereed) Published
Abstract [en]

Medical multi-professional teams are increasingly collaborating via telemedicine. In distributed team settings, members are geographically separated and collaborate through technology. Developing improved training strategies for distributed teams and finding appropriate instruments to assess team performance is necessary. The Team Emergency Assessment Measure (TEAM), an instrument validated in traditional collocated acute-care settings, was tested for validity and reliability in this study when used for distributed teams. Three raters assessed video recordings of simulated team training scenarios (n = 18) among teamswith varying levels of proficiency working with a remotely located physician via telemedicine. Inter-rater reliability, determined by intraclass correlation, was 0.74–0.92 on the TEAM instrument’s three domains of leadership, teamwork, and task management. Internal consistency (Cronbach’s alpha) ranged between 0.89–0.97 for the various domains. Predictive validity was established by comparing scores with proficiency levels. Finally, concurrent validity was established by high correlations, >0.92, between scores in the three TEAM domains and the teams’overall performance. Our results indicate that TEAM can be used in distributed acute-care team settings and consequently applied in future-directed learning and research on distributed healthcare teams.

Keywords
interprofessional teams, team performance, teamwork, distributed team, telemedicine, instrument, validation, assessments
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-206995 (URN)10.3389/fpsyg.2023.1110306 (DOI)000979890100001 ()2-s2.0-85158024637 (Scopus ID)
Funder
The Kamprad Family Foundation
Available from: 2023-04-24 Created: 2023-04-24 Last updated: 2023-06-02Bibliographically approved
Anyatonwu, O. P., Nwoku, K. A., Jonsson, H. & Namatovu, F. (2023). The determinants of postpartum contraceptive use in Nigeria. Frontiers in Global Women's Health, 4, Article ID 1284614.
Open this publication in new window or tab >>The determinants of postpartum contraceptive use in Nigeria
2023 (English)In: Frontiers in Global Women's Health, E-ISSN 2673-5059, Vol. 4, article id 1284614Article in journal (Refereed) Published
Abstract [en]

Introduction: Postpartum contraception is vital for maternal and child health, and reduces the risk of infant mortality. The Health Belief Model (HBM) is a widely accepted framework for exploring health behaviors, such as contraceptive use. Therefore, this study aimed to investigate the factors influencing postpartum contraceptive use in Nigeria and to contextualize the findings within the framework of the HBM.

Methods: This study was a secondary analysis of cross-sectional data collected from the Demographic Health Survey conducted in Nigeria (NDHS). In total, 28,041 women were included in this study. Self-reported contraceptive use was the outcome, while the explanatory variables included maternal age, place of residence, region of residence, religion, marital status, educational level, household wealth quintiles, knowledge of the ovulatory cycle, decision-maker for health care, and distance to health care facilities. Descriptive statistics and multivariate logistic regression were used to summarize and identify factors influencing postpartum contraceptive use. The HBM was used to discuss the main findings.

Results: The prevalence of postpartum contraceptive use in Nigeria is 27%. Our findings showed that the odds of using contraceptives during the postpartum period were higher among women who knew their ovulation cycles, lived in urban areas in the southern region, had no distance barriers to health care, and were 25–49 years old. Education, wealth, and marital status also increase the odds of contraceptive use. However, women who lived in the northeast and northwest regions or shared decision-making with their partners had lower odds.

Conclusion: This study highlights the need for region-specific and age-focused interventions to increase contraceptive use in Nigeria. Additionally, increasing accessibility and affordability of contraceptives for younger and economically disadvantaged women, along with promoting women's autonomy in decision-making, can further enhance contraceptive use across Nigeria.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2023
Keywords
birth spacing, family planning, fertility, HBM, postpartum, women’s health
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-219084 (URN)10.3389/fgwh.2023.1284614 (DOI)001129731400001 ()38148926 (PubMedID)2-s2.0-85180684770 (Scopus ID)
Available from: 2024-01-11 Created: 2024-01-11 Last updated: 2024-01-11Bibliographically approved
Meili, K. W., Jonsson, H., Lindholm, L. & Månsdotter, A. (2022). Perceived changes in capability during the COVID-19 pandemic: A Swedish cross-sectional study from June 2020. Scandinavian Journal of Public Health, 50(1), 102-110
Open this publication in new window or tab >>Perceived changes in capability during the COVID-19 pandemic: A Swedish cross-sectional study from June 2020
2022 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 50, no 1, p. 102-110Article in journal (Refereed) Published
Abstract [en]

Aims: Measures against COVID-19 potentially impact quality of life in different ways. The capability approach by Amartya Sen with a broad and consistent framework for measuring quality of life is suited to capture the various consequences. We aimed to examine (a) whether individuals experienced change in 10 capability dimensions during the first half of 2020, (b) which dimensions were affected most, and (c) whether changes were unequally distributed in terms of gender, education, income, geography, housing, living situation and place of birth.

Methods: We assessed self-reported capability change in Sweden in 10 capability dimensions in a cross-sectional online survey among 500 participants on a five-item Likert scale. We analysed the distribution of answers by comparing the balance of positive and negative perceived changes and used mixed effects logistic regression to examine associations with background characteristics of the participants.

Results: Reported perceived negative changes outweighed positive changes, and a higher proportion stated negative perceived changes if they also stated having low capability in the same dimension. In the capabilities of financial situation, political resources and health, the proportions of perceived negative change were highest. Odds for perceived negative change compared to no or positive change were higher for higher incomes, living in medium-sized municipalities, being born outside Europe, living in the south of Sweden, and renting instead of owning housing.

Conclusions: Self-reported negative capability change, and associated inequalities related to socioeconomic position, place of birth and regional residence should be of concern for policymakers.

Place, publisher, year, edition, pages
Sage Publications, 2022
Keywords
Quality of life, capability approach, COVID-19, cross-sectional survey
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-185846 (URN)10.1177/14034948211023633 (DOI)000672123300001 ()34213363 (PubMedID)2-s2.0-85109165611 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2018-00143
Available from: 2021-07-08 Created: 2021-07-08 Last updated: 2022-07-13Bibliographically approved
Duffy, S. W., Tabár, L., Yen, A.-F. M., Dean, P. B., Smith, R. A., Jonsson, H., . . . Chen, T.-H. H. (2021). Beneficial effect of consecutive screening mammography examinations on mortality from breast cancer: a prospective study. Radiology, 299(3), 541-547
Open this publication in new window or tab >>Beneficial effect of consecutive screening mammography examinations on mortality from breast cancer: a prospective study
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2021 (English)In: Radiology, ISSN 0033-8419, E-ISSN 1527-1315, Vol. 299, no 3, p. 541-547Article in journal (Refereed) Published
Abstract [en]

Background: Previously, the risk of death from breast cancer was analyzed for women participating versus those not participating in the last screening examination before breast cancer diagnosis. Consecutive attendance patterns may further refine estimates.

Purpose: To estimate the effect of participation in successive mammographic screening examinations on breast cancer mortality.

Materials and Methods: Participation data for Swedish women eligible for screening mammography in nine counties from 1992 to 2016 were linked with data from registries and regional cancer centers for breast cancer diagnosis, cause, and date of death (Uppsala University ethics committee registration number: 2017/147). Incidence-based breast cancer mortality was calculated by whether the women had participated in the most recent screening examination prior to diagnosis only (intermittent participants), the penultimate screening examination only (lapsed participants), both examinations (serial participants), or neither examination (serial nonparticipants). Rates were analyzed with Poisson regression. We also analyzed incidence of breast cancers proving fatal within 10 years.

Results: Data were available for a total average population of 549 091 women (average age, 58.9 years 6 6.7 [standard deviation]). The numbers of participants in the four groups were as follows: serial participants, 392 135; intermittent participants, 41 746; lapsed participants, 30 945; and serial nonparticipants, 84 265. Serial participants had a 49% lower risk of breast cancer mortality (relative risk [RR], 0.51; 95% CI: 0.48, 0.55; P ,.001) and a 50% lower risk of death from breast cancer within 10 years of diagnosis (RR, 0.50; 95% CI: 0.46, 0.55; P ,.001) than serial nonparticipants. Lapsed and intermittent participants had a smaller reduction. Serial participants had significantly lower risk of both outcomes than lapsed or intermittent participants. Analyses correcting for potential biases made little difference to the results.

Conclusion: Women participating in the last two breast cancer screening examinations prior to breast cancer diagnosis had the largest reduction in breast cancer death. Missing either one of the last two examinations conferred a significantly higher risk.

Place, publisher, year, edition, pages
Radiological Society of North America (RSNA), 2021
National Category
Cancer and Oncology Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:umu:diva-186354 (URN)10.1148/radiol.2021203935 (DOI)000655251600016 ()33650900 (PubMedID)2-s2.0-85105529822 (Scopus ID)
Funder
The Breast Cancer Foundation
Available from: 2021-07-23 Created: 2021-07-23 Last updated: 2023-11-22Bibliographically approved
Mao, Z., Nyström, L. & Jonsson, H. (2021). Breast cancer screening with mammography in women aged 40-49 years: impact of length of screening interval on effectiveness of the program. Journal of Medical Screening, 28(2), 200-206, Article ID 0969141320918283.
Open this publication in new window or tab >>Breast cancer screening with mammography in women aged 40-49 years: impact of length of screening interval on effectiveness of the program
2021 (English)In: Journal of Medical Screening, ISSN 0969-1413, E-ISSN 1475-5793, Vol. 28, no 2, p. 200-206, article id 0969141320918283Article in journal (Refereed) Published
Abstract [en]

Objectives: To estimate the impact on the effectiveness of Swedish breast cancer screening program in women aged 40-49 years of shortening the screening interval from 21 months to 18 or 12 months.

Methods: The reduction in breast cancer mortality among participants in screening with mammography was previously estimated in the Swedish SCReening of Young women (SCRY) study to be 29%. The expected increased effectiveness with a hypothetical shorter screening interval than the average of 21 months in SCRY was calculated using data about the women who died from breast cancer even though they participated in the SCRY program.

Results: During the study period, 547 women who participated in the index screening round died from breast cancer. Shortening the screening interval to 18 months led to an improved effectiveness of 0.7-3.9% considering interval cancers only and of 1.3-7.6% considering screening-detected cancers only, and for both interval and screening-detected cancers the improvement was 1.9-11.5% when the assumed mortality reduction for the deceased cases varied from 5% to 30%. Shortening the screening interval to 12 months increased the effectiveness by 1.6-9.8% for interval cancers and by 2.9-17.4% for both interval and screening-detected cancers.

Conclusion: Shortening the screening interval for women aged 40-49 years to 18 or 12 months might further reduce the breast cancer mortality rate.

Place, publisher, year, edition, pages
Sage Publications, 2021
Keywords
Breast cancer, mammography, mortality, evaluation, screening interval
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-174263 (URN)10.1177/0969141320918283 (DOI)000532947200001 ()32404033 (PubMedID)2-s2.0-85084573812 (Scopus ID)
Note

Article first published online: May 13, 2020

Available from: 2020-08-19 Created: 2020-08-19 Last updated: 2021-12-10Bibliographically approved
Wood, A. M., Jonsson, H., Nagel, G., Häggström, C., Manjer, J., Ulmer, H., . . . Stocks, T. (2021). The inverse association of body mass index with lung cancer: Exploring residual confounding, metabolic aberrations and within-person variability in smoking. Cancer Epidemiology, Biomarkers and Prevention, 30(8), 1489-1497
Open this publication in new window or tab >>The inverse association of body mass index with lung cancer: Exploring residual confounding, metabolic aberrations and within-person variability in smoking
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2021 (English)In: Cancer Epidemiology, Biomarkers and Prevention, ISSN 1055-9965, E-ISSN 1538-7755, Vol. 30, no 8, p. 1489-1497Article in journal (Refereed) Published
Abstract [en]

Background: The inverse observational association between body mass index (BMI) and lung cancer risk remains unclear. We assessed whether the association is explained by metabolic aberrations, residual confounding, and within-person variability in smoking, and compared against other smoking-related cancers.

Methods: We investigated the association between BMI, and its combination with a metabolic score (MS) of mid-blood pressure, glucose, and triglycerides, with lung cancer and other smoking-related cancers in 778,828 individuals. We used Cox regression, adjusted and corrected for within-person variability in smoking (status/pack-years), calculated from 600,201 measurements in 221,958 participants.

Results: Over a median follow-up of 20 years, 20,242 smoking-related cancers (6,735 lung cancers) were recorded. Despite adjustment and correction for substantial within-person variability in smoking, BMI remained inversely associated with lung cancer [HR per standard deviation increase, 0.87 (95% confidence interval 0.85–0.89)]. Individuals with BMI less than 25 kg/m2 and high MS had the highest risk [HR 1.52 (1.44–1.60) vs. BMI ≥25 with low MS]. These associations were weaker and nonsignificant among nonsmokers. Similar associations were observed for head and neck cancers and esophageal squamous cell carcinoma, whereas for other smoking-related cancers, we generally observed positive associations with BMI.

Conclusions: The increased lung cancer risk with low BMI and high MS is unlikely due to residual confounding and within-person variability in smoking. However, similar results for other cancers strongly related to smoking suggest a remaining, unknown, effect of smoking.

Impact: Extensive smoking-adjustments may not capture all the effects of smoking on the relationship between obesity-related factors and risk of smoking-related cancers.

Place, publisher, year, edition, pages
American Association for Cancer Research Inc, 2021
National Category
Public Health, Global Health, Social Medicine and Epidemiology Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-186556 (URN)10.1158/1055-9965.EPI-21-0058 (DOI)000681661300004 ()2-s2.0-85111624918 (Scopus ID)
Available from: 2021-08-11 Created: 2021-08-11 Last updated: 2023-09-05Bibliographically approved
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