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5. The validity of self-reported use of hormone replacement therapy among Danish nurses

Author

Løkkegaard, E. L., Søren Paaske Johnsen, Heitmann, B. L., Stahlberg, C., Pedersen, A. T., Obel, E. B., Hundrup, Y. A., Hallas, J., and Henrik Toft Sørensen

Subjects
Self-Assessment, Denmark, Estrogen Replacement Therapy, Nurses, Obstetrics and Gynecology, General Medicine, Middle Aged, Sensitivity and Specificity, Cohort Studies, Postmenopause, Surveys and Questionnaires, Humans, Female, Aged
Abstract

Recent findings from randomized clinical trials on the effects of hormone replacement therapy (HRT) among postmenopausal women contradict findings from observational studies indicating a protective effect on the development of cardiovascular disease. Most observational studies on HRT are based on self-reported data, although data on the validity of HRT in postmenopausal women are sparse.We examined self-reported HRT use from questionnaires administered in 1993 (n = 2694) and again in 1999 (n = 2666) to a cohort of Danish nurses living in two Danish counties compared with prescription-reimbursement data from two administrative databases through the Danish National Health Service.The sensitivity and specificity of the self-reported, current HRT use in 1993 were 78.4%[95% confidence interval (95% CI) 75.4-81.4] and 98.4% (95% CI 97.8-98.9), respectively. In 1999, the estimates were 74.8% (95% CI 72.0-77.7) and 98.0% (95% CI 97.3-98.8), respectively. None of the factors examined--including age, alcohol intake, physical activity, smoking, presence of hypertension, and body mass index--was strongly associated with validity. We found a relatively high validity of self-reported data on HRT use. Furthermore, agreement between self-reported and registry-based data was not strongly associated with a range of demographic and lifestyle factors.These findings suggest that use of self-reported data is not an important contributor to the apparent discrepancy between observational studies and randomized trials on the cardiovascular effects of HRT use.

Published
2004
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8. Menarche, menopause, and breast cancer risk: individual participant meta-analysis, including 118 964 women with breast cancer from 117 epidemiological studies

Author

Beral, V, Bull, D, Pirie, K, Reeves, G, Peto, R, Skegg, D, LaVecchia, C, Magnusson, C, Pike, MC, Thomas, D, Hamajima, N, Hirose, K, Tajima, K, Rohan, T, Friedenreich, CM, Calle, EE, Gapstur, SM, Patel, AV, Coates, RJ, Liff, JM, Talamini, R, Chantarakul, N, Koetsawang, S, Rachawat, D, Marcou, Y, Kakouri, E, Duffy, SW, Morabia, A, Schuman, L, Stewart, W, Szklo, M, Coogan, PF, Palmer, JR, Rosenberg, L, Band, P, Coldman, AJ, Gallagher, RP, Hislop, TG, Yang, P, Cummings, SR, Canfell, K, Sitas, F, Chao, P, Lissowska, J, Horn-Ross, PL, John, EM, Kolonel, LM, Nomura, AMY, Ghiasvand, R, Hu, J, Johnson, KC, Mao, Y, Callaghan, K, Crossley, B, Goodill, A, Green, J, Hermon, C, Key, T, Lindgard, I, Liu, B, Collins, R, Doll, R, Bishop, T, Fentiman, IS, De Sanjose, S, Gonzaler, CA, Lee, N, Marchbanks, P, Ory, HW, Peterson, HB, Wingo, P, Ebeling, K, Kunde, D, Nishan, P, Hopper, JL, Eliassen, H, Gajalakshmi, V, Martin, N, Pardthaisong, T, Silpisornkosol, S, Theetranont, C, Boosiri, B, Chutivongse, S, Jimakorn, P, Virutamasen, P, Wongsrichanalai, C, Neugut, A, Santella, R, Baines, CJ, Kreiger, N, Miller, AB, Wall, C, Tjonneland, A, Jorgensen, T, Stahlberg, C, Pedersen, AT, Flesch-Janys, D, Hakansson, N, Cauley, J, Heuch, I, Adami, HO, Persson, I, Weiderpass, E, Chang-Claude, J, Kaaks, R, McCredie, M, Paul, C, Skegg, DCG, Spears, GFS, Iwasaki, M, Tsugane, S, Anderson, G, Daling, JR, Hampton, J, Hutchinson, WB, Li, CI, Malone, K, Mandelson, M, Newcomb, P, Noonan, EA, Ray, RM, Stanford, JL, Tang, MTC, Thomas, DB, Weiss, NS, White, E, Izquierdo, A, Viladiu, P, Fourkala, EO, Jacobs, I, Menon, U, Ryan, A, Cuevas, HR, Ontiveros, P, Palet, A, Salazar, SB, Aristizabal, N, Cuadros, A, Tryggvadottir, L, Tulinius, H, Riboli, E, Andrieu, N, Bachelot, A, Le, MG, Bremond, A, Gairard, B, Lansac, J, Piana, L, Renaud, R, Clavel-Chapelon, F, Fournier, A, Touillaud, M, Mesrine, S, Chabbert-Buffet, N, Boutron-Ruault, MC, Wolk, A, Torres-Mejia, G, Franceschi, S, Romieu, I, Boyle, P, Lubin, F, Modan, B, Ron, E, Wax, Y, Friedman, GD, Hiatt, RA, Levi, F, Kosmelj, K, Primic-Zakelj, M, Ravnihar, B, Stare, J, Ekbom, A, Erlandsson, G, Beeson, WL, Fraser, G, Peto, J, Hanson, RL, Leske, MC, Mahoney, MC, Nasca, PC, Varma, AO, Weinstein, AL, Hartman, ML, Olsson, H, Goldbohm, RA, van den Brandt, PA, Palli, D, Teitelbaum, S, Apelo, RA, Baens, J, de la Cruz, JR, Javier, B, Lacaya, LB, Ngelangel, CA, La Vecchia, C, Negri, E, Marubini, E, Ferraroni, M, Gerber, M, Richardson, S, Segala, C, Gatei, D, Kenya, P, Kungu, A, Mati, JG, Brinton, LA, Freedman, M, Hoover, R, Schairer, C, Ziegler, R, Banks, E, Spirtas, R, Lee, HP, Rookus, MA, van Leeuwen, FE, Schoenberg, JA, Graff-Iversen, S, Selmer, R, Jones, L, McPherson, K, Neil, A, Vessey, M, Yeates, D, Mabuchi, K, Preston, D, Hannaford, P, Kay, C, McCann, SE, Rosero-Bixby, L, Gao, YT, Jin, F, Yuan, J-M, Wei, HY, Yun, T, Zhiheng, C, Berry, G, Booth, JC, Jelihovsky, T, MacLennan, R, Shearman, R, Hadjisavvas, A, Kyriacou, K, Loisidou, M, Zhou, X, Wang, Q-S, Kawai, M, Minami, Y, Tsuji, I, Lund, E, Kumle, M, Stalsberg, H, Shu, XO, Zheng, W, Monninkhof, EM, Onland-Moret, NC, Peeters, PHM, Katsouyanni, K, Trichopoulou, A, Trichopoulos, D, Tzonou, A, Baltzell, KA, Dabancens, A, Martinez, L, Molina, R, Salas, O, Alexander, FE, Anderson, K, Folsom, AR, Gammon, MD, Hulka, BS, Millikan, R, Chilvers, CED, Lumachi, F, Bain, C, Schofield, F, Siskind, V, Rebbeck, TR, Bernstein, LR, Enger, S, Haile, RW, Paganini-Hill, A, Ross, RK, Ursin, G, Wu, AH, Yu, MC, Ewertz, DM, Clarke, EA, Bergkvist, L, Anderson, GL, Gass, M, O'Sullivan, MJ, Kalache, A, Farley, TMM, Holck, S, Meirik, O, Fukao, A, Factors, CGH, Grp, SHNHSIIIR, Epidemiologie, RS: CAPHRI School for Public Health and Primary Care, RS: GROW - School for Oncology and Reproduction, RS: GROW - R1 - Prevention, RS: CAPHRI - R5 - Optimising Patient Care, and Collaborative Group on Hormonal Factors in Breast Cancer

Subjects
Aging, Breast cancer, Risk factors, Menopause, Menarche, cancer, malignancy, Ethnic origin, Disease, 0302 clinical medicine, Breast cancer, Risk Factors, Neoplasms, Receptors, Epidemiology, 80 and over, 030212 general & internal medicine, skin and connective tissue diseases, Aged, 80 and over, Patient, Obstetrics, Reproduction, Smoking, Age Factors, Middle Aged, Reproducibility, 3. Good health, Menopause, Receptors, Estrogen, Oncology, 030220 oncology & carcinogenesis, Menarche, Hormonal therapy, Female, epidemiology, Cancer Type - Breast Cancer, history, Adult, Risk, trends, medicine.medical_specialty, Design, Neoplasms, Hormone-Dependent, Requiring prolonged observation, Hormone Replacement Therapy, Oncology and Carcinogenesis, Breast Neoplasms, and over, Validity, methods, 03 medical and health sciences, Age, Clinical Research, Breast Cancer, medicine, Humans, cancer, Neoplasm Invasiveness, Women, Oncology & Carcinogenesis, Hormone-Dependent, breast, Aged, Gynecology, Collaborative Group on Hormonal Factors in Breast Cancer, therapy, business.industry, Contraception/Reproduction, Research, Estrogens, Etiology - Resources and Infrastructure, medicine.disease, Estrogen, Good Health and Well Being, cessation, Premenopause, Risk factors, Relative risk, Recall, business, malignancy, Meta-Analysis
Abstract

Background Menarche and menopause mark the onset and cessation, respectively, of ovarian activity associated with reproduction, and affect breast cancer risk. Our aim was to assess the strengths of their effects and determine whether they depend on characteristics of the tumours or the affected women.Methods Individual data from 117 epidemiological studies, including 118 964 women with invasive breast cancer and 306 091 without the disease, none of whom had used menopausal hormone therapy, were included in the analyses. We calculated adjusted relative risks (RRs) associated with menarche and menopause for breast cancer overall, and by tumour histology and by oestrogen receptor expression.Findings Breast cancer risk increased by a factor of 1.050 (95% CI 1.044-1.057; p < 0.0001) for every year younger at menarche, and independently by a smaller amount (1.029, 1.025-1.032; p < 0.0001), for every year older at menopause. Premenopausal women had a greater risk of breast cancer than postmenopausal women of an identical age (RR at age 45-54 years 1.43, 1.33-1.52, p < 0.001). All three of these associations were attenuated by increasing adiposity among postmenopausal women, but did not vary materially by women's year of birth, ethnic origin, childbearing history, smoking, alcohol consumption, or hormonal contraceptive use. All three associations were stronger for lobular than for ductal tumours (p < 0.006 for each comparison). The effect of menopause in women of an identical age and trends by age at menopause were stronger for oestrogen receptor-positive disease than for oestrogen receptor-negative disease (p < 0.01 for both comparisons).Interpretation The effects of menarche and menopause on breast cancer risk might not be acting merely by lengthening women's total number of reproductive years. Endogenous ovarian hormones are more relevant for oestrogen receptor-positive disease than for oestrogen receptor-negative disease and for lobular than for ductal tumours.Funding Cancer Research UK.

Published
2012
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9. Menarche, menopause, and breast cancer risk: individual participant meta-analysis, including 118 964 women with breast cancer from 117 epidemiological studies

Author

Beral, V. Bull, D. Pirie, K. Reeves, G. Peto, R. and Skegg, D. LaVecchia, C. Magnusson, C. Pike, M. C. and Thomas, D. Hamajima, N. Hirose, K. Tajima, K. Rohan, T. and Friedenreich, C. M. Calle, E. E. Gapstur, S. M. Patel, A. V. Coates, R. J. Liff, J. M. Talamini, R. and Chantarakul, N. Koetsawang, S. Rachawat, D. Marcou, Y. and Kakouri, E. Duffy, S. W. Morabia, A. Schuman, L. and Stewart, W. Szklo, M. Coogan, P. F. Palmer, J. R. and Rosenberg, L. Band, P. Coldman, A. J. Gallagher, R. P. and Hislop, T. G. Yang, P. Cummings, S. R. Canfell, K. and Sitas, F. Chao, P. Lissowska, J. Horn-Ross, P. L. John, E. M. Kolonel, L. M. Nomura, A. M. Y. Ghiasvand, R. Hu, J. Johnson, K. C. Mao, Y. Callaghan, K. Crossley, B. and Goodill, A. Green, J. Hermon, C. Key, T. Lindgard, I. and Liu, B. Collins, R. Doll, R. Bishop, T. Fentiman, I. S. De Sanjose, S. Gonzaler, C. A. Lee, N. Marchbanks, P. and Ory, H. W. Peterson, H. B. Wingo, P. Ebeling, K. and Kunde, D. Nishan, P. Hopper, J. L. Eliassen, H. and Gajalakshmi, V. Martin, N. Pardthaisong, T. Silpisornkosol, S. Theetranont, C. Boosiri, B. Chutivongse, S. Jimakorn, P. Virutamasen, P. Wongsrichanalai, C. Neugut, A. and Santella, R. Baines, C. J. Kreiger, N. Miller, A. B. and Wall, C. Tjonneland, A. Jorgensen, T. Stahlberg, C. and Pedersen, A. Tonnes Flesch-Janys, D. Hakansson, N. Cauley, J. Heuch, I. Adami, H. O. Persson, I. Weiderpass, E. and Chang-Claude, J. Kaaks, R. McCredie, M. Paul, C. Spears, G. F. S. Iwasaki, M. Tsugane, S. Anderson, G. Daling, J. R. Hampton, J. Hutchinson, W. B. Li, C. I. Malone, K. and Mandelson, M. Newcomb, P. Noonan, E. A. Ray, R. M. and Stanford, J. L. Tang, M. T. C. Weiss, N. S. White, E. and Izquierdo, A. Viladiu, P. Fourkala, E. O. Jacobs, I. and Menon, U. Ryan, A. Cuevas, H. R. Ontiveros, P. Palet, A. and Salazar, S. B. Aristizabal, N. Cuadros, A. and Tryggvadottir, L. Tulinius, H. Riboli, E. Andrieu, N. and Bachelot, A. Le, M. G. Bremond, A. Gairard, B. Lansac, J. Piana, L. Renaud, R. Clavel-Chapelon, F. Fournier, A. and Touillaud, M. Mesrine, S. Chabbert-Buffet, N. and Boutron-Ruault, M. C. Wolk, A. Torres-Mejia, G. Franceschi, S. Romieu, I. Boyle, P. Lubin, F. Modan, B. Ron, E. and Wax, Y. Friedman, G. D. Hiatt, R. A. Levi, F. and Kosmelj, K. Primic-Zakelj, M. Ravnihar, B. Stare, J. and Ekbom, A. Erlandsson, G. Beeson, W. L. Fraser, G. Peto, J. Hanson, R. L. Leske, M. C. Mahoney, M. C. Nasca, P. C. Varma, A. O. Weinstein, A. L. Hartman, M. L. Olsson, H. Goldbohm, R. A. van den Brandt, P. A. Palli, D. and Teitelbaum, S. Apelo, R. A. Baens, J. de la Cruz, J. R. and Javier, B. Lacaya, L. B. Ngelangel, C. A. La Vecchia, C. and Negri, E. Marubini, E. Ferraroni, M. Gerber, M. and Richardson, S. Segala, C. Gatei, D. Kenya, P. Kungu, A. and Mati, J. G. Brinton, L. A. Freedman, M. Hoover, R. and Schairer, C. Ziegler, R. Banks, E. Spirtas, R. Lee, H. P. Rookus, M. A. van Leeuwen, F. E. Schoenberg, J. A. and Graff-Iversen, S. Selmer, R. Jones, L. McPherson, K. and Neil, A. Vessey, M. Yeates, D. Mabuchi, K. Preston, D. and Hannaford, P. Kay, C. McCann, S. E. Rosero-Bixby, L. and Gao, Y. T. Jin, F. Yuan, J-M Wei, H. Y. Yun, T. and Zhiheng, C. Berry, G. Booth, J. Cooper Jelihovsky, T. and MacLennan, R. Shearman, R. Hadjisavvas, A. Kyriacou, K. and Loisidou, M. Zhou, X. Wang, Q-S Kawai, M. Minami, Y. and Tsuji, I. Lund, E. Kumle, M. Stalsberg, H. Shu, X. O. and Zheng, W. Monninkhof, E. M. Onland-Moret, N. C. Peeters, P. H. M. Katsouyanni, K. Trichopoulou, A. Trichopoulos, D. and Tzonou, A. Baltzell, K. A. Dabancens, A. Martinez, L. and Molina, R. Salas, O. Alexander, F. E. Anderson, K. and Folsom, A. R. Gammon, M. D. Hulka, B. S. Millikan, R. and Chilvers, C. E. D. Lumachi, F. Bain, C. Schofield, F. and Siskind, V. Rebbeck, T. R. Bernstein, L. R. Enger, S. and Haile, R. W. Paganini-Hill, A. Ross, R. K. Ursin, G. Wu, A. H. Yu, M. C. Ewertz, Denmark M. Clarke, E. A. and Bergkvist, L. Gass, M. O'Sullivan, M. J. Kalache, A. and Farley, T. M. M. Holck, S. Meirik, O. Fukao, A. and Collaborative Grp Hormonal Factors Collaborative Grp Hormonal Factors S Hankinson Nurses Hlth Study I II

Subjects
skin and connective tissue diseases
Abstract

Background Menarche and menopause mark the onset and cessation, respectively, of ovarian activity associated with reproduction, and affect breast cancer risk. Our aim was to assess the strengths of their effects and determine whether they depend on characteristics of the tumours or the affected women. Methods Individual data from 117 epidemiological studies, including 118 964 women with invasive breast cancer and 306 091 without the disease, none of whom had used menopausal hormone therapy, were included in the analyses. We calculated adjusted relative risks (RRs) associated with menarche and menopause for breast cancer overall, and by tumour histology and by oestrogen receptor expression. Findings Breast cancer risk increased by a factor of 1.050 (95% CI 1.044-1.057; p < 0.0001) for every year younger at menarche, and independently by a smaller amount (1.029, 1.025-1.032; p < 0.0001), for every year older at menopause. Premenopausal women had a greater risk of breast cancer than postmenopausal women of an identical age (RR at age 45-54 years 1.43, 1.33-1.52, p < 0.001). All three of these associations were attenuated by increasing adiposity among postmenopausal women, but did not vary materially by women’s year of birth, ethnic origin, childbearing history, smoking, alcohol consumption, or hormonal contraceptive use. All three associations were stronger for lobular than for ductal tumours (p < 0.006 for each comparison). The effect of menopause in women of an identical age and trends by age at menopause were stronger for oestrogen receptor-positive disease than for oestrogen receptor-negative disease (p < 0.01 for both comparisons). Interpretation The effects of menarche and menopause on breast cancer risk might not be acting merely by lengthening women’s total number of reproductive years. Endogenous ovarian hormones are more relevant for oestrogen receptor-positive disease than for oestrogen receptor-negative disease and for lobular than for ductal tumours. Funding Cancer Research UK.

Published
2012

10. Menarche, menopause, and breast cancer risk: Individual participant meta-analysis, including 118 964 women with breast cancer from 117 epidemiological studies

Author

Hamajima, N, Hirose, K, Tajima, K, Rohan, T, Friedenreich, CM, Calle, EE, Gapstur, SM, Patel, AV, Coates, RJ, Liff, JM, Talamini, R, Chantarakul, N, Koetsawang, S, Rachawat, D, Marcou, Y, Kakouri, E, Duffy, SW, Morabia, A, Schuman, L, Stewart, W, Szklo, M, Coogan, PF, Palmer, JR, Rosenberg, L, Band, P, Coldman, AJ, Gallagher, RP, Hislop, TG, Yang, P, Cummings, SR, Canfell, K, Sitas, F, Chao, P, Lissowska, J, Horn-Ross, PL, John, EM, Kolonel, LM, Nomura, AMY, Ghiasvand, R, Hu, J, Johnson, KC, Mao, Y, Beral, V, Bull, D, Callaghan, K, Crossley, B, Goodill, A, Green, J, Hermon, C, Key, T, Lindgard, I, Liu, B, Pirie, K, Reeves, G, Collins, R, Doll, R, Peto, R, Bishop, T, Fentiman, IS, De Sanjosé, S, Gonzalez, CA, Lee, N, Marchbanks, P, Ory, HW, Peterson, HB, Wingo, P, Ebeling, K, Kunde, D, Nishan, P, Hopper, JL, Eliassen, H, Hankinson, S, Gajalakshmi, V, Martin, N, Pardthaisong, T, Silpisornkosol, S, Theetranont, C, Boosiri, B, Chutivongse, S, Jimakorn, P, Virutamasen, P, Wongsrichanalai, C, Neugut, A, Santella, R, Baines, CJ, Kreiger, N, Miller, AB, Wall, C, Tjonneland, A, Jorgensen, T, Stahlberg, C, Pedersen, AT, Flesch-Janys, D, Hakansson, N, Cauley, J, Heuch, I, Adami, HO, Persson, I, Weiderpass, E, and Magnusson, C

Subjects
skin and connective tissue diseases
Abstract

Background Menarche and menopause mark the onset and cessation, respectively, of ovarian activity associated with reproduction, and affect breast cancer risk. Our aim was to assess the strengths of their effects and determine whether they depend on characteristics of the tumours or the affected women. Methods Individual data from 117 epidemiological studies, including 118 964 women with invasive breast cancer and 306 091 without the disease, none of whom had used menopausal hormone therapy, were included in the analyses. We calculated adjusted relative risks (RRs) associated with menarche and menopause for breast cancer overall, and by tumour histology and by oestrogen receptor expression. Findings Breast cancer risk increased by a factor of 1.050 (95% CI 1.044-1.057; p

Published
2012
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11. Bone mineral density and microarchitecture in patients with essential thrombocythemia and polycythemia vera.

Author

Frederiksen, H., Farmer, S., Vestergaard, H., Shanbhogue, V., Hansen, S., Hermann, A., and Stahlberg, C.

Subjects
HIP joint radiography, SPINE radiography, RISK factors of fractures, BONE remodeling, BIOMARKERS, COMPUTED tomography, LONGITUDINAL method, POLYCYTHEMIA, RADIAL bone, THROMBOCYTOSIS, TIBIA, BONE density, CROSS-sectional method, PHOTON absorptiometry
Abstract

Summary: In this cross-sectional study of 45 patients with myeloproliferative neoplasms, we found no evidence of secondary osteoporosis. Introduction: Patients with essential thrombocythemia (ET) and polycythaemia vera (PV) are at increased risk of fractures but the underlying mechanisms have not been settled. We conducted a study to assess bone mineral density, microarchitecture, estimated bone strength and global bone turnover in 45 patients with ET or PV. Methods: Patients were evaluated in a cross-sectional study with dual energy X-ray absorptiometry (DXA) at the hip and spine; high-resolution peripheral quantitative computed tomography (HR-pQCT) at the distal radius and distal tibia; and biochemical markers of bone turnover including pro-collagen type 1 N-terminal pro-peptide, osteocalcin, C-terminal cross-linking telopeptide of type 1 collagen and bone-specific alkaline phosphatase. Also, 45 healthy comparisons, matched on age, height and weight with each patient were included as control subjects. Results: Patients and comparisons had almost identical BMDs: 0.96 (IQR: 0.85-1.07) g/cm and 0.96 g/cm (IQR: 0.86-1.05 g/cm), respectively. As well all microarchitecture and estimated bone strength measures were highly similar in the two groups. Levels of bone turnover markers were within reference values in patients. Conclusion: These results reveal no evidence of secondary osteoporosis among patients with ET or PV. The mechanism behind the increased fracture risk in ET or PV patients remains unknown. [ABSTRACT FROM AUTHOR]

Published
2017
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12. Breast cancer incidence by estrogen receptor status in Denmark from 1996 to 2007

Author

Bigaard, J, Stahlberg, C, Jensen, M-B, Ewertz, Marianne, Kroman, N, Bigaard, J, Stahlberg, C, Jensen, M-B, Ewertz, Marianne, and Kroman, N

Abstract

During the past 50 years, breast cancer incidence has increased by 2-3 % annually. Despite many years of testing for estrogen receptors (ER), evidence is scarce on breast cancer incidence by ER status. The aim of this paper was to investigate the increase in breast cancer incidence by ER status. Data were obtained from the clinical database of the Danish Breast Cancer Cooperative Group which holds nationwide data on diagnosis, including pathology, treatment, and follow-up on primary breast cancers since 1977. All Danish women

Published
2012

19. Primary thymic extranodal marginal zone B cell lymphoma as an incidental finding in a Caucasian woman.

Author

Petersen JK, Larsen TS, Møller MB, and Stahlberg C

Subjects
Diagnosis, Differential, Female, Humans, Incidental Findings, Lupus Erythematosus, Systemic pathology, Middle Aged, Multimodal Imaging, Positron-Emission Tomography, Tomography, X-Ray Computed, Lymphoma, B-Cell, Marginal Zone pathology, Thymus Neoplasms pathology
Abstract

Primary thymic extranodal marginal zone B cell lymphoma (TML) is an extremely rare lymphoma strongly associated with autoimmune disease. We report an exceedingly rare case of TML found in a non-Asian population. TML was found incidentally in a 60-year-old Caucasian woman with a short history of muscle and joint pain. An anterior mediastinal mass was detected by a positron emission tomography-CT (PET-CT) scan and thymectomy was performed. The mass was contained within the thymus with a homogeneous pale cut surface with solid areas. Histologically, the typical morphological and immunophenotypic features of TML were found, with a prominent lymphoid infiltrate comprising of small-to-medium-sized neoplastic lymphocytes, plasmacytic differentiation and a distorted thymic epithelial network. Postoperative follow-up has indicated an associated undifferentiated connective tissue disease (UCTD) with features of systemic lupus erythaematosus., (2015 BMJ Publishing Group Ltd.)

Published
2015
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20. Are work-related stressors associated with diagnosis of more advanced stages of incident breast cancers?

Author

Nielsen NR, Stahlberg C, Strandberg-Larsen K, Kristensen TS, Zhang ZF, Hundrup YA, and Grønbaek M

Subjects
Female, Humans, Prognosis, Breast Neoplasms pathology, Breast Neoplasms psychology, Stress, Psychological physiopathology, Work psychology
Abstract

Objective: To assess the relation between work-related stressors and breast cancer incidence and prognostic characteristics (estrogen receptor status, grade, lymph node status, size, stage) at the time of diagnosis., Methods: The 18,932 women included in the Danish Nurse Cohort reported work-related stressors in 1993 and again in 1999 and were followed until the end of 2003 in national registries. Prognostic characteristics were obtained from a clinical database and fewer than 0.1% were lost to follow up., Results: During follow-up, 455 women were diagnosed with breast cancer. Neither women with high work pressure (HR = 1.17; 95% CI: 0.79, 1.73) nor women with self-reported low influence on work organization (0.98; 0.69, 1.39) or long working hours (0.93; 0.54, 1.58) were at higher risk of breast cancer than women with no such stressors. Women with high work tempo had a slightly higher risk of breast cancer (1.25; 1.02, 1.54) than women with a suitable work tempo, but there was no dose-response effect. There were no clear differences in the prognostic characteristics of breast tumors diagnosed in women with and without work-related stressors., Conclusions: Work-related stressors do not affect breast cancer risk or the prognostic characteristics of incident breast cancers at the time of diagnosis. These results may be a comfort to working women and can hopefully prevent self-blaming among women who develop breast cancer.

Published
2008
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21. Breast cancer incidence, case-fatality and breast cancer mortality in Danish women using hormone replacement therapy--a prospective observational study.

Author

Stahlberg C, Lynge E, Andersen ZJ, Keiding N, Ottesen B, Rank F, Hundrup YA, Obel EB, and Pedersen AT

Subjects
Aged, Denmark epidemiology, Female, Humans, Incidence, Middle Aged, Proportional Hazards Models, Prospective Studies, Surveys and Questionnaires, Breast Neoplasms mortality, Estrogen Replacement Therapy adverse effects
Published
2005
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22. Increased risk of breast cancer following different regimens of hormone replacement therapy frequently used in Europe.

Author

Stahlberg C, Pedersen AT, Lynge E, Andersen ZJ, Keiding N, Hundrup YA, Obel EB, and Ottesen B

Subjects
Aged, Cohort Studies, Confidence Intervals, Denmark epidemiology, Estrogens administration & dosage, Europe epidemiology, Female, Humans, Incidence, Middle Aged, Nurses statistics & numerical data, Odds Ratio, Progestins administration & dosage, Randomized Controlled Trials as Topic, Registries, Risk Assessment, Risk Factors, Surveys and Questionnaires, Breast Neoplasms chemically induced, Breast Neoplasms epidemiology, Hormone Replacement Therapy adverse effects, Hormone Replacement Therapy methods
Abstract

Epidemiologic studies have shown an increased risk of breast cancer following hormone replacement therapy (HRT). The aim of this study was to investigate whether different treatment regimens or the androgenecity of progestins influence the risk of breast cancer differently. The Danish Nurse Cohort was established in 1993, where all female nurses aged 45 years and above received a mailed questionnaire (n = 23,178). A total of 19,898 women returned the questionnaire (86%). The questionnaire included information on HRT types and regimens, reproductive history and lifestyle-related factors. Breast cancer cases were ascertained using nationwide registries. The follow-up ended on 31 December 1999. Women with former cancer diagnoses, women with missing information on HRT, surgical menopause, premenopausal, as well as hysterectomized women were excluded, leaving 10,874 for analyses. Statistical analyses were performed using Cox proportional hazards model. A total of 244 women developed breast cancer during follow-up. After adjustment for confounding factors, an increased risk of breast cancer was found for the current use of estrogen only (RR = 1.96; 95% CI = 1.16-3.35), for the combined use of estrogen and progestin (RR = 2.70; 95% CI = 1.96-3.73) and for current users of tibolone (RR = 4.27; 95% CI = 1.74-10.51) compared to the never use of HRT. In current users of combined HRT with testosterone-like progestins, the continuous combined regimens were associated with a statistically significant higher risk of breast cancer than the cyclical combined regimens (RR = 4.16, 95% CI = 2.56-6.75, and RR = 1.94, 95% CI = 1.26-3.00, respectively). An increased risk of breast cancer was noted with longer durations of use for the continuous combined regimens (p for trend = 0.048). The European traditional HRT regimens were associated with an increased risk of breast cancer. The highest risk was found for the use of continuous combined estrogen and progestin., (Copyright 2004 Wiley-Liss, Inc.)

Published
2004
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23. [Arm morbidity after axillary dissection for breast cancer].

Author

Stahlberg CI and Jørgensen T

Subjects
Axilla, Female, Humans, Lymphedema diagnosis, Lymphedema etiology, Pain, Postoperative diagnosis, Postoperative Complications pathology, Postoperative Complications physiopathology, Surveys and Questionnaires, Arm pathology, Arm physiopathology, Breast Neoplasms surgery, Lymph Node Excision adverse effects, Postoperative Complications diagnosis
Abstract

Introduction: Axillary dissection for breast cancer is known to leave the patient with arm morbidity. The aim of this study was to describe the occurrence of lymphoedema, subjective swelling, abnormal sensations, and pain in a consecutive group of patients operated for breast cancer., Methods: From April to October 1992, 140 consecutive women underwent an operation for breast cancer with axillary dissection at levels one and two. Patients with bilateral breast cancer or radiotherapy towards the axilla were excluded. The surviving 124 patients were invited to an investigation on arm morbidity and a questionnaire on subjective complaints was sent to them. Medical records and pathology reports were reviewed. Ninety-five patients (77%) were examined. Oedema of the arm was assessed by circumference measurements at three points., Results: Objective oedema was found in six patients (6%). Subjective swelling was reported by 24 women (25%). Of these, 14 women reported slight swelling, seven had moderate swelling, and three had severe swelling of the arm. Pain within the three months preceding the examination was reported by 31 (33%). Analgesics were taken by 13 women (14%), of whom five used analgesics daily. Abnormal sensations in the ipsilateral arm was reported by 62 (65%). Young patients in the low risk group, with removal of more than ten lymph nodes, suffered a higher degree of arm morbidity., Conclusions: The only modifiable risk factor identified is the number of lymph nodes removed in axillary dissection. Other methods of staging could probably lessen arm morbidity.

Published
2001

24. Morphological effects of transposing a segment of transverse colon into the ileum of the Holtzman rat.

Author

St Clair WH, Stahlberg CA, and Osborne JW

Subjects
Adaptation, Physiological, Animals, Cell Division, Colon anatomy & histology, Colon physiology, Ileum anatomy & histology, Male, Rats, Transplantation, Autologous, Colon transplantation, Ileum surgery
Abstract

In order to determine if the rat colon is capable of adaptation when placed in another location within the intestinal tract and/or subject to different luminal contents, a 3 cm segment of transverse colon was transposed into the ileum. Sixteen days later, the animals were injected with tritiated thymidine (1 microCi/g body weight) and killed one hour later. Autoradiographs were analyzed for number of cells per crypt column, number of labeled cells per crypt column, position of labeled cells in the crypt column, and formation of Paneth cells or villi in the transposed colon. Proliferative activity of the epithelium was measured by isolating whole crypts and determining disintegrations per minute per crypt. Except for alterations in the positions of labeled cells, as determined by crypt profiles, no changes from normal were observed in any of the parameters measured. Hence, unlike the small bowel, the colon is refractory to the influences of a new environment.

Published
1984
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