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Objective: To study the relationship between consumption of milk and milk products, calcium, lactose and vitamin D and occurrence of colorectal cancers. Design: Prospective cohort study. Subjects: A total of 9959 men and women aged 15 y or older without history of cancer at baseline. During a 24 y follow-up, 72 new cancers of the large bowel (38 in the colon and 34 in the rectum) were detected. Results: Consumption of milk and total milk products was suggested to be inversely related to colon cancer incidence, whereas no similar association was seen for rectal cancer. The relative risk between the highest and lowest quartiles of intake adjusted for potential confounding factors was 0.46 (95% confidence interval 0.14–1.46, P for trend 0.09) for milk and 0.37 (95% CI=0.12–1.39, P for trend 0.06) for total milk products. Lactose intake showed a similar inverse relationship with colon cancer: the relative risk was 0.31 (95% CI=0.08–1.15, P for trend 0.03). Intake of vitamin D or total dietary calcium was not significantly related to colorectal cancer risk, whereas calcium provided by fermented milk products was associated with increased colorectal cancer incidence; in the highest quartile the multivariate adjusted relative risk for colorectal cancer was 2.07 (95% CI=1.00–4.28). Conclusions: Our results indicate that individuals showing high consumption of milk have a potentially reduced risk of colon cancer; however, the association does not appear to be due to intake of calcium, vitamin D, or to specific effects of fermented milk. Sponsorship: This study was supported by a grant from the Swedish Cancer Foundation. European Journal of Clinical Nutrition (2001) 55, 1000–1007

Models of excess mortality with random effects were used to estimate regional variation in relative or net survival of cancer patients. Statistical inference for these models based on the Markov chain Monte Carlo (MCMC) methods is computationally intensive and, therefore, not feasible for routine analyses of cancer register data. This study assessed the performance of the integrated nested Laplace approximation (INLA) in monitoring regional variation in cancer survival. Poisson regression model of excess mortality including both spatially correlated and unstructured random effects was fitted to the data of patients diagnosed with ovarian and breast cancer in Finland during 1955–2014 with follow up from 1960 through 2014 by using the period approach with five‐year calendar time windows. We estimated standard deviations associated with variation (i) between hospital districts and (ii) between municipalities within hospital districts. Posterior estimates based on the INLA approach were compared to those based on the MCMC simulation. The estimates of the variation parameters were similar between the two approaches. Variation within hospital districts dominated in the total variation between municipalities. In 2000–2014, the proportion of the average variation within hospital districts was 68% (95% posterior interval: 35–93%) and 82% (60–98%) out of the total variation in ovarian and breast cancer, respectively. In the estimation of regional variation, the INLA approach was accurate, fast, and easy to implement by using the R‐INLA package.

The net survival of a patient diagnosed with a given disease is a quantity often interpreted as the hypothetical survival probability in the absence of causes of death other than the disease. In a relative survival framework, net survival summarises the excess mortality that patients experience compared with their relevant reference population. Based on follow-up data from the Finnish Cancer Registry, we derived simulation scenarios that describe survival of patients in eight cancer sites reflecting different excess mortality patterns in order to compare the performance of the classical Ederer II estimator and the new estimator proposed by Pohar Perme et al. At 5 years, the age-standardised Ederer II estimator performed equally well as the Pohar Perme estimator with the exception of melanoma in which the Pohar Perme estimator had a smaller mean squared error (MSE). At 10 and 15 years, the age-standardised Ederer II performed most often better than the Pohar Perme estimator. The unstandardised Ederer II estimator had the largest MSE at 5 years. However, its MSE was often superior to those of the other estimators at 10 and 15 years, especially in sparse data. Both the Pohar Perme and the age-standardised Ederer II estimator are valid for 5-year net survival of cancer patients. For longer-term net survival, our simulation results support the use of the age-standardised Ederer II estimator.

The Estonian study of Chernobyl cleanup workers was one of the first investigations to evaluate the possible health consequences of working in the Chernobyl area (the 30 km exclusion zone and/or adjacent territories) after the 1986 reactor accident. The cohort consists of 4831 men who were dispatched in 1986-1991 for tasks involving decontamination, construction of buildings, transport, radiation measurement, guard duty or other activities. By 31 December 2012, the follow-up of the cohort yielded 102 158 person-years of observation. Exposure and health data were collected by postal questionnaires, biodosimetry evaluations, thyroid screenings, and record-linkages with cancer, causes of death and health insurance reimbursement registers and databases. These data cover socio-demographic factors, employment history, aspects of health behaviour, medical history, work and living conditions in the Chernobyl area, biomarkers of exposure, cancer and non-cancer disease occurrence and causes of death. Cancer incidence data were obtained for 1986-2008, mortality data for 1986-2011 and non-cancer morbidity data for 2004-2012. Although the cohort is relatively small, it has been extensively examined and benefited from comprehensive nationwide population and health registers. The major finding was an increased risk of suicide. Thyroid examinations did not reveal an association with thyroid nodular disease and radiation dose, but did indicate the importance of accounting for screening when making comparisons with unscreened populations. No risk of leukaemia was observed and risks higher than 2.5-fold could be excluded with 95% confidence. Biodosimetry included GPA analyses and chromosomal translocation analyses and indicated that the Estonian cleanup workers experienced a relatively low mean exposure of the order of 0.1 Gy. One value of the Estonian study is in the methodologic processes brought to bear in addressing possible health effects from the Chernobyl accident. Twenty-five years of research are summarised and opportunities for the future listed.

A new net survival method has been introduced by Pohar Perme et al. (2012 [4]) and recommended to substitute the relative survival methods in current use for evaluating population-based cancer survival.The new method is based on the use of continuous follow-up time, and is unbiased only under non-informative censoring of the observed survival. However, the population-based cancer survival is often evaluated based on annually or monthly tabulated follow-up intervals. An empirical investigation based on data from the Finnish Cancer Registry was made into the practical importance of the censoring and the level of data tabulation. A systematic comparison was made against the earlier recommended Ederer II method of relative survival using the two currently available computer programs (Pohar Perme (2013) [10] and Dickman et al. (2013) [11]).With exact or monthly tabulated data, the Pohar-Perme and the Ederer II methods give, on average, results that are at five years of follow-up less than 0.5% units and at 10 and 14 years 1-2% units apart from each other. The Pohar-Perme net survival estimator is prone to random variation and may result in biased estimates when exact follow-up times are not available or follow-up is incomplete. With annually tabulated follow-up times, estimates can deviate substantially from those based on more accurate observations, if the actuarial approach is not used.At 5 years, both the methods perform well. In longer follow-up, the Pohar-Perme estimates should be interpreted with caution using error margins. The actuarial approach should be preferred, if data are annually tabulated.

Studies on cancer screening often evaluate the performance by indirect indicators. In case the screening detects pre-invasive lesions, they may be a mixture of benefit of sensitivity and effect as well as of harm of overdiagnosis. Here, we develop the formulae for the sensitivity, the effect and overdiagnosis in screening for pre-invasive lesions of cancer. Sensitivity is the ability of screening to identify a progressive lesion at the level of test (relevant for the laboratory), episode (relevant in the clinic) and programme (relevant at the population level). Effect is reduction of cancer incidence in those screened (efficacy) and in the target population (effectiveness). The sensitivity is estimated by interval cancers between two consecutive screens (incidence method) and the effect by interval cancers and cancers detected at the subsequent screen. Overdiagnosis is estimated as the detection rate of pre-invasive lesions minus the rate of invasive cancer prevented by screening in one screening round. All the indicators are corrected for nonattendance and selective attendance by disease risk. The population to be followed and the period of follow-up are defined for each indicator separately. Data on cervix cancer screening with Papnet® automation device are given as an example. Estimation of sensitivity and effect are consistent with the purpose of the screening to prevent invasive disease. We further define the purpose at the level of laboratory, clinical medicine and public health and derive six estimators corresponding to the specific purposes considered in our article.

Twenty-five years have passed since the Chernobyl accident, but its health consequences remain to be well established. Finland was one of the most heavily affected countries by the radioactive fallout outside the former Soviet Union. We analyzed the relation of the estimated external radiation exposure from the fallout to cancer incidence in Finland in 1988-2007. The study cohort comprised all ∼ 3.8 million Finns who had lived in the same dwelling for 12 months following the accident (May 1986-April 1987). Radiation exposure was estimated using data from an extensive mobile dose rate survey. Cancer incidence data were obtained for the cohort divided into four exposure categories (the lowest with the first-year committed dose

Summary We extend a mixture cure fraction model with random effects to allow estimation of relative survival of cancer patients by region in a country with a parsimonious number of parameters. The heterogeneity in the expected survival was taken into account such that the expected mortality rate was considered as a random quantity varying across regions. Two sets of random effects were used to describe regional variation, both in the cure fraction and in the relative survival of the non-cured patients. This hierarchical model was fitted in a Bayesian framework to the follow-up data of Finnish colon cancer patients diagnosed in 1975–2004. The public health importance of the regional differences was described by the extra survival time and avoidable deaths that could be gained, if the regional variation were eliminated and all the hospital districts in Finland achieved the most favourable level of relative survival. The differences in relative survival between the districts were quite small during the three decades. If all the districts had achieved the most favourable level of relative survival, the mean survival times of the female patients diagnosed in 1975–1984, 1985–1994 and 1995–2004 would have increased by 5%, 4% and 2% respectively.

Objective In addition to disease-specific mortality, a randomized controlled cancer screening trial may be evaluated in terms of excess mortality, in which case no patient-specific information on causes of death is needed. We studied the effect of not accounting for attendance on the calculated excess mortality in a prostate cancer screening trial. Methods The numerator of the excess mortality rate related to prostate cancer diagnoses in each study arm equals the excess number of deaths observed in the cancer patients. The estimation of the expected number of deaths in the absence of the prostate cancer diagnoses has to account for the self-selection of those participating in the trial, particularly if the proportion of non-participants is substantial. Setting The European prostate cancer screening trial (ERSPC). Results In the screening arm, non-attendees had roughly twice the mortality rate of attendees. Approximately twice as many cancers were detected in the screening arm compared with the control arm, primarily in attendees. Unless attendance is properly accounted for, the expected mortality of prostate cancer patients in the screening arm is overestimated by 0.9–3.6 deaths per 1000 person-years. Conclusions Attendees have a lower all-cause mortality rate (are healthier) and a higher probability of a prostate cancer diagnosis than non-attendees and the men randomized to the control arm. If attendance is not accounted for, the excess mortality and the between-arm excess mortality rate ratio are underestimated and screening is considered more effective than it actually is. These effects may be sizeable, notably if non-attendance is common. Correcting for attendance status is important in the calculation of the excess mortality rate in prostate cancer patients that can be used in conjunction with a disease-specific mortality analysis in a randomized controlled cancer screening trial.

Some animal experiments and human studies suggest that vitamin E may protect against cancer. Serum alpha-tocopherol concentration was studied for its prediction of cancer in a cohort of 36,265 adults in Finland. During a mean follow-up of 8 y, cancer was diagnosed in 766 persons. The levels of serum alpha-tocopherol were determined from stored serum samples (at -20 degrees C) taken from these cancer patients and from 1419 matched control subjects. Individuals with a low level of alpha-tocopherol had about a 1.5-fold risk of cancer compared with those with a higher level. The strength of the association between serum alpha-tocopherol level and cancer risk varied for different cancer sites and was strongest for some gastrointestinal cancers and for the combined group of cancers unrelated to smoking. The association was strongest among nonsmoking men and among women with low levels of serum selenium. The findings agree with the hypothesis that dietary vitamin E in some circumstances protects against cancer.

Only few prospective studies have examined the association between coffee consumption and risk of gastric and pancreatic cancer. This study is designed to evaluate this relationship among Finns, whose coffee consumption is the highest in the world. A total of 60,041 Finnish men and women who were 26-74 years of age and without history of any cancer at baseline were included in the present analyses. Coffee consumption and other study parameters were determined at baseline using standardized measurements. Participants were prospectively followed up for onset of gastric and/or pancreatic cancer, emigration, death or until June 30, 2006. During a mean follow-up period of 18 years, 299 cases of gastric cancer and 235 cases of pancreatic cancer were found. There was a nonsignificant inverse association between coffee consumption and risk of gastric cancer among men but not in the women. The multivariate-adjusted hazard ratio of stomach and pancreatic cancer incidence for ≥ 10 cups of coffee per day compared with nondrinkers were 0.75 (95% CI, 0.40-1.41) (P for trend = 0.19) and 0.82 (95% CI, 0.38-1.76) (P for trend = 0.95) for the combined population of men and women, respectively. We did not find a significant association between coffee consumption and the risk of gastric and/or pancreatic cancers.

Background: Relative survival estimates cancer survival in the absence of other causes of death. Previous work has shown that standard errors of non-standardised relative survival may be substantially overestimated by the conventionally used method. However, evidence was restricted to non-standardised relative survival estimates using Hakulinen's method. Here, we provide a more comprehensive evaluation of the accuracy of standard errors including age-standardised survival and estimation by the Ederer II method. Methods: Five- and ten-year non-standardised and age-standardised relative survival was estimated for patients diagnosed with 25 common forms of cancer in Finland in 1989–1993, using data from the nationwide Finnish Cancer Registry. Standard errors of mutually comparable non-standardised and age-standardised relative survival were computed by the conventionally used method and compared with bootstrap standard errors. Results: When using Hakulinen's method, standard errors of non-standardised relative survival were overestimated by up to 28%. In contrast, standard errors of age-standardised relative survival were accurately estimated. When using the Ederer II method, deviations of the standard errors of non-standardised and age-standardised relative survival were generally small to negligible. Conclusion: In most cases, overestimations of standard errors are effectively overcome by age standardisation and by using Ederer II rather than Hakulinen's method.

Background A new net survival method has been introduced by Pohar Perme et al. (2012 [4]) and recommended to substitute the relative survival methods in current use for evaluating population-based cancer survival. Methods The new method is based on the use of continuous follow-up time, and is unbiased only under non-informative censoring of the observed survival. However, the population-based cancer survival is often evaluated based on annually or monthly tabulated follow-up intervals. An empirical investigation based on data from the Finnish Cancer Registry was made into the practical importance of the censoring and the level of data tabulation. A systematic comparison was made against the earlier recommended Ederer II method of relative survival using the two currently available computer programs (Pohar Perme (2013) [10] and Dickman et al. (2013) [11]). Results With exact or monthly tabulated data, the Pohar-Perme and the Ederer II methods give, on average, results that are at five years of follow-up less than 0.5% units and at 10 and 14 years 1–2% units apart from each other. The Pohar-Perme net survival estimator is prone to random variation and may result in biased estimates when exact follow-up times are not available or follow-up is incomplete. With annually tabulated follow-up times, estimates can deviate substantially from those based on more accurate observations, if the actuarial approach is not used. Conclusion At 5 years, both the methods perform well. In longer follow-up, the Pohar-Perme estimates should be interpreted with caution using error margins. The actuarial approach should be preferred, if data are annually tabulated.

Population-based relative survival is widely used as a method of monitoring the success of cancer control. This success may not be relevant only for an entire country but also regional developments over time are of interest. It would not only be important that the relative survival improved but also that the differences between regions decreased over time.In this paper the authors show how relative survival methods can be used to study such differences. In addition to standard methods, some more recently introduced approaches are used, most notably a method for checking the goodness of fit of the relative survival model. This gives confidence in the obtained results and provides additional insight when assumptions are not met.An analysis of cancers of the colon and ovary by cancer control region in Finland in 1953-2003 shows an overall improvement in relative survival, accompanied in colon cancer also by a decrease of differences in relative survival between the regions. Thus, the desired course was observed in colon cancer but not in cancer of the ovary.These results, applied to further sites, should lead to investigation of differences in cancer control policies between regions.

Please cite this paper as: Kalliala I, Anttila A, Dyba T, Hakulinen T, Halttunen M, Nieminen P. Pregnancy incidence and outcome among patients with cervical intraepithelial neoplasia: a retrospective cohort study. BJOG 2012;119:227–235. Objective To investigate the effect of cervical intraepithelial neoplasia (CIN) treatment on incidence of pregnancy and pregnancy outcome. Design Retrospective cohort study. Setting Helsinki University Central Hospital, Finland, the sole reference centre in the Helsinki–Uusimaa region for women referred for colposcopy. Population A cohort of 6179 women treated for CIN between 1974 and 2001, and a randomly selected, age- and municipality-matched, reference population of 30 436 women. Methods Based on nationwide registers, all women were followed-up for pregnancy outcomes until death, emigration, sterilization, or until the end of 2004. Main outcome measures Incidence of any pregnancy, livebirths, miscarriages, extrauterine pregnancies, molar pregnancies, and terminations of pregnancies (TOPs) before and after CIN treatment, estimated by calculating hazard ratios (HRs) with stratified Cox regression and Poisson regression. Results After CIN treatment, both incidence of pregnancy (HR 1.20; 95% CI 1.15–1.26; P

This study was conducted to investigate whether annual surgical unit caseload affects extent of breast cancer surgery, breast cancer recurrence or breast cancer-specific survival. In a population-based cohort study, 12,604 women diagnosed with breast cancer in Finland during the years 1998–2001 were followed up until the end of year 2008. Surgical units were divided into subgroups: >200, 100–200, 50–99 or

Objectives To study the difference between the disease-specific and excess mortality rate in the European Randomized Study of Screening for Prostate Cancer section Rotterdam. Methods A total of 42,376 men were randomized to systematic screening or usual care. The excess number of deaths was defined as the difference between the observed number of deaths in the prostate cancer (PC) patients and the expected number of deaths up to 31 December 2006. The expected number was derived from mortality of all study participants before a possible diagnosis with PC. The disease-specific mortality rate was based on the number of men who died from PC. The excess mortality rate based on the arm-specific excess number of deaths and the disease-specific mortality rate were compared between the two study arms. Results The overall mortality rate was not significantly different between the intervention and the control arms of the study: RR 1.02 (95% CI 0.98–1.07). The disease-specific mortality rate was 0.42 men per 1000 person-years in the intervention and 0.48 men per 1000 person-years in the control arm: RR 0.86 (95% CI 0.64–1.17). The excess mortality rate was 0.40 per 1000 person-years in the intervention arm and 0.61 men per 1000 person-years in the control arm, and the RR for excess mortality was 0.66 (95% CI 0.39–1.13). Conclusions In contrast to the disease-specific mortality rates an increased difference in the excess mortality rates was observed between the two arms. This observation may be due to a systematic underestimation of the disease-specific deaths, and/or an additional disease-related mortality that is measured by an excess mortality analysis but not by a disease-specific mortality.

Early exposure to complex dietary proteins may increase the risk of beta-cell autoimmunity and type 1 diabetes in children with genetic susceptibility. We tested the hypothesis that supplementing breast milk with highly hydrolyzed milk formula would decrease the cumulative incidence of diabetes-associated autoantibodies in such children.In this double-blind, randomized trial, we assigned 230 infants with HLA-conferred susceptibility to type 1 diabetes and at least one family member with type 1 diabetes to receive either a casein hydrolysate formula or a conventional, cow's-milk-based formula (control) whenever breast milk was not available during the first 6 to 8 months of life. Autoantibodies to insulin, glutamic acid decarboxylase (GAD), the insulinoma-associated 2 molecule (IA-2), and zinc transporter 8 were analyzed with the use of radiobinding assays, and islet-cell antibodies were analyzed with the use of immunofluorescence, during a median observation period of 10 years (mean, 7.5). The children were monitored for incident type 1 diabetes until they were 10 years of age.The unadjusted hazard ratio for positivity for one or more autoantibodies in the casein hydrolysate group, as compared with the control group, was 0.54 (95% confidence interval [CI], 0.29 to 0.95), and the hazard ratio adjusted for an observed difference in the duration of exposure to the study formula was 0.51 (95% CI, 0.28 to 0.91). The unadjusted hazard ratio for positivity for two or more autoantibodies was 0.52 (95% CI, 0.21 to 1.17), and the adjusted hazard ratio was 0.47 (95% CI, 0.19 to 1.07). The rate of reported adverse events was similar in the two groups.Dietary intervention during infancy appears to have a long-lasting effect on markers of beta-cell autoimmunity--markers that may reflect an autoimmune process leading to type 1 diabetes. (ClinicalTrials.gov number, NCT00570102.).

Background: Relative survival after cancer in Finland is at the highest level observed in Europe and has, in general, been on a steady increase. The aim of this study is to assess whether the high survival is equally shared by different population subgroups and to estimate the possible gains that might be achieved if equity prevailed. Materials and method: The educational level and occupation before the cancer diagnosis of patients diagnosed in Finland in 1971–2005 was derived from an antecedent population census. The cancers were divided into 27 site categories. Cancer (cause)-specific 5-year survival proportions were calculated for three patient categories based on the educational level and for an occupational group of potentially health-conscious patients (physicians, nurses, teachers etc.). Proportions of avoidable deaths were derived by assuming that the patients from the two lower education categories would have the same mortality owing to cancer, as those from the highest educational category. Estimates were also made by additionally assuming that even the mortalities owing to other causes of death were all equal to those in the highest category. Results: For almost all the sites considered, survival was consistently highest for patients with the highest education and lowest for those with only basic education. The potentially health-conscious patients had an even higher survival. The differences were, in part, attributable to less favourable distributions of tumour stages in the lower education categories. In 1996–2005, 4–7% of the deaths in Finnish cancer patients could have potentially been avoided during the first 5-year period after diagnosis, if all the patients had the same cancer mortality as the patients with the highest educational background. The proportion would have also been much higher, 8–11%, if, in addition, the mortality from other causes had been the same as that in the highest educational category. Interpretation: Even in a potentially equitable society with high health care standards, marked inequalities persist in cancer survival. Earlier cancer diagnosis and the ability to cope within the health care system may be a partly relevant explanation, but personal habits and lifestyles also have a role, particularly for the cancer patients' mortality from other causes of death than cancer.

Background Faecal occult blood test (FOBT) screening has been shown to decrease the incidence and mortality from colorectal cancer. This study compared the stage profile of patients with colorectal cancer diagnosed at the first FOBT screening round with that of an unscreened control group. Methods Subjects aged 60–64 years were allocated randomly to biennial FOBT screening (52 998 subjects) or a control group (53 002) in a Finnish prospective public health policy in 2004–2006. FOBT was performed with a guaiac test. At the end of 2007 the screened and control populations were linked to the Finnish Cancer Registry database, and the colonoscopic findings in the screen positives were analysed. Results Early-stage colorectal cancer was observed in 52 per cent of the FOBT-positive subjects, in 42·2 per cent of the total screened population and in 38 per cent of the control population (P = 0·191 for FOBT positives, P = 0·592 for total screened population). The prevalence of adenomas and colorectal cancer was 31·5 and 8·2 per cent respectively among the 806 subjects with a positive FOBT. Some 27·3 per cent of all colorectal tumours in the screened population were interval cancers. The tumour was located in the right colon in 28·9 per cent of the screened subjects and 22 per cent of controls (P = 0·255). Conclusion Biennial FOBT screening improves detection of colorectal cancer at the first screening round, but the high percentage of interval cancers is a cause for concern.

Objective. The aim is to estimate the future lung cancer incidence in Poland and Finland based on forecasts on hypothetical changes in smoking habits. Material and methods. Data on population, lung cancer and smoking prevalence come from known sources. The simulation model utilized for forecasting was based on smoothing the smoking habit – specific risk ratios estimated for males and females in Europe. Results. Depending on the analyzed scenario in 2030 in Poland mortality rates among men would range from 8 to 125/105 and among women from 7 to 47/105; in Finland among men 5 to 60/105 and among women 4 to 22/105. Conclusions. The results obtained clearly indicate that cutting down on the number of smokers translates directly into a considerable reduction of the lung cancer incidence rate.

To identify disparities in the management of colon and rectal cancer across Europe by assessing population-based information from 12 European cancer registries (CR) participating in EUROCARE, together with additional information obtained from individual clinical records.We considered five indicators: (a) resection with curative intent; (b) post-operative mortality; (c) proportion of stage II/III colon cancer cases given adjuvant chemotherapy; (d) proportion of rectal cancer cases receiving radiotherapy; and (e) proportion of curative intent resections with 12 or more lymph nodes examined.A total of 6 871 colorectal cancer patients, diagnosed between 1996-1998, were examined. Overall 71% of patients received resection with curative intent, range 44-86% by CR; 46% of stage III colon cancer cases (range 24-73% by CR) and 22% of stage II cases (not then recommended) received adjuvant chemotherapy; 12% of rectal cancer cases received adjuvant radiotherapy, rangeor =2% in five CRs to51% in two CRs. For only 29% of curative intent resections were 12 or more lymph nodes examined.This study reveals that, although most patients received surgery with curative intent, disparities in treatment for colorectal cancer across Europe in the late 1990s were unexpectedly large, with many patients not receiving treatments indicated by published clinical trials. Consensus guidelines for CRC management are now becoming available and should be adopted across Europe. It is hoped that dissemination of guidelines will improve the use of scientifically proven treatments for the disease, but this should be monitored by further population-based studies.

Hodgkin lymphoma, Non-Hodgkin lymphoma, multiple myeloma, and acute and other leukaemias constitute about 7% of the overall cancer incidence and 8% of cancer mortality in the Nordic countries. The aim of this study is to describe and interpret the trends in relative survival and excess mortality in the five Nordic populations among these patients.Using the NORDCAN database 1964-2003, we estimated age-standardised incidence and mortality rates, 5-year relative survival, and excess mortality rates for varying follow-up periods, and age-specific 5-year relative survival by country, sex, and 5-year diagnostic period.Taking into account classification and registration problems in the earlier periods, the patterns of incidence, mortality, and survival are fairly similar between the countries within each cancer form studied. High 5-year relative survival ratios of over 80% were seen in the most recent period 1999-2003 for Hodgkin lymphoma, between 50 and 60% for Non-Hodgkin lymphoma, 38-49% for acute leukaemia and 60-73% for other leukaemia. The variations were between 28 and 41% for multiple myeloma. Danish patients diagnosed with these malignancies tend to fare slightly worse than their Nordic neighbours, with excess mortality rates marginally higher one to three months after diagnosis.Although the recent trends and absolute levels of incidence, mortality and survival for the lympho-haematopoietic malignancies are similar, the consistently lower survival of Danish patients--irrespective of type of malignancy--points to an impact of co-morbidity related lifestyle factors, which may negatively affect the chemotherapy and radiation offered as standard treatments for these diseases.

After treatment of the cervical intraepithelial neoplasia (CIN) cervical cancer incidence remains elevated at least for 20 years. Whether the overall or cervical cancer mortality after treatment of CIN is elevated is unknown. The aim of this study was to determine the long-term survival and cause-specific mortality among women treated for CIN. The study population consisted of 7,104 women treated for CIN between 1974 and 2001 and 35,437 individually matched controls. The follow-up of mortality was based on nationwide registries and closed at death, emigration or December 31, 2005. The possible differences in mortality were assessed using Cox proportional hazard model. With follow-up time of approximately 630,000 woman-years, overall 2,781 deaths were observed, 530 among women treated for CIN and 2,251 among reference population (HR 1.1, 95% CI 1.0–1.3). Mortality from any cancer (HR 1.4, 95% CI 1.2–1.7), lung cancer (HR 2.7, 95% CI 1.8–4.1) and HPV-related anogenital cancer (HR 3.1, 95% CI 1.1–8.6) was higher among CIN patients, but mortality from cervical cancer was not (HR 1.0, 95% CI 0.3–4.0). Elevated cervical cancer incidence after treatment of CIN, documented earlier, did not predict elevation in cervical cancer mortality. This suggests high effectiveness of CIN management. Most of the excess mortality observed among CIN patients was due to increased risk of other cancers. These long-term mortality patterns should be considered when planning and evaluating the management of CIN lesions and related cervical or other cancer prevention activity. Worldwide, cervical cancer is one the most frequent causes of cancer deaths among women, with about 288,000 deaths annually. 1 Treatment of preinvasive lesions, cervical intraepithelial neoplasia (CIN), has decreased age-adjusted cervical cancer incidence and mortality rates by 60–90% in countries with a long history of screening programs for cervical can

Overall survival after cancer is frequently used when assessing the health care service performance as a whole. While used by the public, politicians, and the media, it is often discarded by clinicians and epidemiologists due to the heterogeneous mix of different cancers, risk factors and treatment modalities. We studied the trend in the Nordic 5-year relative survival and excess mortality for all cancers combined to see if the impact of case-mix and variations between countries in diagnostic methods such as breast screening and PSA testing could explain the lower survival in Denmark.From the NORDCAN database 1964-2003, we defined two cohorts of cancer patients, one excluding non-melanoma skin cancer and another also excluding breast and prostate cancer. We estimated age-standardised incidence and mortality rates, 5-year relative survival, and excess mortality rates for varying follow-up periods, and age-specific 5-year relative survival by country, sex and 5-year diagnostic period.Prostate cancer is the main driver of the incidence increase in men, as do breast cancer in women, whereas cancer mortality in all Nordic countries is declining. The 5-year relative survival ratios are increasing in each Nordic population, but less so in Denmark. Country differences in survival stem mainly from follow-up periods immediately after diagnosis. Adjusting for the case-mix of diagnoses diminished differences a little while exclusion of breast and prostate cancer reduced the gap between countries in survival and excess mortality more considerably, yet post-adjustment, Danish patients still fare worse during the first three months after diagnosis.Adjustment for case-mix and exclusion of sites where diagnostic procedures change the pattern of incidence is important when comparing overall cancer survival across countries, but the correction only explains part of the observed differences in survival. Other factors such as stage at presentation, co-morbidity, tobacco and alcohol consumption are likely contributors.

Previous studies have shown systematic differences between the Nordic Countries in population-based relative survival following a kidney or urinary bladder cancer diagnosis. Comparison of bladder cancer over time and between Nordic registries is complicated by variable coding practices with respect to the inclusion of in situ cases with invasive tumours.Five-year relative survival of patients with urinary cancer diagnosed in the Nordic countries 1964-2003 and followed up for death through 2006 was studied and contrasted with developments in incidence and mortality.The survival following bladder cancer was higher than for kidney cancer and highest for men. Survival increased over the years in all countries, more for kidney cancer than bladder cancer. For Danish kidney cancer patients, the rate of increase over all the years has been lower than in the other countries, especially among women, resulting in a survival in Denmark some 10-20% points lower than elsewhere in 1999-2003. Danish bladder cancer patient survival was in the last period 4% points lower among men and 10% points lower among women than in the other Nordic countries. The differences were mainly found in the first year following diagnosis, where a higher excess mortality in Denmark was observed. Survival decreased with higher age at diagnosis.The increasing 5-year relative survival in all the Nordic countries for both kidney and bladder cancer are promising, but for kidney cancer a higher percentage detected coincidentally during an imaging investigation for other diseases could play a role. Denmark had the lowest survival, despite their known practice of including benign conditions with invasive bladder cancers. The lower Danish survival after kidney and bladder cancer in the first year after diagnosis could be due to later diagnosis on average, a higher co-morbidity from smoking-related diseases, and perhaps, less adequate cancer treatment and management in Denmark.

Previous studies have shown that there have been systematic differences between the Nordic countries in population-based relative survival of patients with respiratory cancer (lung, pleura, larynx, nose and sinuses).Relative survival of patients with respiratory cancer diagnosed in the Nordic countries in 1964-2003 and followed up to the end of 2006 was studied and contrasted with developments in incidence and mortality.For cancer of the lung, relative survival is lower in Danish patients than in the other countries during the first months of follow-up after diagnosis. For cancer of pleura, the relative survival ratios indicate that there may be problems in the official coding of the causes of death in Denmark, Norway and Sweden. There has been little improvement in survival of patients with cancer of the respiratory organs in the Nordic countries over time.The slightly lower survival of Danish lung cancer patients may be related to a less favourable stage distribution and to an increased prevalence of causal factors, affecting the mortality due to competing risks of death. A reclassification of official causes of death at the cancer registry may be needed for cancer of the pleura in order to make the corresponding mortality rates comparable between countries.

A previous Nordic study showed a marked and steady increase in the age-adjusted 5-year relative survival of skin melanoma patients diagnosed during the period 1958 through 1987. Males had considerably poorer survival than females. Material and methods Using the NORDCAN database, we studied relative survival and excess mortality of patients diagnosed with melanoma of the skin in the Nordic countries 1964-2003 followed up to the end of 2006. These were contrasted with concomitant trends in incidence and mortality. Results The overall incidence of melanoma almost quadrupled, but there was considerable variation in the trends in the five countries. Mortality was low but doubled during the study period. Survival ratios increased steadily to between 80% and 90% for patients diagnosed in 1999-2003. Swedish patients had consistently higher survival, whereas Danish patients had the highest excess death rates the first three months after diagnosis up until 1990, but thereafter, rates reached a similar low level to that observed in the other Nordic countries. The survival of Nordic women is still higher than that of men, but the difference has diminished, while the mortality rates among men are becoming increasingly higher relative to those for women among individuals 50 years and older. In younger individuals, mortality rates are similar in the two sexes, and declining. Conclusions Nordic patient survival following melanoma diagnosis is generally high and has been steadily increasing in the last decades. Differences in incidence between the five countries are more pronounced than the differences in survival. The strong upward trends in incidence and survival may mainly be the result of extensive changes in sunbathing habits or other UV exposure and, more recently, of an increasing awareness by the medical community and the public concerning early detection of melanoma of the skin.

This is the first comprehensive population-based study on relative survival of lip, oral cavity and pharyngeal cancer in the Nordic countries.Relative survival of patients with cancers of the lip, oral cavity, and pharynx diagnosed in the Nordic countries in 1964-2003 and followed up to the end of 2006 was studied and contrasted with trends in incidence and mortality.There are marked differences in incidence between countries and over time. The stability of the relative survival ratios gives support to the hypothesis that the incidence differences are more likely to be real and not materially affected by differences in definitions and coding. Of particular note are the steep rises in pharyngeal cancer incidence in Denmark in both sexes. Survival has only moderately improved over time and has tended to be slightly higher in females than males.Co-morbidity caused by smoking and high alcohol consumption are likely to be partially responsible for differences between countries. Advances in therapy and standards of care are also likely to have played a role in the increasing survival trends.

Prostate, testicular and penile cancer constitute about one-third of the cancer incidence burden among Nordic males, but less than one-fifth of the corresponding mortality. The aim of this study is to describe and interpret trends in relative survival and excess mortality in the five Nordic populations.Age-standardised incidence and mortality rates, 5-year relative survival, and excess mortality rates for varying follow-up periods are presented, as are age-specific 5-year relative survival by country, sex and 5-year diagnostic period.The vast majority of male genital cancer incident cases and deaths are prostate cancers, with 5-year and 10-year survival trends resembling the diagnostic-led increasing incidence over the past 25 years. Five-year prostate cancer survival is estimated at 53% in Denmark compared to 78% or above in the other Nordic populations for patients diagnosed 1999-2003. Excess mortality has declined over time, with Denmark having a greater excess of deaths compared to the other countries, irrespective of time of diagnosis. Concomitant with the declines in testicular cancer mortality, testicular cancer survival has increased since the 1970s in each Nordic country. Men diagnosed with testicular cancer in recent decades have had, on average, a continually better prognosis with time, with relative 5-year survival for patients diagnosed 1999-2003 ranging from 88% in Finland to 94% in Sweden. For the few patients diagnosed with cancer of the penis and other male genital organs, survival trends have been rather stable over time, with recent 5-year relative survival estimates ranging from 62% in Finland to 80% in Norway.There are intriguing country-specific and temporal variations in male genital cancer survival in the Nordic countries. Prognosis varies widely by cancer site and relates to both changing diagnostic and clinical practices. The increasing PSA detection and biopsy makes interpretation of the prostate cancer survival trends particularly difficult.

Cancers of the digestive organs (including the oesophagus, stomach, small intestine, colon, rectum and anus, liver, gallbladder, and pancreas) constitute one-fifth of all cancer cases in the Nordic countries and is a group of diseases with diverse time trends and varying consequences for public health. In this study we examine trends in relative survival in relation to the corresponding incidence and mortality rates in the Nordic countries during the period 1964-2003.Data were retrieved from the NORDCAN database for the period 1964 to 2003, grouped into eight 5-year periods of diagnosis. The patients were followed up until the end of 2006. Analysis comprised trends in 5-year relative survival, excess mortality and age-specific relative survival.Survival following cancers of the colon and rectum has increased continuously over the observed period, yet Danish patients fall behind those in the other Nordic countries. The largest inter-country variation is seen for the rare cancers in the small intestine. There has been little increase in prognosis for patients diagnosed with cancers of the liver, gallbladder or pancreas; 5-year survival is generally below 15%. Survival also remains consistently low for patients with oesophageal cancer, while minor increases in survival are seen among stomach cancer patients in all countries except Denmark. The concomitant incidence and mortality rates of stomach cancer have steadily decreased in each Nordic country at least since 1964.While the site-specific variations in mortality and survival largely reflect the extent of changing and improving diagnostic and clinical practices, the incidence trends highlight the importance of risk factor modification. Alongside the ongoing clinical advances, effective primary prevention measures, including the control of alcohol and tobacco consumption as well as changing dietary pattern, will reduce the incidence and mortality burden of digestive cancers in the Nordic countries.

The aim of this study was to present detailed population-based survival estimates for patients with a rectal adenocarcinoma, using cancer register data supplemented with clinical data. Based on cancer register data, differences in rectal cancer survival have been reported between countries in Europe. Variation in the distribution of stage at diagnosis, initial therapy including surgical technique, and comorbidity are possible explanatory factors. Adenocarcinomas in the rectum, diagnosed in 1997 and identified in the national cancer registries in the Nordic countries and Scotland were included. Age standardized 5-year relative survival and multiplicative regression models for the relative excess mortality were calculated. 3888 patients were included in the survival study. Men in Denmark, Finland and Iceland had lower 5-year relative survival and poorer stage distribution compared to Norway, Sweden and Scotland. Danish men had the highest rate of excess deaths in the first six months after diagnosis. Stage adjusted, the elevated relative excess mortality decreased and after six months the excess mortality rates were the same in all countries. The poor 5-year relative survival in Danish men was mainly due to a high excess rate of death during the first six months after diagnosis. The low survival in Finland and Iceland was not in accordance with other periods. For both countries this may be explained by random variation due to small numbers. The study emphasizes the need for high quality and detailed data in order to understand international survival differences, and cautions comparisons between large national samples and those of smaller areas.

Since its introduction in 1996, period analysis has been shown to be useful for deriving more up-to-date cancer survival estimates, and the method is now increasingly used for that purpose in national and international cancer survival studies. However, period analysis, like other commonly employed methods, is just a special case from a broad class of design options in the analysis of cancer survival data. Here, we explore a broader range of design options, including 2 model-based approaches, for deriving up-to-date estimates of 5- and 10-year relative survival for patients diagnosed in the most recent 5-year interval for which data are available. The performance of the various designs is evaluated empirically for 20 common forms of cancer using more than 50-year long time series of data from the Finnish Cancer Registry. Period analysis as well as the 2 model-based approaches, one using a "cohort-type model" and another using a "period-type model", all performed better than traditional cohort or complete analysis. Compared with "standard period analysis", the cohort-type model further increased up-to-dateness of survival estimates, whereas the period-type model increased their precision. While our analysis confirms advantages of period analysis over traditional methods in terms of up-to-dateness of cancer survival data, further improvements are possible by flexible use of model-based approaches.

A recent method of age-standardisation of relative survival ratios for cancer patients does not require calculation of age-specific relative survival ratios, as ratios of age-specific proportions between the standard population and study group at the beginning of the follow-up are used to substitute the original individual observations. This method, however, leads to direct age-standardisation with weights that are different for each patient group if the general population mortality patterns for the groups are different. This is the case in international comparisons, and in comparisons between genders and time periods. The magnitude of the bias caused by the differences in general population mortality is investigated for comparisons involving European countries and the USA. Patients in each country are assumed to have exactly the same age-specific relative survival ratios as those diagnosed in Finland in 1985-2004. An application of a properly functioning age-standardisation method should then give exactly equal age-standardised relative survival ratios for each country. However, the recent method shows substantial differences between countries, with highest relative survival for populations, where the general population mortality in the oldest ages is the highest. This source of error can thus be a serious limitation for the use of the method, and other methods that are available should then be employed.

Experimental data support the suppressing effect of vitamin D on lung carcinogenesis, but epidemiologic evidence is limited. The aim of the present study was to evaluate whether serum 25-hydroxyvitamin D [25(OH)D] level is associated with the risk of lung cancer in a prospective cohort study in Finland. 25(OH)D levels were measured by RIA from serum collected at baseline (1978-1980) from 6,937 men and women. During a maximum follow-up of 24 years, 122 lung cancers were identified. After adjustment for potential confounders, no overall significant association between vitamin D and lung cancer risk was observed [relative risk (RR) for the highest versus lowest tertile, 0.72; 95% confidence interval (95% CI), 0.43-1.19; Ptrend = 0.22]. There was a statistically significant interaction between vitamin D and sex (P = 0.02) and age (P = 0.02): serum 25(OH)D level was inversely associated with lung cancer incidence for women (RR, 0.16; 95% CI, 0.04-0.59; Ptrend < 0.001) and younger participants (RR, 0.34; 95% CI, 0.13-0.90; Ptrend = 0.04) but not for men (RR, 1.03; 95% CI, 0.59-1.82; Ptrend = 0.81) or older individuals (RR, 0.92; 95% CI, 0.50-1.70; Ptrend = 0.79). In conclusion, although there was no overall association between vitamin D and lung cancer risk, women and young participants with a higher level of vitamin D were observed to have a lower lung cancer risk. Although experimental data support the suppressing effect of vitamin D on the development of lung cancer, large epidemiologic studies from different populations with repeated measurements of vitamin D are warranted to confirm this finding. (Cancer Epidemiol Biomarkers Prev 2008;17(11):3274–8)

Background The CONCORD study compares population-based relative survival from cancer using data from cancer registries in five continents. To estimate relative survival, general mortality life tables are required. Available statistics are incomplete, so various approaches are used to construct complete life tables. This article outlines how the life tables were constructed for CONCORD; it compares life expectancy at birth between 101 populations covered by cancer registries in 31 countries and compares the impact of two approaches to the deployment of life tables in relative survival analysis. Methods The CONCORD approach, using specific mathematical methods, produced complete (single-year-of-age) life tables by sex, cancer registry area, calendar year (1990–1999) and race (only in the USA). In order to study the impact of different approaches, we compared relative survival in the USA using the US national life table, centered on the relevant census years, and the CONCORD approach. We estimated relative survival in each American participating cancer registry for patients diagnosed with breast (women), colorectal or prostate cancer during 1990–1994 and followed up to 1999. Results Average life expectancy at birth during 1990–1999 varied in CONCORD cancer registry areas from 64 to 78 years in males and from 71 to 84 years in females. It increased during the 1990s more in men than in women. In the USA, it was lower in blacks than in whites. Relative survival in American populations was lower with the CONCORD approach, which incorporates trends and geographic variation in background mortality, than with the USA census life tables. Conclusions International variation in background mortality by geographic area, calendar time, race, age and sex is wide. We suggest that in international comparisons of cancer relative survival, complete life tables that are specific for cancer registry area, calendar year and race should be used.

Only three Japanese prospective studies have suggested an inverse association between coffee drinking and liver cancer risk. No prospective studies on the association between serum gamma-glutamyltransferase (GGT) and liver cancer risk have been reported. We aimed to determine the single and joint associations of coffee consumption and serum GGT with the risk of primary liver cancer. Study cohorts included 60,323 Finnish participants who were 25-74 years of age and free of any cancer at baseline. During a median follow-up period of 19.3 years (interquartile range: 9.3-29.2 years), 128 participants were diagnosed with an incident liver cancer. The multivariable-adjusted (age, sex, alcohol consumption, education, smoking, diabetes and chronic liver disease at baseline and during follow-up, and body mass index) hazards ratios of liver cancer in participants who drank 0-1, 2-3, 4-5, 6-7, and ≥8 cups of coffee daily were 1.00, 0.66, 0.44, 0.38, and 0.32 (P for trend = 0.003), respectively. Further adjustment for serum GGT in subgroup analysis affected the results only slightly. The multivariable-adjusted and coffee-adjusted hazard ratio of liver cancer for the highest versus the lowest quartile of serum GGT was 3.13 (95% confidence interval = 1.22-8.07). The multivariable-adjusted inverse association between coffee consumption and liver cancer risk persisted when stratified by baseline factors: age more/less than 50 years, current smoker/never smoked/ever smoked, alcohol drinker/never drinker, obese/nonobese, and the highest/lowest three quartiles of serum GGT. A combination of very low coffee consumption and high level of serum GGT was associated with nearly nine-fold increased risk. Conclusion: Coffee drinking has an inverse and graded association with the risk of liver cancer. High serum GGT is associated with an increased risk of liver cancer. (HEPATOLOGY 2008.)

We present a framework for a multi-user server-based installation of the Shaman gamma-ray spectrum identification software. It allows users to access centrally managed Shaman and UniSampo software packages in a laboratory-wide multi-workstation environment. The server-based framework allows coordinated management of the software packages themselves as well as analysis parameter sets and analysis results either in a file system-based data vault or in an SQL-database based on the Linssi gamma-ray spectrometry database definition. Hierarchical management of analysis parameter sets allows full control of the individual analysis runs yet maintaining flexibility when analyzing a variety of sample types.

Recently, 2 modeling strategies have been proposed and shown to be useful to increase precision of up-to-date cancer survival estimates and to predict cancer patient survival: modeled period analysis and modeled cohort analysis. We aimed to compare the performance of both types of modeling for providing up-to-date and precise cancer survival estimates. Data from the nationwide Finnish Cancer Registry were used to assess how well both approaches would have been able to predict 5-year relative survival of concurrently diagnosed patients if they had been applied for that purpose throughout the past decades. Analyses were carried out for 20 common forms of cancer. For each cancer, 5-year relative survival was modeled with either approach for each single calendar year from 1962 to 1997. Mean differences and mean squared differences from 5-year relative survival later observed for patients diagnosed in the 5-year period around those calendar years were calculated. Survival estimates obtained by period modeling had much lower standard errors than those obtained by cohort modeling. Furthermore, for a clear majority of cancers, period modeling on average also provided better prediction of 5-year relative survival than cohort modeling. We conclude that, although both modeling strategies have their merits and specific indications, period modeling of survival has distinct advantages for up-to-date and precise estimation of cancer survival in population-based cancer survival studies.

The age-standardised relative survival ratio is used to compare population-based cancer survival patterns when the population age structures differ. Traditionally, the direct standardisation method based on age-specific relative survival ratios has been used. In a new method [ Brenner H, Arndt V, Gefeller O, Hakulinen T. An alternative approach to age adjustment of cancer survival rates. Eur J Cancer 2004; 40 :2317–22 ], weighted observations depending on the age structures of the study and standard populations are used to substitute the patients leading to a use of weighted counts. The relative survival ratio is then calculated in the conventional way. However, no standard error of the age-standardised relative survival estimate has been reported. In this paper, we introduce a generalisation of the well-known Greenwood formula for that purpose. This method is also applicable for the observed survival and particularly when the observed survival probabilities of the patient population differ by age stratum. The traditional Greenwood formula is a special case of the method when no specific weights are used and the observed survival probability is the same in each stratum. Data from the Finnish Cancer Registry are used for illustration.

CERN (European Organization for Nuclear Research) is an international particle physics laboratory located in Geneva, Switzerland. CERN carries out fundamental research in particle and nuclear physics using several large particle accelerators, including the Large Hadron Collider (CERN 2015).

In an era of ongoing improvement in cancer patient survival, available long-term survival figures from cancer registries are often outdated and too pessimistic for two reasons: first, delay in availability of cancer registry data, typically in the order of a few years, and, second, application of cohort-based methods of survival analysis, which provide survival estimates for patients diagnosed many years ago. We developed a model-based period analysis approach aimed to overcome both problems. We provide extensive empirical evaluation of our approach by comparing its performance with that of previously available methods for monitoring of 5- and 10-year relative survival, with the use of data from the nationwide Finnish Cancer Registry of 490,279 patients ages ≥15 years and diagnosed with one of 20 common forms of cancer between 1953 and 1997. We show that, in most cases, the model-based approach predicts 5- and 10-year relative survival expectations of newly diagnosed patients quite closely and much better than any of the previously available methods, including standard period analysis. We conclude that the model-based approach may enable deriving up-to-date cancer survival rates even with the common latency in availability of cancer registry data. (Cancer Epidemiol Biomarkers Prev 2006;15(9):1727–32)

Background and Objective Period analysis provides more up-to-date estimates of cancer patient survival than traditional methods, but there is a trade-off between up-to-dateness and precision. Our objective was to compare the performance of period and complete analysis in terms of up-to-dateness and precision of survival estimates. Study Design and Setting Five-year relative survival data actually observed for patients diagnosed with 1 of 20 common forms of cancer in Finland in 36 overlapping 5-year periods between 1958–1962 and 1993–1997 were compared with period estimates and various variants of complete estimates of 5-year relative survival potentially available during these periods. Results At comparable levels of up-to-dateness, survival estimates from period analysis were more precise than survival estimates from complete analysis. At comparable levels of precision, period analysis provided more up-to-date survival estimates than did complete analysis. Conclusion These results further encourage more widespread use of period analysis as a standard tool for up-to-date monitoring of cancer patient survival by population-based cancer registries.

{\rtf1\ansi\ansicpg1250\deff0\deflang1038\deflangfe1038\deftab708{\fonttbl{\f0\froman\fprq2\fcharset238{\*\fname Times New Roman;}Times New Roman CE;}} \viewkind4\uc1\pard\scaps\f0\fs24 UniSampo\scaps0 and \scaps Shaman\scaps0 are well-established analytical tools for gamma-ray spectrum analysis and the subsequent radionuclide identification. These tools are normally run locally on a Unix or Linux workstation in interactive mode. However, it is also possible to run them in batch/non-interactive mode by starting them with the correct parameters. This is how they are used in the standard analysis pipeline operation. This functionality also makes it possible to use them for remote operation over the network. We have developed a framework for running \scaps UniSampo\scaps0 and \scaps Shaman\scaps0 analysis using the standard WWW-protocol. A WWW-server receives requests from the client WWW-browser and runs the analysis software via a set of CGI-scripts. Authentication, input data transfer, and output and display of the final analysis results is all carried out using standard WWW-mechanisms. This WWW-framework can be utilized, for example, by organizations that have radioactivity surveillance stations in a wide area. A computer with a standard internet/intranet connection suffices for on-site analyses. \par }

The dose rate to personnel due to remnant radioactivity during maintenance periods will be an important issue at the forthcoming Large Hadron Collider (LHC). Among the most abundant construction materials are aluminum, steel, copper and lead. In order to obtain more reliable estimates on the radioisotope production in a high-energy hadron environment, we irradiated small samples of these materials behind the beam-stop of the CERN 24 GeV/c proton synchrotron. This environment is characterized by high spallation neutron flux and a non-negligible contribution of protons and pions up to the total beam momentum. Gamma-ray spectra of the samples were measured and analyzed with the SAMPO program and detailed nuclide identification was carried out with the SHAMAN program. The total energy emission and results of the spectrum analyses were compared to predictions of the FLUKA hadron cascade simulation package.

Selective underascertainment of cases may bias estimates of cancer patient survival. We show that the magnitude of potential bias strongly depends on the time periods affected by underascertainment and on the type of survival analysis (cohort analysis vs period analysis). We outline strategies on how to minimise or overcome potential biases.

Some environmental xenon sampling like the Automated Radioxenon Sampler-Analyzer (ARSA) and the Swedish Automated Noble Gas Unit (SAUNA), use b-g coincidence detectors that are energy dispersive on both the g and b axes. Applying conventional region-of-interest (ROI) analysis algorithms to such 3-D spectra is problematic due to spectral interferences in the low-resolution spectra. Deconvolving the 3-D sample spectra into the most probable combination of signals using non-negative least-squares results shows promise to robustly resolve the spectral interferences. This paper describes the multiple isotope component analysis (MICA) algorithm developed for analysis of 3-D b-g spectra from xenon sampling and measurement units.