ABSTRACT
BACKGROUND: Danish breast cancer patients diagnosed in 1978-1994 experienced a trend over time towards a more favourable distribution of lymph node status at time of diagnosis, which was not due to mammography screening. We investigated how this trend could be explained by patient characteristics at diagnosis: age (biological processes), calendar period (e.g. environmental changes), birth cohort (living conditions over a life time), post-menopausal status (a predictor of less favourable nodal status), and tumour diameter (a marker of detection time). MATERIAL AND METHODS: The data set consisted of 22 955 patients aged 30-69 years at time of diagnosis with known lymph node status, known tumour diameter, known menopausal status, and clinically detected tumours, available from the Danish Breast Cancer Cooperative Group (DBCG). Age, period, cohort, menopausal status, and tumour diameter were used as predictors in generalised linear models with either node-positive status (at least one of the excised lymph nodes being tumour-positive) or severely node-positive status (at least half of the excised lymph nodes being tumour-positive) as outcomes. Lymph node status was assessed both empirically and estimated using an EM algorithm in order to reduce misclassification. RESULTS AND DISCUSSION: We found that the improved lymph node status distribution was most likely a period effect due to a combination of earlier detection of clinical tumours, explaining most of the trend in node-positive breast cancer and half of the trend in severely node-positive breast cancer, and some unknown factor affecting lymph node status but not necessarily other tumour characteristics.
Subject(s)
Breast Neoplasms/epidemiology , Breast Neoplasms/pathology , Lymph Nodes/pathology , Mass Screening , Adult , Age Factors , Aged , Breast Neoplasms/mortality , Denmark/epidemiology , Female , Humans , Incidence , Linear Models , Lymphatic Metastasis , Mammography , Mass Screening/methods , Menopause , Middle Aged , Odds Ratio , Predictive Value of Tests , Prognosis , Risk Assessment , Risk Factors , Time FactorsABSTRACT
We studied the impact on survival of changes in breast cancer patients' distribution by lymph node status at the time of diagnosis. Our study included breast cancer patients diagnosed from 1978 to 1994 in Denmark, where the treatment schemes for breast cancer patients were fairly stable, and where mammography screening was limited. We measured lymph node status by the proportion of positive lymph nodes of all excised lymph nodes, as assessed by a pathologist. This measure was available for two-thirds of the breast cancer patients. The outcome was 5-year relative survival. Changes in lymph node status distribution explained half of the improvement in 5-year relative survival, and seem to be the single most important cause behind the improved survival of breast cancer patients in Denmark.
Subject(s)
Breast Neoplasms/mortality , Lymph Nodes/pathology , Aged , Breast Neoplasms/diagnosis , Breast Neoplasms/epidemiology , Denmark , Female , Humans , Incidence , Middle Aged , Survival Analysis , Survival Rate/trendsABSTRACT
Cadmium (Cd) distribution between the soil solid phase and the soil solution is a key issue in assessing the environmental effect of Cd in the terrestrial environmental. Previous studies have shown that many individual minerals and other components found in soils can bind Cd, but most studies on whole soil samples have shown that pH is the main parameter controlling the distribution. To identify further the components that are important for Cd binding in soil we measured Cd distribution coefficients (Kd) at two fixed pH values and at low Cd loadings for 49 soils sampled in Denmark. The Kd values for Cd ranged from 5 to 3000 L kg(-1). The soils were described pedologically and characterized in detail (22 parameters) including determination of contents of the various minerals in the clay fraction. Correlating parameters were grouped and step-wise regression analysis revealed that the organic carbon content was a significant variable at both pH values. Cation exchange capacity (CEC) and gibbsite were important at the low pH (5.3) while iron oxides also were important at the high pH (6.7). None of the other clay minerals present in the soils (illite, smectite, kaolinite, hydroxy interlayered clay minerals [HIM], chlorite, quartz, microcline, plagioclase) were significant in explaining the Cd distribution coefficient.
