Faculties https://hdl.handle.net/20.500.14178/1 2026-05-05T18:30:39Z 2026-05-05T18:30:39Z Hemminki, Kari Jussi Zitrický, František Sundquist, Kristina Sundquist, Jan Försti, Asta Hemminki, Akseli Hemminki, Otto https://hdl.handle.net/20.500.14178/3797 2026-05-05T07:11:22Z 2026-01-01T00:00:00Z

Diagnosis of prostate cancer in brothers with signs of detection bias and related consequences Hemminki, Kari Jussi; Zitrický, František; Sundquist, Kristina; Sundquist, Jan; Försti, Asta; Hemminki, Akseli; Hemminki, Otto Background: Swedish nationwide family and cancer data offer an unbiased opportunity to study familial prostate cancer (PC) and allow an assessment of the possible diagnostic bias that might have been introduced in the prostate-specific antigen (PSA) era. We address this bias in a setting between brothers diagnosed with PC.Methods: Brothers were identified from year 1932 onwards until the end of the study 2021. Differences between diagnostic ages, incidence, TNM stage and survival were compared between brothers.Results: A total of 18317 brothers were diagnosed in brotherships of two or more PCs. If there were no bias in diagnostics between the brothers, the null hypothesis was that their diagnostic ages were equal. This was clearly refuted by the data: subsequent brothers were preferentially diagnosed within a year of the first brother. The bias for subsequent brothers was higher when the brothers lived in the same community, and it was highest for large cities, particularly Stockholm. Comparing incidence rates between the first and subsequent brothers, subsequent brothers showed higher rates except at very high age. Proportions of patients detected with PSA (stage T1c) were higher in subsequent brothers compared to the first ones; the proportions were reversed for stages T2-4. Subsequent brothers were diagnosed less frequently with metastases compared to first brothers. Subsequent brothers survived better than first, but the difference depended on age and time since diagnosis.Conclusions: The results between brothers, using objective measures of diagnostic age, incidence and stage of disease, confirmed the existence of detection bias which however appeared to weaken towards high age.

2026-01-01T00:00:00Z Zitrický, František Sundquist, Kristina Sundquist, Jan Försti, Asta Hemminki, Akseli Kaaks, Rudolf Hemminki, Kari Jussi https://hdl.handle.net/20.500.14178/3796 2026-05-05T06:41:21Z 2026-01-01T00:00:00Z

Does Lung Adenocarcinoma Subtyping Offer Clinical Benefits? A Population-Based Study from Sweden Zitrický, František; Sundquist, Kristina; Sundquist, Jan; Försti, Asta; Hemminki, Akseli; Kaaks, Rudolf; Hemminki, Kari Jussi Purpose: Classification of lung adenocarcinoma into subtypes is relatively recent and not universally practiced. Consequently, large representative studies describing clinical outcomes are rare, failing to pervasively present advantages of subtyping. We describe the situation in Sweden with focus on survival.Methods: Patient data were obtained from the Swedish cancer registry from 2005 to 2021 accounting for 1418 patients, less than 5% of the reference group 'adenocarcinoma not otherwise specifed (NOS)'. Non-parametric survival estimates were calculated using the Kaplan-Meier method and testing for linear consistency using Weibull modelling.Results: Survival was generally better for women compared to men and this was most prominent for early-stage cancers. Female 5-year survival decreased in order, lepidic (59%), papillary (51%), invasive mucinous (46%), colloid (36%) and adenocarcinoma NOS (24%). Male 5-year survival for lepidic (46%) and colloid subtypes (22%) was significantly lower than female survival. Survival slopes for T1, T2, N0, M0 cases of lepidic, papillary and adenocarcinoma NOS were almost linear, in agreement with Weibull modelling k-values of 1.00 or slightly higher, impling that mortality increased slowly with time.Conclusions: The results showed female survival advantage for all adenocarcinoma subtypes. Survival in T1 and T2 classes with N0 and M0 for lepidic, papillary and adenocarcinoma NOS was close to linear, suggesting that patients are homogeneously diagnosed and treated. Survival benefits of lepidic and papillary subtypes over adenocarcinoma NOS give justification for adenocarcinoma subclassification, and also an independent validation of the WHO 2021 adenocarcinoma grading classification specifying lepidic and papillary subtypes.

2026-01-01T00:00:00Z Hemminki, Kari Jussi Zitrický, František Försti, Asta Hemminki, Akseli https://hdl.handle.net/20.500.14178/3795 2026-05-05T01:00:23Z 2026-01-01T00:00:00Z

RECENT SURVIVAL TRENDS IN THE MOST FATAL CANCERS IN THE NORDIC COUNTRIES: GAINS IN SOME BUT NOT IN ALL Hemminki, Kari Jussi; Zitrický, František; Försti, Asta; Hemminki, Akseli BackgroundGlobal survival studies distinguish a group of solid cancers with especially poor survival, which in the Nordic countries are cancers of the hypopharynx, esophagus, stomach, liver, gallbladder, pancreas, lung and pleura, each with a 5-year overall survival ranging between 15 to 30%. These cancers need extra attention.MethodsWe analyze here 1- and 5- year relative survival in the above cancers in Denmark, Finland, Norway and Sweden comparing periods 2013-18 and 2019-23 using the NORDCAN database.ResultsSurvival improvement was significant for lung cancer in each country, more for women than for men. For females, 1- and 5-year lung cancer survival improvements were about 5 and 6 % units between the two periods, compared to all cancer of 1.5 and 2 % units, respectively. Regarding other individual sites, Norway and Sweden demonstrated significant survival improvements in stomach cancer, and Norway also in pancreatic cancer. However, non-significant survival improvements were observed for most cancers. No positive evidence was found for esophageal cancer in Finland and gallbladder cancer in Norway. More significant improvements were found for 1- than for 5-year survival.ConclusionsSurvival in lung cancer increased in all countries well over improvements for all cancers. Survival increased also significantly for stomach and pancreatic cancers in some countries, and improvements were seen for other cancers. Although the results show success in fight against the most fatal cancers, continuous efforts are needed in early detection, facile clinical handling and novel therapeutics. However, for these fatal cancers primary prevention would be highly rewarding.

2026-01-01T00:00:00Z Hemminki, Kari Jussi Zitrický, František Sundquist, Kristina Sundquist, Jan Försti, Asta Hemminki, Akseli Hemminki, Otto https://hdl.handle.net/20.500.14178/3794 2026-05-05T01:00:16Z 2026-01-01T00:00:00Z

Three-generation familial risks in prostate cancer with a special focus on the early onset patients and their maternal and paternal relatives Hemminki, Kari Jussi; Zitrický, František; Sundquist, Kristina; Sundquist, Jan; Försti, Asta; Hemminki, Akseli; Hemminki, Otto Background: Swedish nationwide family and cancer data extend through three generations providing a unique chance for study of familial cancer in PC between first-degree relatives (FDR) and second-degree relatives (SDR). It also enables a test for the usefulness of maternal family information.Methods: Familial relative risks (standardized incidence ratios, SIRs) for PC were calculated for young men in generation 3 when their brothers, fathers, uncles and grandparents were diagnosed with PC (they were probands).Results: Familial SIRs for two affected brothers were 4.0 but when additionally a SDR (uncle or grandfather) was affected SIR reached 10.3. When a father was the proband, SIR was 3.1 but when additionally a SDR was affected SIR reached 4.7, and risk increased up to 11.6 with increasing numbers of affected SDRs. Importantly, affected SDRs were more numerous than FDRs. When a maternal or paternal grandfather was the only proband SIR for both was about 1.6. Both maternal and paternal uncles transmitted a risk of 1.6, and when two uncles were affected SIR climbed to about 2.0. The highest familial risk of 27 was found for affected brothers with a father and 2 SDRs diagnosed with PC.Conclusions: The results showed that for the young patients in generation 3 the richest sources of familial probands were SDRs. The uncles belong to the generation of fathers, and they are likely to be more numerous than grandparents. Maternal and paternal SDRs are equally informative for genetic counseling and both parental lineages should be used as they provide equal familial information about the risks of PC.

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