Asymptomatic deep venous thrombosis is associated with a low risk of post-thrombotic syndrome.

UNLABELLED: Post-thrombotic syndrome (PTS) is a well-recognized condition that develops after symptomatic deep venous thrombosis, but the clinical significance and late complications of asymptomatic deep venous thrombosis (ADVT) are unclear. OBJECTIVE: To determine whether ADVT following minor surgery affects venous function and contributes to the later development of PTS. PATIENTS/METHODS: The study included 83 patients operated on for Achilles tendon rupture; 38 patients with postoperative ADVT and 45 patients without (control group). The follow-up examinations five years after the operation comprised computerised strain-gauge plethysmography, colour duplex ultrasonography, clinical scoring of venous disease, and quality of life (QOL). RESULTS: Villalta scores, CEAP classification and QOL did not differ between groups. PTS (=Villalta score > or =5) was found in three ADVT patients (8%) and in two controls (4%). Ultrasonography revealed post-thrombotic changes in 55% of ADVT patients and in none of the controls. Deep venous reflux occurred in 22 ADVT patients and in three controls (P<0.001). There was no difference between groups in plethysmographic variables, demonstrating that the ultrasonographic abnormalities were of negligible haemodynamic significance. CONCLUSIONS: PTS is not a common sequel to ADVT after minor surgery. Although more than 50% of patients with ADVT developed post-thrombotic changes according to ultrasound, these changes did not result in haemodynamically significant venous dysfunction.

High sensitivity with color duplex sonography in thrombosis screening after ankle fracture surgery.

BACKGROUND: Phlebography is regarded as the reference standard for diagnosing asymptomatic deep vein thrombosis (DVT) in studies of thromboprophylaxis. However, technical advances with noninvasive color duplex sonography (CDS) have made this procedure an interesting alternative. OBJECTIVES: The objective of the present prospective study was to compare the sensitivity and specificity of CDS with those of phlebography. PATIENTS: The first 180 consecutive patients included in a larger randomized trial for prolonged thromboprophylaxis were subject to unilateral CDS and to phlebography after ankle fracture surgery. The patients were examined 6 weeks after surgery, all examinations being evaluated blindly. After patient drop outs and exclusions, 144 patients were left for analysis. RESULTS: Phlebography and CDS examinations were inconclusive or were not completed for 19% of these patients (28/144). DVT was diagnosed by phlebography in 21% (24/116) of the remaining patients. Most of the thrombi were isolated calf DVTs (18/24). In contrast, DVT was diagnosed by CDS in 31% of these patients (36/116): only one case diagnosed by phlebography was missed by CDS. The specificity of CDS is thus 86% and its sensitivity is 96%. The positive predictive value is 64%, and the negative predictive value is 99%. CONCLUSIONS: CDS is a safe method for detecting asymptomatic distal DVT. It has a high sensitivity and high negative predictive value, which means that the method is highly reliable to rule out DVT. Our results indicate that CDS could be considered as an alternative method for DVT screening.

Low sex-hormone-binding globulin concentration as independent risk factor for development of NIDDM. 12-yr follow-up of population study of women in Gothenburg, Sweden.

Serum sex-hormone-binding globulin (SHBG) and corticosteroid-binding globulin (CBG) concentrations were evaluated as risk factors for the development of non-insulin-dependent diabetes mellitus (NIDDM), myocardial infarction, stroke, and premature death in a prospective study of 1462 randomly selected women, aged 38-60 yr, over 12 yr of observation. In multivariate analysis, taking only age into consideration as a confounding factor, low initial concentration of SHBG was significantly correlated to the incidence of NIDDM and stroke, and high initial concentration of CBG was correlated to the incidence of NIDDM. There were also significant correlations between SHBG and CBG concentrations on one hand and possible risk factors for the end points studied, such as serum triglycerides, serum cholesterol, fasting blood glucose, body mass, body mass index, waist/hip ratio, smoking habits, and systolic blood pressure, on the other. When these possible confounders, in addition to age, were taken into consideration in multivariate analyses, only the inverse significant correlation between SHBG and NIDDM remained. The increased incidence of diabetes was confined to the lowest quintile of SHBG values, where it was 5-fold higher than in the remaining group. This incidence was further increased to 8- and 11-fold in the lowest 10 and 5% of the values, respectively. We conclude that SHBG is a uniquely strong independent risk factor for the development of NIDDM in women.

Morbidity, mortality, and quality of life for patients treated with levothyroxine.

In a population study of 1462 middle-aged women initiated in 1968 and 1969 we identified 29 women treated with levothyroxine from 1 to 28 years. In a 12-year follow-up in 1980 and 1981 we investigated the subjects for end-point myocardial infarction, diabetes mellitus, stroke, cancer, and death (the status of 99.7% of the initial participants was established). The women treated with levothyroxine showed no increase in morbidity or mortality. Of the 24 women still receiving levothyroxine in 1980 and 1981, 22 had serum thyrotropin and triiodothyronine concentrations with-in reference limits. These individuals were compared with the 968 women from the population study having no history of thyroid disease, and appeared identical as to laboratory and clinical data, with the exception of a slightly higher body mass, taller stature, and lower serum cholesterol concentration. The treated group did not differ in a life quality estimate based on 19 questions regarding life satisfaction and sensory function. We conclude that the levothyroxine-treated woman suffers no side effects from her life-long therapy.

Family history of diabetes in relation to different types of obesity and change of obesity during 12-yr period. Results from prospective population study of women in Göteborg, Sweden.

OBJECTIVE--To assess the relationship between family history and different types of obesity and change in obesity in a longitudinal population study. RESEARCH DESIGN AND METHODS--A longitudinal population study of 1462 randomly selected women (38-60 yr old) was conducted in Göteborg, Sweden, in 1968-69. The women were restudied after 12 yr. RESULTS--A family history of diabetes in mothers but not fathers showed, in univariate analysis, a significant positive association with obesity expressed as BMI. A family history of diabetes in the mothers was inversely related to body fat distribution expressed as WHR. No other association was observed between family history of diabetes and WHR. The association with BMI was independent of age, WHR, smoking habits, blood glucose, systolic blood pressure, serum cholesterol, serum triglycerides, maternal obesity, and the incidence of diabetes during the 12-yr follow-up period. Twelve years later, in 1980-1981, an independent association still existed between family history for diabetes and BMI measured at that examination, whereas there was no relationship with WHR. Women who had a family history of diabetes increased their BMI significantly more during the 12-yr follow-up compared with the women without a family history of diabetes, whereas there was no difference for the change of WHR. Family history of coronary heart disease and family history of cancer did not correlate to any kind of obesity. CONCLUSIONS--These findings indicate that family history of diabetes is related to overall obesity but not to abdominal adiposity per se.

Fasting insulin in relation to subsequent blood pressure changes and hypertension in women.

The role of hyperinsulinemia in the development of hypertension is not well understood, particularly insofar as both conditions relate to obesity. The present analysis examines the hypothesis that hyperinsulinemia, independent of obesity, precedes hypertension and natural blood pressure increases in women. The subjects were 50-year-old women from a prospective population study in Gothenburg, Sweden. Fasting insulin levels were determined at baseline (1968-1969) and were evaluated in relation to subsequent hypertension. Blood pressures were measured at the initial physical examination and at the 6- and 12-year follow-up examinations. The first analysis presented here (n = 278) identified incident cases of hypertension during the 12-year follow-up period, whereas the second analysis (n = 219) examined continuous changes in blood pressure. In both analyses, degree, type, and changes in obesity were considered as possible confounding factors. High fasting insulin values were predictive of subsequent incidence of hypertension over the 12-year follow-up period. Subjects with insulin values above the 75th percentile experienced three times more hypertension than did those below the 25th percentile. There was also a significant association between insulin at baseline and increases in diastolic (but not systolic) blood pressure. The positive relations between fasting insulin, on one hand, and diastolic blood pressure changes and hypertension, on the other, could not be explained by confounding effects of body mass index, waist/hip ratio, or weight gain. These findings are consistent with the hypothesis that fasting insulin levels may be one predisposing factor in the etiology of hypertension.

Estrogen replacement therapy decreases hyperandrogenicity and improves glucose homeostasis and plasma lipids in postmenopausal women with noninsulin-dependent diabetes mellitus.

Hyperandrogenicity in women is closely associated with insulin resistance and a risk factor for cardiovascular disease and noninsulin-dependent diabetes mellitus (NIDDM). Therefore, 25 postmenopausal women with NIDDM and sex hormone-binding globulin values less than 60 nmol/L, as an indicator of a moderate hyperandrogenicity, were treated with 2 mg 17-beta-estradiol orally for 3 months in a double-blind, cross-over, placebo-controlled trial. During the last 16 days of active treatment, 1 mg norethisterone acetate was added for 10 days for endometrial protection. Blood glucose, glycosylated hemoglobin, insulin, c-peptide, lipoprotein profile, sex steroid hormones, GH, and insulin-like growth factor I (IGF-I) were measured, and insulin sensitivity was determined by the euglycemic hyperinsulinemic clamp method. All metabolic measurements were taken at baseline and after 68 days of active or placebo treatment. Estradiol treatment, compared with the placebo period, was followed by a marked increase of sex hormone-binding globulin and a decrease of free testosterone. Blood glucose, glycosylated hemoglobin, c-peptide, total cholesterol, low-density lipoprotein cholesterol, and IGF-I decreased significantly (P < 0.01-P < 0.001), whereas high-density lipoprotein cholesterol rose (P < 0.001). In conclusion, estrogen replacement therapy in postmenopausal women with NIDDM ameliorated hyperandrogenicity, and this was accompanied by marked improvements in glucose homeostasis and lipoprotein profile.

Differences in associations of familial and nutritional factors with serum lipids between boys and girls: the Luxembourg Child Study.

BACKGROUND: Sex differences in the effects of genetic and environmental factors on circulating lipids have been examined mainly in adults, in whom the influences of sex steroid hormones are well known. OBJECTIVE: Our objective was to determine the effect of sex on genetic and environmental influences on serum lipids in prepubertal boys and girls. DESIGN: Children aged 6-8, 8-10, and 10-12 y (n = 1028) were selected at random in the Belgian province of Luxembourg, a region in Europe with a high prevalence of risk factors for cardiovascular disease and diabetes. Blood glucose and serum cholesterol, triacylglycerol, and insulin concentrations were measured, and anthropometric data and blood pressure were recorded. Familial data were obtained from standardized questionnaires. Nutritional status was obtained from a 3-d record. Participation was 70.3% of the primary cohort. RESULTS: Cholesterol, triacylglycerol, and insulin values were among the highest recorded in studies of children. In girls, cholesterol correlated positively with the energy density of intake of saturated fat (r = 0.13, P = 0.001), cholesterol (r = 0.11, P = 0.006), and protein (r = 0.12, P = 0.007) and negatively with the ratio of polyunsaturated to saturated fat intake (r = -0.14, P = 0.001) and the energy density of carbohydrate intake (r = -0.11, P = 0.019). In boys, no such relations were found. Triacylglycerol was not significantly related to nutritional factors. Consistent, independent relations were found between reported elevated cholesterol concentrations in the parental and grandparental generation and cholesterol (r = 0.101, P = 0.011) and triacylglycerol (r = 0.09, P = 0.03) in boys. No such associations were found in girls. CONCLUSION: Environmental and genetic factors may have different effects on serum cholesterol in girls and boys.

Dietary habits in relation to incidence of cardiovascular disease and death in women: a 12-year follow-up of participants in the population study of women in Gothenburg, Sweden.

Dietary intake as initially estimated by means of a 24-h recall has been related to the incidence of ischemic heart disease, stroke, and overall mortality during a 12-yr follow-up period in a prospective study of 1462 women representative of the general population. Energy intake was inversely correlated to the 12-yr incidence of myocardial infarction. The correlation was independent of age, indices of obesity, smoking habits, serum cholesterol, serum triglycerides, diabetes, systolic blood pressure, and physical activity. No correlation was found between dietary intake and incidence of stroke or overall mortality, nor was any correlation found between end-points and intake of fish, energy percentage of fat, protein, and carbohydrates. These observations suggest that suboptimal intake of nutrients may be an important factor in the pathogenesis of ischemic heart disease.

Dietary habits and incidence of noninsulin-dependent diabetes mellitus in a population study of women in Gothenburg, Sweden.

Dietary intake as initially estimated in a cross-sectional study has been related to the 12-y incidence of diabetes mellitus in a prospective study of 1462 women. In addition, all 50-y-old women (n = 352) were subjected to an intravenous glucose tolerance test. Because of the sampling procedure and a high participation rate the participants were representative of middle-aged women in the general population. No differences of statistical significance were observed concerning intake of energy and different nutrients. Neither did the number of meals nor the longest time between meals differ between women who developed diabetes and those who did not. Women with impaired glucose tolerance who developed diabetes did not differ from those who did not develop diabetes, concerning dietary intake. Body mass index was significantly higher in women who developed diabetes compared with other women. No specific dietary recommendations can be based on the results of this study.

Blood pressure and hypertension in middle-aged women in relation to weight and length at birth: a follow-up study.

OBJECTIVES: To examine the relationship between indicators at birth and adult blood pressure and risk for developing hypertension at two age levels. DESIGN: Original midwife records of 438 women born at term participating in a prospective population study in Göteborg, Sweden with blood pressure and hypertension assessment at both 50 and 60 years of age. RESULTS: Systolic blood pressure at both age levels showed a U-shaped relationship to weight and length at birth. Hypertension prevalence at 60 years was significantly and inversely related to both weight and length at birth, but not at 50 years. Significantly higher risk for hypertension was found in the lowest birth weight quintile [odds ratio (OR) = 2.0, 95% confidence interval (CI) 1.1-3.8] and lowest birth length tertile (OR = 1.8, 95% CI 1.1-3.0), in relation to the middle quintile/tertile, with or without adjustment for adult body size (as body mass index), at 60 years but not at 50 years. At 50 years, hypertension risk decreased by 3% (95% CI 0.92-1.01) for every 100 g increase in birth weight and 6% (95% CI 0.83-1.05) per cm birth length. At age 60 years, hypertension risk decreased by 4% (95% CI 0.92-0.99) per 100 g birth weight and 10% (95% CI 0.81-0.99) per cm length. CONCLUSIONS: Size at birth was a predictor of hypertension risk in women at 60 years but not 50 years. This study supports the hypothesis that poor fetal growth, as measured by low weight or length at birth, may contribute to the development of hypertension in later life and that this relationship became stronger with age.

Pharmacokinetics and pharmacodynamics of melagatran, a novel synthetic LMW thrombin inhibitor, in patients with acute DVT.

Forty-eight patients with acute proximal deep vein thrombosis (DVT) were randomised to intravenous infusions for 4 to 6 days with melagatran, a novel synthetic low molecular weight thrombin inhibitor, or unfractionated heparin adjusted by the activated partial thromboplastin time (APTT). The aim of the study was to investigate the pharmacokinetics, pharmacodynamics and the safety of melagatran therapy at three different doses. Steady-state plasma concentrations were rapidly achieved and maintained throughout the infusion period. The mean plasma concentrations in the low, medium and high dose groups were 0.17, 0.31 and 0.53 micromol/l, respectively. The prolongation of APTT was stable during the melagatran infusions and correlated to the plasma concentration. Phlebographically verified regression of thrombus size measured as decrease in Marder score was seen after 4 to 6 days in 8 of 12 patients, 6 of 12 patients and 5 of 11 patients in the low, medium and high dose groups of melagatran and in 5 of the heparin-treated patients. In the low dose group with melagatran, thrombus extension was seen in one patient. At the dose levels studied, melagatran was well tolerated with no clinically significant bleeding problems, suggesting that melagatran could safely be given to patients suffering from DVT.

Hemostatic and metabolic variables in women with polycystic ovary syndrome.

OBJECTIVE: To study whether a previously demonstrated increased morbidity in cardiovascular disease (CVD) and diabetes mellitus in women with polycystic ovary syndrome (PCOS) is associated with certain hemostatic variables that are known to be markers for CVD. DESIGN: The study was a trans-sectional follow-up study from a cohort of women with PCOS. SETTING: The women with PCOS were recruited from hospital clinics and referents were randomized from a population study of women from the same area. PARTICIPANTS: The investigation involved 28 women aged 43 to 62 years diagnosed to have PCOS on ovarian histopathology at wedge resection 25 to 34 years previously and 56 referents who were matched by age and body mass index. MAIN OUTCOME MEASURES: In connection with a clinical investigation, the hemostatic variables fibrinogen, von Willebrand factor antigen, factor VII procoagulant activity, factor VII antigen, and plasminogen activator inhibitor as well as the metabolic variables serum insulin and serum triglycerides were assayed. RESULTS: There was a strong positive correlation between serum concentrations of triglyceride, basal insulin, and abdominal obesity on the one hand, and plasminogen activator inhibitor, fibrinogen, and von Willebrand factor on the other, among women with PCOS as well as among referents. There were significantly higher mean concentrations of fibrinogen and factor VII:Ag among referents, but the mean values of most hemostatic variables studied showed no differences between the groups. CONCLUSION: Women with an altered metabolic profile were also found to have affected hemostatic factors, but PCOS in itself did not seem to influence them.

Self-reported stress levels predict subsequent breast cancer in a cohort of Swedish women.

The association between stress and breast cancer has been studied, mostly using case-control designs, but rarely examined prospectively. The purpose of this paper is to describe the role of stress as a predictor of subsequent breast cancer. A representative cohort of 1,462 Swedish women aged 38-60 years were followed for 24 years. Stress experience at a baseline examination in 1968-69 was analysed in relation to incidence of breast cancer with proportional hazards regression. Women reporting experience of stress during the five years preceding the first examination displayed a two-fold rate of breast cancer compared with women reporting no stress (age-adjusted relative risk 2.1; 95% CI [1.2-3.7]). This association was independent of potential confounders including reproductive and lifestyle factors. In conclusion, the significant, positive relationship between stress and breast cancer in this prospective study is based on information that is unbiased with respect to knowledge of disease, and can be regarded as more valid than results drawn from case-control studies.

Sociodemographic characteristics influencing birth outcome in Sweden, 1908-1930. Birth variables in the Population Study of Women in Gothenburg.

STUDY OBJECTIVE: To identify variables available in early Swedish delivery records and their relation to birth outcomes for home and hospital deliveries in Gothenburg at the early part of this century. DESIGN: A retrospective recovery of original delivery records and social variables in a cross sectional population. SETTING: Gothenburg, Sweden. PARTICIPANTS: 851 fullterm singleton female births with known gestational age born into five birth cohorts on selected dates (1908, 1914, 1918, 1922 and 1930). MAIN RESULTS: Delivery site, maternal parity, gestational age, and social group were significant factors influencing birth outcome as birth weight and length. The mean birth weight and length of hospital born infants was consistently lower than for home deliveries across all cohorts. Site of delivery changed significantly during the period of births under study, 1908-1930. CONCLUSIONS: In this study, which was based on original delivery records from the early part of this century, it was found that delivery site was an important factor influencing birth outcome across five birth cohorts. Utilisation of delivery services changed during the period of study. Thus, to avoid selection bias, the application of delivery records should reflect the birthing practice of the time period in question.

Obesity and nutrition in children. The Belgian Luxembourg Child Study IV.

OBJECTIVE: To analyse the association between nutritional and familial factors and obesity in boys and girls. DESIGN: Randomized, cross-sectional population study. SETTING: Province de Luxembourg, Belgium. SUBJECTS: One thousand and twenty-eight boys and girls in age strata 6-8, 8-10 and 10-12 y, comprising 70.3% of primary cohort. METHODS: Examinations included anthropometric measurements and questionnaires covering familial, socioeconomic and psychosocial factors. A three day dietary record was obtained in 955 children. This was analysed in relation to the anthropometric data. RESULTS: In comparison with similar studies from other regions and recommended allowances, the intakes of total energy, fat, particularly saturated fat and cholesterol, were high, while consumption of carbohydrate and fiber was low, as well as the polyunsaturated/saturated ratio of fat. Total energy intake showed no or weakly significant correlations with anthropometric factors. However, total fat (P=0.045) and saturated fat (P=0.0005) intake showed consistent positive correlations with body mass index (BMI, kg/m2) and skinfold thickness, with corresponding negative relationships to carbohydrate intake (P=0.034) in boys. Such relationships were also found when calculated as energy density. These associations were not statistically significant in girls. The high fat, low carbohydrate pattern of the nutritional status seemed to be more pronounced in families where the father had a low level of education (lipids, boys, P=0.0007), and where both parents were obese (saturated fat, boys, P=0.023), suggesting involvement of socioeconomic and familial factors. CONCLUSION: The lack of correlation between factors indicating obesity and total energy intake suggests that the positive energy balance causing obesity is due mainly to a low energy output. However, since energy intake measurements are imprecise, overeating can not be excluded, particularly since elevated consumption of food with high contents of fat, found in these children seems to be poorly regulated.

Iron balance in menstruating women.

OBJECTIVES: To study factors determining iron balance in menstruating women by examining the relationships between total iron requirements, based on menstrual iron losses and basal iron losses, and serum ferritin concentration, transferrin saturation, blood haemoglobin concentration, bone marrow haemosiderin and absorption of iron from a test dose of ferrous sulphate (0.56 mg Fe). SUBJECTS: The study was made in 203 women all aged 38 years, randomly selected from the census register of Göteborg. The study was originally made in 1968-69. Serum ferritin in frozen sera was first analysed in 1978. Reanalyses, calibrated to the International Standard 80/602, and studies on the effect of storage of sera, were made in 1992. This allowed a complete re-examination of the importance of different determinants of iron balance in women. RESULTS: With increasing iron requirements there was an increase in iron absorption, and a decrease in serum ferritin concentration and transferrin saturation. Above a certain level of iron requirement there was a rather sudden decrease in haemoglobin concentration and in stainable iron in bone marrow smears, indicating the critical level of iron requirements in these women that could be balanced by an increased iron absorption from the present diet. This level represents the maximal adaptation to maintain iron balance in an iron-replete state that can be achieved with this diet and corresponds to a prevalence of iron deficiency of about 25%. CONCLUSIONS: The continuous regulation of iron absorption from iron deficiency to iron repletion has a critical balance point determined by the properties of the diet.

Energy and macronutrient intake in relation to cancer incidence among Swedish women.

Two dietary reporting methods were used to examine associations between macronutrient intake and subsequent cancer incidence in a cohort of Swedish women born between 1908 and 1930. 1361 subjects gave 23-h dietary recalls at their baseline examinations in 1968-1969, and 412 of them also provided detailed dietary histories. The cohort was followed up 19 years later by means of linkages with the National Cancer and Death Registries. Both dietary methods indicated that subjects who were ranked in the highest tertile of energy intake, relative to the lowest, were at significantly greater risk of developing cancer (all-site). Relative risks across energy intake tertiles were 1, 1.15 and 2.04, respectively, using the dietary history method and 1, 1.02 and 1.55 using the 24-h recall data. Examination of specific macronutrient energy sources indicated that dietary fat and carbohydrate are likely to have made the largest contribution to this association. However, after adjustment for total energy, none of the individual macronutrients was significantly associated with all-site cancer, by either dietary reporting method. When expressed as a percentage of total energy, low protein density of the diet was associated with increased cancer risk, by both dietary methods. However, this appeared to be a function of high energy intake rather than low protein intake. Simultaneous statistical adjustment for seven potential confounders of the association between energy intake and cancer was performed using both the 24-h recall and the dietary history data.(ABSTRACT TRUNCATED AT 250 WORDS)

Psychosocial factors and risk of ischaemic heart disease and death in women: a twelve-year follow-up of participants in the population study of women in Gothenburg, Sweden.

A community sample of 795 women of the ages 38, 46, 50 and 54 yr was subjected to comprehensive medical and psychiatric examinations and was followed up for 12 yr. The 12-yr incidence of angina pectoris was 3.2% and of electrocardiographic changes indicating ischaemic heart disease 5.8%. The corresponding incidence of myocardial infarction was 1.4% and death rate 4.2%. High initial ratings of passive dependency, neuroticism, experience of strain, grade of mental disorder and severity of major or minor depression were predictive of angina pectoris. A low rating of aggression was predictive of the development of electrocardiographic changes indicating ischaemic heart disease. Low ratings of guilt feelings and neurotic self-assertiveness were predictive of myocardial infarction. Death rate was not related to any of the psychosocial factors studied. These associations remained significant after adjustments for age, social class, marital status or confounding conventional risk factors for ischaemic heart disease. The results show that the different clinical manifestations of ischaemic heart disease are related to different sets of psychosocial predictors.

Malignant neoplastic disease in women.

This study refers to a longitudinal population study of women in Gothenburg, Sweden. The prevalences of malignant neoplastic disease in two cross-sectional studies in 1968-1969 and in 1980-1981, respectively, and incidence figures for the 12-year period between these cross-sectional studies are presented. The data on malignant neoplasms were based on interview of the participants in the population study, on information from the Cancer Registry of the Swedish National Board of Health and Welfare and from the Swedish National Bureau of Statistics and were confirmed by death certificates, inpatient and outpatient records and reexaminations of tissue specimens from the tumor tissue. The prevalences of malignant neoplastic disease increased with age from 0.3% at the age of 38 to 9.9% in women aged 60. The incidence rates during the 12-year period increased with age from about 2% in women aged 38 at the beginning of the study to be about 10% in women initially aged 60. Breast cancer was found to be the most common single malignant neoplasm followed by cancer of uterus and cancer of the ovaries.