Improvements in esophageal and gastric cancer care in Sweden-population-based results 2007-2016 from a national quality register.

The Swedish National Register for Esophageal and Gastric cancer was launched in 2006 and contains data with adequate national coverage and of high internal validity on patients diagnosed with these tumors. The aim of this study was to describe the evolution of esophageal and gastric cancer care as reflected in a population-based clinical registry. The study population was 12,242 patients (6,926 with esophageal and gastroesophageal junction (GEJ) cancers and 5,316 with gastric cancers) diagnosed between 2007 and 2016. Treatment strategies, short- and long-term mortality, gender aspects, and centralization were investigated. Neoadjuvant oncological treatment became increasingly prevalent during the study period. Resection rates for both esophageal/GEJ and gastric cancers decreased from 29.4% to 26.0% (P = 0.022) and from 38.8% to 33.3% (P = 0.002), respectively. A marked reduction in the number of hospitals performing esophageal and gastric cancer surgery was noted. In gastric cancer patients, an improvement in 30-day mortality from 4.2% to 1.6% (P = 0.005) was evident. Overall 5-year survival after esophageal resection was 38.9%, being higher among women compared to men (47.5 vs. 36.6%; P < 0.001), whereas no gender difference was seen in gastric cancer. During the recent decade, the analyses based on the Swedish National Register for Esophageal and Gastric cancer database demonstrated significant improvements in several important quality indicators of care for patients with esophagogastric cancers. The Swedish National Register for Esophageal and Gastric cancer offers an instrument not only for the control and endorsement of quality of care but also a unique tool for population-based clinical research.

Tumour incidence in Swedish women who gave birth following IVF treatment.

BACKGROUND: Possible effects on maternal tumour incidence of a full-term pregnancy following IVF treatment with indicated supraphysiologic steroid and peptide hormonal levels in pregnancy remain uncertain. METHODS: National registries were used to compare incidence of non-invasive and invasive tumour disease in Swedish women with live birth following IVF treatment with women with live birth without IVF. RESULTS: The study had a mean follow-up period of 6.2 years in the IVF group and 7.8 years in the non-IVF group, and the mean gestation period (s.d.) for IVF and non-IVF group was 271.0 (21.1) days and 278.5 (14.1) days, respectively. In a multivariate Poisson regression analysis, adjusted rate ratios of 0.70 (0.52-0.92) and 0.93 (0.58-1.43) among IVF women were found for the risk of carcinoma in situ (CIS) of the cervix and breast cancer, respectively. When date of conception plus 1 and 3 years were used as start of follow-up, the rate ratios of CIS of the cervix increased to 0.77 (0.57-1.03) and 0.86 (0.60-1.19), respectively, and the corresponding figures for breast cancer decreased to 0.91 (0.58-1.42) and 0.74 (0.40-1.26). CONCLUSION: Following a relatively short follow-up period, there is little if any increased risk of premenopausal cancer development in women who gave birth after IVF treatment. The women who gave birth after IVF treatment had a decreased incidence of CIS of the cervix and breast cancer, but only the former was statistically significant. However, further studies are necessary to include longer follow-up times.

Early determinants of first hospital admissions for asthma and acute bronchitis among Swedish children.

AIM: To assess the changing impact of prenatal and perinatal factors with increasing age on first admissions for asthma and acute bronchitis. METHODS: The Swedish Medical Birth Registry was linked to the National Hospital Discharge Registry for 214,276 Swedish children born in 1987 and 1988. The linkage comprised first admissions for acute bronchitis or asthma from 1987 to 1995. First admissions for gastroenteritis were included to distinguish between factors specific to asthma or bronchitis and non-specific factors related to an increased risk of hospital admission. RESULTS: Admissions for asthma and acute bronchitis before 2 y of age had a close dose-response relationship with maternal smoking, low gestational age, low maternal age and older siblings. Very premature children exposed to more than 9 cigarettes a day in utero ran a 10 times higher risk of hospitalization than postmature children without exposure to maternal smoking. However, the proportion of admissions attributed to maternal smoking was only 4.7% after adjustments for significant covariates. The number of significant determinants declined in children with their first admission for asthma after 2 y of age but male gender and low educational level were independent determinants in all age groups. Older siblings were related to an increased risk of first asthma admission before 2 y of age but a slightly reduced risk of first admission after 2 y of age. CONCLUSION: This study illustrates the varied epidemiology of asthma in different age groups. Maternal smoking was an important determinant for admission before 2 y of age but mainly in combination with other factors. The decline in hospital admissions in early childhood would therefore be small, even after the elimination of maternal smoking, if other significant perinatal and socioeconomic factors were unchanged.