Simple exact analysis of the standardised mortality ratio.

Liddell, F. D. K.

doi:10.1136/jech.38.1.85

Cited by 238 publications

(134 citation statements)

References 9 publications

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“…Standardised incidence ratios (SIRs) were calculated by dividing the observed number of cancers (O) by the expected number (E). Tests of statistical significance were two sided and were based on Poisson exact methods (Liddell, 1984).…”

Section: Discussionmentioning

confidence: 99%

Second solid cancers after radiotherapy for breast cancer in SEER cancer registries

et al. 2009

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BACKGROUND: Radiotherapy for breast cancer reduces disease recurrence and breast cancer mortality. However, it has also been associated with increased second cancer risks in exposed sites. METHODS: We evaluated long-term second cancer risks among 182 057 5-year survivors of locoregional invasive breast cancer diagnosed between 1973 and 2000 and reported to US NCI-SEER Program cancer registries. Multivariate Poisson regression was used to estimate the relative risk (RR) and excess cases of second cancer in women who had surgery and radiotherapy, compared with those who had surgery alone. Second cancer sites were grouped according to doses received from typical tangential breast fields. RESULTS: By the end of 2005 (median follow-up ¼ 13.0 years), 15 498 second solid cancers had occurred, including 6491 contralateral breast cancers. The RRs for radiotherapy were 1.45 (95% confidence interval (CI) ¼ 1.33 -1.58) for high-dose second cancer sites (1 þ Gy: lung, oesophagus, pleura, bone and soft tissue) and 1.09 (1.04 -1.15) for contralateral breast cancer (E1 Gy). These risks decreased with increasing age and year of treatment. There was no evidence of elevated risks for sites receiving medium (0.5 -0.99 Gy, RR ¼ 0.89 (0.74 -1.06)) or low doses (o0.5 Gy, RR ¼ 1.01 (0.95 -1.07)). The estimated excess cases of cancer in women treated with radiotherapy were as follows: 176 (95% CI ¼ 69 -284) contralateral breast cancers or 5% (2 -8%) of the total in all 1 þ year survivors, and 292 (222 -362) other solid cancers or 6% (4 -7%) of the total. CONCLUSIONS: Most second solid cancers in breast cancer survivors are not related to radiotherapy.

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Section: Discussionmentioning

confidence: 99%

Second solid cancers after radiotherapy for breast cancer in SEER cancer registries

et al. 2009

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“…9 The expected number of deaths was calculated by multiplying the 5-year age and calendar period-specific mortality rates in the background population by correspondingly stratified person-years at risk in the cohort and summing all the products. 12 We calculated overall SMRs by timing of birth in relation to mother's diagnosis and stratified attained age of the offspring and cancer site. …”

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confidence: 99%

Mortality among offspring of women diagnosed with cancer: A population‐based cohort study

Verkooijen

Ang

Liu

et al. 2012

Intl Journal of Cancer

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One in five cancers in women is diagnosed prior to and during a woman's fertile years. Our study evaluates mortality risks in offspring of mothers with history of cancer. From the Swedish Multi-generation Register and the Cancer Register, we identified all 174,893 children whose mother had been diagnosed with cancer between 1958 and 2001. We categorized offspring into those born before (>1 year before), around (within 1 year before and after diagnosis) and after (>1 year after) their mother's cancer diagnosis and compared their risks of death (standardized mortality ratios, SMRs) and causes of death to the background population. Overall, offspring of mothers diagnosed with cancer had no increased mortality risk (SMR, 1.00; 95% confidence interval [CI], 0.97-1.03). Increased mortality risks were found in offspring of mothers with tobacco-related cancers (head and neck, thoracic and cervical) (SMR, 1.23; 95% CI, 1.13-1.33), in children born around their mother's diagnosis (SMR, 1.66; 95% CI, 1.25-2.13) and in children born after their mother's hematopoietic cancer diagnosis (SMR, 2.07; 95% CI, 1.10-3.35). Compared to the background population, children born around their mother's diagnosis were more likely to die of congenital and perinatal conditions. Overall, offspring of women diagnosed with cancer were not at increased risk of death, except for certain subgroups. Timing of pregnancy in relation to diagnosis and cancer site modifies mortality risks in the offspring.Eighteen percent of female cancers are diagnosed prior to and during a woman's fertile years.1 About one in 1,000 pregnancies is complicated by a cancer diagnosis 2 and substantial proportion of cancer survivors give birth after their diagnosis (unpublished data). Pregnancy during or after a malignancy has repeatedly been shown not to affect maternal prognosis.3-5 However, exposure to (the effects of) diagnostic investigations, radiation therapy and systemic treatment before and around the time of birth may have adverse effects on the child. 3,4,[6][7][8] Population-based estimates on the outcome of offspring of cancer survivors are lacking. Most studies on childbirth after cancer are hampered by small numbers, as pregnancy during and after cancer is a relatively rare event. As such, these studies are underpowered to pick up small, but real increases in mortality risks in the offspring. Although small effects may not be so relevant on an individual patient level, small increases in risk of complications or death in offspring of cancer patients are important from a public health perspective, especially in the light of the growing number of young cancer survivors and improvement in fertility preservation techniques.With our study, using data of the large population-based Swedish Multi-Generation Registry including over three million families and eleven million individuals, we assess mortality risks in offspring of women with a history of cancer in relation to timing of birth and cancer site. MethodsWe linked data from the Multi-Generation Register (incl...

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“…For each cancer type diagnosed in the cohort an expected number was computed based on the mean incidence data mentioned above. The 95% confi dence intervals (CI) for the SIR were determined assuming Poisson distribution for the observed cases [13]. For the statistical analysis and matching of the database to the different registries SPSS statistics 17.0 (IBM corporation) and Microsoft Offi ce Excel 2007 (Microsoft) were used.…”

Section: Discussionmentioning

confidence: 99%

The risk of cancer among persons with a history of injecting drug use in Sweden – a cohort study based on participants in a needle exchange program

et al. 2011

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Simple exact analysis of the standardised mortality ratio.

Cited by 238 publications

References 9 publications

Second solid cancers after radiotherapy for breast cancer in SEER cancer registries

Second solid cancers after radiotherapy for breast cancer in SEER cancer registries

Mortality among offspring of women diagnosed with cancer: A population‐based cohort study

The risk of cancer among persons with a history of injecting drug use in Sweden – a cohort study based on participants in a needle exchange program

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