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•Condyloma reductions were seen after HPV vaccination introduction in women and men.•Onset of condyloma reductions in men appeared with >1 year delay compared to women.•Greatest reductions in condyloma incidence were seen in the youngest study cohorts. Between 2007 and 2011, opportunistic HPV-vaccination was available in Sweden and partially subsidized to girls aged 13–17, reaching a ∼30% overall coverage. All Swedish women/men aged 15–44 were followed between 2006 and 2012 for condyloma. Average annual percent changes (AAPCs) in incidence were estimated. Substantial decreases were seen in women aged 15–24 from 2008-onwards (AACP-range: −8.5% to −18.5%); similar effects were seen for men aged 15–29 (AACP-range: −7.0% to −16.6%) from 2010-onwards. Despite low population vaccination coverage in women and no coverage in men, similar condyloma incidence reductions were observed among men and women, with delays of >1 years in men.

ObjectivesTo assess the association between occupational exposure to asbestos and the risk of cholangiocarcinoma (CC).MethodsWe conducted a case–control study nested in the Nordic Occupational Cancer (NOCCA) cohort. We studied 1458 intrahepatic CC (ICC) and 3972 extrahepatic CC (ECC) cases occurring among subjects born in 1920 or later in Finland, Iceland, Norway and Sweden. Each case was individually matched by birth year, gender and country to five population controls. The cumulative exposure to asbestos (measured in fibres (f)/ml × years) was assessed by applying the NOCCA job-exposure matrix to data on occupations collected during national population censuses (conducted in 1960, 1970, 1980/81 and 1990). Odds ratios (OR) and 95% CI were estimated using conditional logistic regression models adjusted by printing industry work.ResultsWe observed an increasing risk of ICC with cumulative exposure to asbestos: never exposed, OR 1.0 (reference category); 0.1–4.9 f/mL × years, OR 1.1 (95% CI 0.9 to 1.3); 5.0–9.9 f/mL × years, OR 1.3 (95% CI 0.9 to 2.1); 10.0–14.9 f/mL × years, OR 1.6 (95% CI 1.0 to 2.5); ≥15.0 f/mL × years, OR 1.7 (95% CI 1.1 to 2.6). We did not observe an association between cumulative asbestos exposure and ECC.ConclusionsOur study provides evidence that exposure to asbestos might be a risk factor for ICC. Our findings also suggest that the association between ECC and asbestos is null or weaker than that observed for ICC. Further studies based on large industrial cohorts of asbestos workers and possibly accounting for personal characteristics and clinical history are needed.

ObjectivesTo evaluate cancer incidence among Swedish firefighters and analyze risk in relation to work duration as a proxy for cumulative exposure.MethodsThis cohort study is based on the Swedish component of the Nordic Occupational Cancer (NOCCA) project. The cohort includes six million people who participated in one or more of the population censuses in 1960, 1970, 1980 and 1990. The census data were linked to the Swedish Cancer Registry for the 1961–2009 period, extending a previous NOCCA follow-up time by 4 years. We identified 8136 male firefighters. SIRs were calculated using cancer incidence rates in the national population as a reference.ResultsWe found a statistically significant excess of non-melanoma skin cancer (SIR = 1.48, 95% CI 1.20–1.80) but no positive relationship between risk and work duration. There was a small, yet statistically significant increased risk of prostate cancer among firefighters with service times of 30 years or more. The first follow-up period (1961–1975) showed an increased risk of stomach cancer relative to the reference group, while the last period (1991–2009) showed an increased risk of non-melanoma skin cancer. There was no excess risk for all cancer sites combined (SIR = 1.03, 95% CI 0.97–1.09).ConclusionsOur results do not support an overall risk of cancer among Swedish firefighters, but a possible risk of non-melanoma skin cancer exists. The previously noted excess of prostate cancer among Swedish firefighters in NOCCA was no longer statistically significant in this extended follow-up but was present among those with the longest service times.

ObjectivesTo investigate whether cervical screening attendance differs between human papillomavirus (HPV)-vaccinated and unvaccinated women and to investigate potential underlying socioeconomic factors.DesignProspective cohort using registry linkage of vaccinations, screening invitations, screening attendance and socioeconomic covariates.SettingSwedish national HPV vaccination and cervical screening programmes.ParticipantsAll Swedish women born between 1988 and 1991 and invited to screening (n=261 434).Outcome measuresAll participants were followed for up to 3 years. Screening attendance was compared between HPV-vaccinated and unvaccinated women. HR and 95% CI were estimated using Cox regression.ResultsVaccination age averaged 18.1 years and the coverage for≥1 dose was 13.5%. In HPV-vaccinated women (n=35 460), screening attendance was higher than in unvaccinated women (n=225 974) (74%vs69%, p<0.001). The crude HR of attendance in HPV-vaccinated women was 1.32 (95% CI 1.30 to 1.34). A positive association remained after adjustment for education, income and migration history (HR=1.10, 95% CI 1.09 to 1.12).ConclusionHPV-vaccinated women were more likely to attend screening than unvaccinated women. Yet, the question needs to be reassessed in routinely vaccinated cohorts, since the vaccinated women included here represent a selected group and may be prone to more health-conscious habits.

Background Limited evidence suggests that preeclampsia (PE) is associated with reduced cancer risk later in life. We aimed to investigate this using large registry-based cohorts. We hypothesised that enhanced immune activation in PE women, suggested by autoimmune-type reactivity, lowers their subsequent cancer risk. Methods Utilising Medical Birth Registry data from Sweden and Finland, we identified 123,495 women with PE and 3,223,537 women without. Data were cross-linked to the national Cancer Registries. Incidence rate ratios with 95% CIs were calculated and adjusted for maternal birth year, age at first birth, and parity. Results Overall cancer risk was significantly lower in Swedish PE women (IRR 0.91) but not in Finnish. Lower IRRs in PE women were found in both cohorts for breast (IRR 0.90 and 0.91), cervical (IRR 0.79 and 0.55) and lung cancer (IRR 0.72 and 0.63), while endometrial cancer showed increased incidence (IRR 1.28 and 1.46). Foetal sex had no impact on cancer risk. Among Swedish siblings to PE women, a slight reduction in cancer risk, driven by lower lung cancer incidence (IRR 0.86), was noted. Conclusion Our data show a link between PE and subsequent cancer risk, suggesting that shared mechanisms may predispose to PE and influence cancer development.

OBJECTIVE:The purpose of the study was to describe the variation of bladder cancer incidence according to occupational categories in the Nordic countries. METHODS:The study cohort comprised 15 million individuals older than 30 years who participated in one or more population censuses in 1960, 1970, 1980/1981, and/or 1990. Standardized incidence ratios (SIRs) were estimated for 53 occupational categories. RESULTS:Significantly increased SIRs were observed among tobacco workers (1.57; 95% confidence interval [CI] 1.24 to 1.96), chimney sweeps (1.48; 95% CI 1.21 to 1.80), waiters (1.43; 95% CI 1.33 to 1.53), hairdressers (1.28; 95% CI 1.18 to 1.40), seamen (1.22; 95% CI 1.16 to 1.30), printers (1.21; 95% CI 1.14 to 1.30), and plumbers (1.20; 95% CI 1.13 to 1.30). A significantly decreased risk of bladder cancer was observed among gardeners (0.78, 0.75 to 0.80), forestry workers (0.74; 95% CI 0.70 to 0.78), and farmers (0.70; 95% CI 0.68 to 0.71). CONCLUSIONS:The SIR of bladder cancer was overall similar across the Nordic countries. The study suggests that occupation is evidently associated with bladder cancer risk.

OBJECTIVE:The aim of this study was to describe the occupational variation in the incidence of kidney cancer in the Nordic population. METHODS:The population comprised of 14.9 million individuals included in censuses between 1960 and 1990. Standardized incidence ratios (SIRs) were calculated for each occupational group. RESULTS:Significantly increased SIRs were observed in welders [1.24, 95% confidence interval (95% CI) 1.14 to 1.35], public safety workers (1.16, 95% CI 1.08 to 1.25), and seamen (1.16, 95% CI 1.07 to 1.26). Significantly decreased SIRs were found in laboratory assistants (0.76, 95% CI 0.60 to 0.94) and forestry workers (0.77, 95% CI 0.72 to 0.83). CONCLUSION:A relatively small variation in the incidence of malignancies of the kidney between occupational groups was found in the cohort. There is abundant room for further progress in determining the effect of smoking in particular occupational groups.

Purpose Almost 200,000 tongue cancers were diagnosed worldwide in 2020. The aim of this study was to describe occupational risk variation in this malignancy. Methods The data are based on the Nordic Occupational Cancer (NOCCA) study containing 14.9 million people from the Nordic countries with 9020 tongue cancers diagnosed during 1961–2005. The standardized incidence ratio (SIR) of tongue cancer in each occupational category was calculated using national incidence rates as the reference. Results Among men, the incidence was statistically significantly elevated in waiters (SIR 4.36, 95% confidence interval (CI) 3.13-–5.92), beverage workers (SIR 3.42, 95% CI 2.02-5.40), cooks and stewards (SIR 2.55, 95% CI 1.82-3.48), seamen (SIR 1.66, 95% CI 1.36-2.00), journalists (SIR 1.85, 95% CI 1.18-2.75), artistic workers (SIR 2.05, 95% CI 1.54-2.66), hairdressers (SIR 2.17, 95% CI 1.39-3.22), and economically inactive persons (SIR 1.57, 95% CI 1.42-1.73). Among women, the SIR was statistically significantly elevated only in waitresses (SIR 1.39, 95% CI 1.05-1.81). Statistically significant SIRs ≤ 0.63 were observed in male farmers, gardeners, forestry workers and teachers, and in female launderers. Conclusions These findings may be related to consumption of alcohol and tobacco, but the effect of carcinogenic exposure from work cannot be excluded.

Objective. To asses the burden and correlates of genital warts in women. Methods. We conducted a population-based cross-sectional study in 69,147 women (18–45 years of age) randomly chosen from the general population in Denmark, Iceland, Norway, and Sweden. Information on clinically diagnosed genital warts and lifestyle habits was collected using a questionnaire. Results. Overall, 10.6% reported ever having had clinically diagnosed genital warts. In addition, 1.3% reported having experienced genital warts within the past 12 months. The cumulative incidence for different birth cohorts, estimated on the basis of age at first diagnosis of genital warts, increased with each subsequent younger birth cohort (P<.01). The lifetime number of sex partners was strongly correlated with a history of genital warts (odds ratio for ⩾15 partners vs. 1 partner, 9.45 [95% confidence interval, 7.89–11.30]). The likelihood of reporting genital warts also increased with a history of sexually transmitted disease, use of hormonal contraceptives, use of condoms, smoking, and higher education. Conclusions. The data suggest that ∼1 in 10 women in the Nordic countries experience genital warts before the age of 45 years, with an increasing occurrence in younger birth cohorts. These data are important for developing and evaluating strategies (e.g., human papillomavirus [HPV] vaccination) to control and prevent HPV infection and disease in the population.

Objective To determine factors influencing long term risks for acquiring or dying from invasive cervical or vaginal cancer in women previously treated for cervical intraepithelial neoplasia grade 3 (CIN3).Design Population based cohort study conducted in 1958-2008, followed up until 2009 in the Swedish Cancer Registry and Swedish Cause of Death Register, linked to the Swedish Population Register. Standardised incidence and mortality ratios were calculated for the risk of acquiring or dying from vaginal or cervical cancer, with the general female population in Sweden as reference. Relative risks in multivariable regression models were also calculated, adjusting for follow-up duration, treatment period, and age at CIN3 treatment or attained age.Setting Entire female population of Sweden.Participants 150 883 women in Sweden diagnosed and treated with CIN3 and followed up for invasive cervical or vaginal cancer, and related mortality. The cohort comprised 3 148 222 woman years.Main outcome measures Standardised incidence and mortality ratios, stratified by period for treatment. Relative standardised incidence ratios and standardised mortality ratios for age at acquiring or dying from cervical or vaginal cancer (attained age), adjusted for preset variables.Results Women previously diagnosed with CIN3 had an increased risk of dying from invasive cervical or vaginal cancer, compared with the general female population (standardised mortality ratio 2.35, 95% confidence interval 2.11 to 2.61). After age 60 years, these women had an accelerated increased risk of acquiring invasive cancer; a similar steep increase in mortality risk was seen after age 70. Regression analyses indicated that the increase in risk over time is highly attributable to ageing.Conclusions Women previously treated for CIN3 are at increased risk of developing and dying from cervical or vaginal cancer, compared with the general female population. The risk accelerates above age 60 years, suggesting a need for lifelong surveillance of these women.