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Aim of the article: We present our new GDPR-compliant federated analysis programme (nordcan.R), how it is used to compute statistics for the Nordic cancer statistics web platform NORDCAN, and demonstrate that it works also with non-Nordic data. Materials and methods: We chose R and Stata programming languages for writing nordcan.R. Additionally, the internationally used CRG Tools programme by International Agency for Research on Cancer (IARC/WHO) was employed. A formal assessment of (GDPR-compliant) anonymity of all nordcan.R outputs was performed. In order to demonstrate that nordcan.R also works with non-Nordic data, we used data from the Netherlands Cancer Registry. Results: nordcan.R, publicly available on Github, takes as input cancer and general population data and produces tables of statistics. Each NORDCAN participant runs nordcan.R locally and delivers its results to IARC for publication. According to our anonymity assessment the data can be shared with international organizations, including IARC. nordcan.R incidence results on Norwegian and Dutch data are highly similar to those produced by two other independent methods. Conclusion: nordcan.R produces accurate cancer statistics where all personal and sensitive data are kept within each cancer registry. In the age of strict data protection policies, we have shown that international collaboration in cancer registry research and statistics reporting is achievable with the federated analysis approach. Undertakings similar to NORDCAN should consider using nordcan.R. [ABSTRACT FROM AUTHOR]

Abstract Background Physical activity has been shown to reduce the risk of colon, endometrial and postmenopausal breast cancer. The aim of this study was to quantify the proportion of the cancer burden in the Nordic countries linked to insufficient levels of leisure time physical activity and estimate the potential for cancer prevention for these three sites by increasing physical activity levels. Methods Using the Prevent macrosimulation model, the number of cancer cases in the Nordic countries over a 30-year period (2016–2045) was modelled, under different scenarios of increasing physical activity levels in the population, and compared with the projected number of cases if constant physical activity prevailed. Physical activity (moderate and vigorous) was categorised according to metabolic equivalents (MET) hours in groups with sufficient physical activity (15+ MET-hours/week), low deficit (9 to <15 MET-hours/week), medium deficit (3 to <9 MET-hours/week) and high deficit (<3 MET-hours/week). Results If no one had insufficient levels of physical activity, about 11,000 colon, endometrial and postmenopausal breast cancer cases could be avoided in the Nordic countries in a 30-year period, which is 1% of the expected cases for the three cancer types. With a 50% reduction in all deficit groups by 2025 or a 100% reduction in the group of high deficit, approximately 0.5% of the expected cases for the three cancer types could be avoided. The number and percentage of avoidable cases was highest for colon cancer. Conclusion 11,000 cancer cases could be avoided in the Nordic countries in a 30-year period, if deficit in physical activity was eliminated. Highlights • Physical activity reduces the risk of colon, endometrial and postmenopausal breast cancer. • Eliminating deficit in physical activity in the Nordic countries avoids 11,000 cancer cases in 30 years. • This corresponds to 1% of expected cancers for these three sites causally linked to physical activity. • The number and percentage of avoidable cases was highest (1.3%) for colon cancer. [ABSTRACT FROM AUTHOR]

Abstract Background Alcohol consumption is an important and preventable cause of cancer. The aim of this study was to quantify the proportion of the cancer burden in the Nordic countries linked to alcohol and estimate the potential for cancer prevention by changes in alcohol consumption. Methods Using the Prevent macro-simulation model, the number of cancer cases in the Nordic countries over a 30-year period (2016–2045) was modelled for six sites, under different scenarios of changing alcohol consumption, and compared to the projected number of cases if constant alcohol consumption prevailed. The studied sites were colorectal, post-menopausal breast, oral cavity and pharynx, liver, larynx as well as oesophageal squamous cell carcinoma. The alcohol consumption was based on the categories of non-drinkers/occasional drinkers, light drinkers (<=12.5 g alcohol per day), moderate drinkers (>12.5 and ≤ 50 g/day) and heavy drinkers (>50 g/day). Results About 83,000 cancer cases could be avoided in the Nordic countries in a 30-year period if alcohol consumption was entirely eliminated, which is 5.5% of the expected number of cases for the six alcohol-related cancer types. With a 50% reduction in the proportion with moderate alcohol consumption by year 2025, 21,500 cancer cases could be avoided. The number of avoidable cases was highest for post-menopausal breast and colorectal cancer, but the percentage was highest for oesophageal squamous cell carcinoma. Conclusion The results from this study can be used to understand the potential impact and significance of primary prevention programmes targeted towards reducing the alcohol consumption in the Nordic countries. Highlights • Eliminating alcohol consumption in the Nordic countries could avoid 83,000 cancers in 30 years. • This corresponds to 5.5% of the expected cancers for the six cancer sites causally linked to alcohol. • The number of avoidable cases was highest for breast and colorectal cancer. • Oesophageal squamous cell carcinoma showed the largest percentage of avoidable cancers. [ABSTRACT FROM AUTHOR]

Abstract Background Tobacco smoking is a leading cause of cancer and the most preventable cause of cancer worldwide. The aim of this study was to quantify the proportion of the cancer burden in the Nordic countries linked to tobacco smoking and estimate the potential for cancer prevention by changes in smoking prevalence. Methods The Prevent macro-simulation model was used, estimating the future number of cancer cases in the Nordic countries over a 30-year period (2016–2045), for 13 cancer sites, under different scenarios of changing smoking prevalence, and compared to the projected number of cases if constant prevalence prevailed. Results A total of 430,000 cancer cases, of the 2.2 million expected for the 13 studied cancer sites, could be avoided in the Nordic countries over the 30-year period if smoking was eliminated from 2016 onwards. If prevalence of smoking is reduced to 5% by year 2030 and to 2% by 2040, 230,000 cancer cases could be avoided. The largest proportion of cancers can be avoided in Denmark, where smoking prevalence is the highest, and similar to the prevalence in many European countries. Conclusion A large amount of cancers could be avoided in the Nordic countries if smoking prevalence was reduced. The results from this study can be used to understand the potential impact and significance of primary prevention programmes targeted towards reducing the prevalence of tobacco smoking in the Nordic countries. Highlights • Eliminating smoking in the Nordic countries could avoid 430,000 cancers in 30 years. • The number of avoidable cases was highest for lung and bladder cancer. • Lung and laryngeal cancer showed the largest percentage of avoidable cancers. • Denmark had the highest number and percentage of avoidable cancers. [ABSTRACT FROM AUTHOR]

Immunosuppression involves an inability to control virus infections and increased incidence of virus-associated cancers. Some cancers without known viral etiology are also increased, but data on exactly which cancer forms are increased has been inconsistent. To provide a reliable and generalizable estimate, with high statistical power and long follow-up time, we assessed cancer risks using comprehensive, population-based registries in two different countries and from two different immunosuppressed patient groups (solid organ transplant recipients (OTRs) and long-term dialysis patients (LDPs)). National registries in Denmark and Sweden identified 20,804 OTRs and 31,140 LDPs that were followed up using national cancer registries. Standardized incidence ratios (SIR) compared to the general population were estimated. We found highly similar results, both for the two different countries and for the two different immunosuppressed cohorts, namely an increased incidence for the following specific cancer forms: Non-melanoma skin cancer (NMSC), non-Hodgkin's lymphoma and cancers of the lip, kidney, larynx and thyroid. The SIR for overall cancer among OTRs was 3.5 [ n = 2,142, 95% CI, 3.4-3.7] in Sweden, 2.9 [ n = 1,110, 95% CI, 2.8-3.1] in Denmark and 1.6 [ n = 1,713, 95% CI, 1.5-1.6] among LDP. The SIR for NMSC among OTRs was 44.7 [ n = 994, 95% CI, 42-47.5] in Sweden and 41.5 [ n = 445, 95% CI, 37.8-45.5] in Denmark. The increased SIR for NMSC among LDPs was 5.3 [ n = 304, 95% CI, 4.7-5.9]). In summary, an increased SIR for a specific, similar set of cancer forms is consistently found among the immunosuppressed. Conceivable explanations include surveillance bias and immunosuppression-related susceptibility to viral infections. [ABSTRACT FROM AUTHOR]

Objective. To explore the variation in ovarian cancer survival in Denmark in the period 1978-2002 in relation to time since diagnosis, age at diagnosis, period of diagnosis, stage and histology. Design. Register-based cohort study. Setting. Denmark in the period 1978-2002. Population. Using the nationwide Danish Cancer Registry, we included a total of 13,035 women diagnosed with invasive ovarian cancer in Denmark in the period 1978-2002. Methods. Excess mortality risk analyses of five-year relative survival of ovarian cancer patients diagnosed in the period 1978-2002 with follow-up through 2006 were made based on data from the NORDCAN database. Main outcome measures. Five-year relative survival, excess mortality rate (ER) and relative excess mortality risk (RER) after an ovarian cancer diagnosis. Results. The relative survival of Danish ovarian cancer patients slightly increased in the period 1978-2002. The ERs were highest in the first year following diagnosis, in particular in the first three months, and among older patients, even for localized and regional tumors. The pattern remained the same when stratified by histological subgroup. Older age at diagnosis, earlier period of diagnosis, more advanced stage at diagnosis and being diagnosed with undifferentiated carcinoma predicted poorer survival among Danish ovarian cancer patients diagnosed in the period 1978-2002. Conclusions. The survival of Danish ovarian cancer patients has slightly increased from 1978 through 2002. Despite this, the mortality rate of ovarian cancer in Denmark is still higher than in the other Nordic countries. Explanations for these differences are still to be identified. [ABSTRACT FROM AUTHOR]

Aims: Diet is considered an important aspect of lifestyle related to cancer development. To contribute further knowledge within this field a Danish prospective cohort study "Diet, Cancer and Health" has been initiated. The aims of this paper are to give a description of the study design, measurement procedures, and differences between participants and non-participants with special reference to socioeconomic characteristics. Methods: A total of 160,725 individuals 50-64 years of age living in Copenhagen or Aarhus were invited to participate. Information concerning diet and other lifestyle factors was obtained from 57,053 participants using questionnaires and interviews. Anthropometric measurements were taken and biological material collected. In addition, detailed (selected) socioeconomic information on all invited persons including 103,671 non-participants was obtained from statistical registers in Statistics Denmark. Results: Differences were seen between participants and non-participants on a number of socioeconomic factors. The highest participation in relation to education was found among participants with higher education, with a significant tendency to be highest in the second highest level of higher education (3-4 years). Married people were more likely to participate than persons living alone or cohabiting. Conclusion: Results from the prospective cohort study "Diet, Cancer and Health" support the general assumption that lower socioeconomic groups are underrepresented in epidemiological studies. [ABSTRACT FROM AUTHOR]

Objectives: Studies in traditional paper mills have indicated an excess cancer risk, and mutagenic compounds have been identified in the industry. No studies have reported on risk of cancer in paper recycling. Therefore the cancer incidence in Danish paper recycling mills was investigated. Methods: 5377 employees in five paper recycling plants were included in a historical cohort study. The workers had been employed in paper recycling in 1965-90, and the cohort was followed up until 31 December 1993. The expected number of cancer cases was calculated from national rates. Results: There was significantly more pharyngeal cancer among male workers (seven observed (standardised incidence ratio (SIR) 3.33, 95% confidence interval (95% CI) 1.34 to 6.87)). There was slightly more lung cancer among male workers mi production (39 observed, SIR 1.21, 95% CI 0.86 to 1.65). Risk of Hodgkin's disease was doubled in male production worker (four observed, SIR 1.90, 95% CI 0.51 to 4.85). Conclusions: The increased risk of pharyngeal cancer found in this study is interesting but may be influenced by confounders such as smoking and alcohol intake. This study also indicates an excess risk of Hodgkin's disease, which is in accordance with some studies in the traditional paper mills. As this is the first report on risk of cancer in paper recycling, further studies are needed. [ABSTRACT FROM AUTHOR]

Objectives: To study the relative and absolute risks of main types of lung cancer in a cohort of asbestos cement workers from Denmark.Method: A cohort of 7887 men and 576 women employed between 1928 and 1984 was compiled from the personnel files of Danish Eternit Production. The cohort was followed up for deaths, emigrations, and incident cancer cases during the period 1943-90. The observed number of lung cancer cases in the cohort was compared with the expected number based on incidences for the Danish population. Internal comparison was made with Poisson modelling.Results: A total of 226 lung cancer cases were observed (223 men and three women). The standardised incidence ratio (SIR) for all lung cancer among men was 1.7 (observed number 223, expected number 129.7, 95% confidence interval (95% CI) 1.5-2.0). The SIRs were raised for all main types of lung cancer; adenocarcinoma 2.6, squamous cell carcinoma 1.7, and anaplastic carcinoma 1.5. The higher SIR for adenocarcinomas was found particularly with a latency period of 25 years or more. Among the 93 excess lung cancer cases, 36 were squamous cell carcinomas and 32 were adenocarcinomas.Conclusion: Asbestos cement work is associated with an increased risk of lung cancer of all main types. During the first 25 years after the start of employment this excess risk is shared almost equally between the different histological types of lung cancer, but the risk of adenocarcinomas is clearly higher after this point. [ABSTRACT FROM AUTHOR]

Background Several types of cancers are causally linked to overweight and obesity, which are increasing in the Nordic countries. The aim of this study was to quantify the proportion of the cancer burden linked to overweight and obesity in the Nordic countries and estimate the potential for cancer prevention. Methods Under different prevalence scenarios of overweight and obesity, the number of cancer cases in the Nordic countries in the next 30 years (i.e. 2016–2045) was estimated for 13 cancer sites and compared to the projected number of cancer cases if the prevalence stayed constant. The Prevent macro-simulation model was used. Results Over the period 2016–2045, 205,000 cancer cases out of the 2.1 million expected for the 13 cancer sites (9.5%) that have been studied, could be avoided in the Nordic countries by totally eliminating overweight and obesity in the target population. The largest proportional impact was found for oesophageal adenocarcinoma (24%), and the highest absolute impact was observed for colon (44638) and postmenopausal breast cancer (41135). Conclusion Decreased prevalence of overweight and obesity would reduce the cancer burden in the Nordic countries. The results from this study form an important step to increase awareness and priorities in cancer control by controlling overweight and obesity in the population. [ABSTRACT FROM AUTHOR]

Abstract: The purpose of this nationwide, population register-based study was to describe variations in cancer incidence and survival by social position in a social welfare state, Denmark, on the basis of a range of socioeconomic, demographic and health-related indicators. Our study population comprised all 3.22 million Danish residents born in 1925–1973 and aged ⩾30 years, who were followed up for cancer incidence in 1994–2003 and for survival in 1994–2006, yielding 147,973 cancers. The incidence increased with lower education and income, especially for tobacco- and other lifestyle-related cancers, although for cancers of the breast and prostate and malignant melanoma the association was inverse. Conversely there was a general increase in incidence among early retirement pensioners, persons living in rented housing and those living in the smallest dwellings. Also incidence rates were generally higher in persons living alone compared to those living with a partner and in the capital area compared to the rural areas. Social inequality in the prognosis of most cancers was observed, despite the equal access to health care in Denmark, with poorer relative survival related to fewer advantages, regardless of how they were measured, often most pronounced in the first year after diagnosis. Also living alone and having somatic or psychiatric comorbidity negatively impacted the relative survival after most cancers. Our study shows that inequalities in cancer incidence and survival must be addressed in all aspects of public health, with interventions both to reduce incidence and to prolong survival. [Copyright &y& Elsevier]

Abstract: The purpose of this register-based study was to identify variations in cancer incidence and survival after cancer in Denmark on the basis of a range of socioeconomic, demographic and health-related indicators. The indicators were level of education, disposable income, affiliation to the work market, social class, housing tenure, size of dwelling, cohabitation status, type of district, ethnicity, Charlson comorbidity index, depression and schizophrenia measured at the individual level on an annual basis. The study population comprised all Danish residents born between 1925 and 1973 and aged ⩾30 years, who were followed up for cancer incidence in 1994–2003 and for survival in 1994–2006. The study was based on 3.22 million persons, yielding almost 26 million person-years and 147,973 cancers. In this paper, we provide a detailed description of the indicators and the statistical methods, and we discuss the strengths and limitations of our approach. [Copyright &y& Elsevier]

Abstract: In a population based retrospective cohort study we studied cancer risk in Danish soldiers deployed to the war in the Balkans. In particular, leukaemia, earlier linked to ammunition enforced with depleted uranium (DU) in other deployed soldiers, was a concern. Military personnel, 13,552 men and 460 women, without known cancer at first deployment to the Balkans, January 1, 1992 to December 31, 2001 were followed through December 2002. We found 96cases of cancer, 84 among men (standardised incidence ratio (SIR) 0.9) and 12 among women (SIR 1.7). Only four male bone cancers (SIR 6.0), with three during the first year of follow-up, exceeded expectations. Earlier reports on increased risk of leukaemia and testis cancer among deployed military personnel to the Balkans are not corroborated by our study. Quick and open communication about potential risks, a health check, a telephone counselling line and careful monitoring, and diminished anxiety all helped contain the ‘Balkan syndrome’ in Denmark. [Copyright &y& Elsevier]