Background and aims: Polypectomy in the colon has been shown to prevent colorectal cancer in both the general population and in familial colorectal cancer. Individuals with a family history of colorectal cancer have an increased risk of the disease. Over a period of 10 years, 304 subjects at risk were included in ongoing surveillance with regular colonoscopies. To compile the medical findings and experience generated during this period, a retrospective cross sectional study was performed. Subjects: Subjects were classified into three family groups: families with hereditary non-polyposis colorectal cancer (HNPCC); families with hereditary colorectal cancer (HCC, non-Lynch syndrome); and a third group of families with only empirical risk estimates based on a family history of two close relatives (TCR) with colorectal cancer. Methods: The risk population was studied with regard to age at onset, prevalence, number, cancer risk, size, dysplasia, and distribution of adenomas. A comparison was made within the family groups and with a reference group representing the general population. Results: In total, 195 adenomas and six cancers were detected among 85 individuals. The relative risk of having an adenoma in the whole risk population compared with the general population was 2.6. Subjects from TCR families had most adenomas and HNPCC subjects had the least. A shift from proximal adenomas to distal carcinomas in families with HCC and TCR suggested a higher cancer risk in distal adenomas in these syndromes. HNPCC families showed a younger age at onset and adenomas with a higher degree of dysplasia. In HNPCC, there was a similar localisation of adenomas and carcinomas, suggesting a high risk of cancer in all adenomas. Conclusions: There was clear overrepresentation of adenomas in all three family types compared with the reference population. In HNPCC, we found earlier onset of adenomas and faster progression to cancer. Families with HCC, and even more so TCR subjects, had a later onset and lower risk of cancer from proximal adenomas. Based on these results, surveillance protocols in Sweden have been revised.
During the period 1964-1973, a defined sample of 740 Swedish urban school children (360 girls and 380 boys) from 40 different urban areas all over the country were followed longitudinally. Height and weight were measured twice a year and age at menarche was recorded. Mean ages at peak height velocity (PHV) and peak weight velocity (PWV) were 11-91 years (SD 0-95) and 12-50 years (SD 1-08) for girls with average values of 8-30 cm/year (SD 1-32) and 7-37 kg/year (SD 1-94). Mean age at menarche was 13-05 years (SD 1-03). PHV and PWV in boys occurred on average at 14-09 years (SD 1-11) and 14-30 years (SD 1-11) with magnitudes of 9-84 cm/year (SD 1-40) and 9-07 kg/year (SD 2-04). No significant differences between socio-economic strata defined by father's occupation and family income were found either for height and weight or for ages at PHV, PWV and menarche. Girls but not boys in the lowest social group (III) had more weight for height during puberty than had girls in social groups I and II. Between the three main geographical regions of Sweden some differences were found. Boys in the South were at the ages of 17 and 18 on average heavier than boys from the rest of the country. Boys and girls in the South had PHV, PWV and menarche half a year later than children in Middle Sweden. In analysis of variance for age at PHV significant interaction terms were found for regions times urbanization. In the South and North age at PHV was earlier the higher the urbanization level, but in Middle Sweden the reverse occurred.
A sample of Swedish urban schoolchildren (357 girls, 373 boys) born in 1954/55 followed from 10 to 18 years were grouped according to peak height velocity age (PHV age) into early, average and late maturers. Mean heights differed between the maturity groups at ages from 10.0 to 14.0 years for girls and 10.5 to 17.0 years for boys. Mean weights differed between the maturity groups at all ages up to 16.0 years for girls and up to 18.0 years for boys. The earlier the maturity process, the heavier for given height. The time differences between peak weight velocity (PWV) and PHV significantly differed between early, average and late maturers amounting to 0.9, 0.5 and 0.2 years respectively for girls and 0.6, 0.3 and -0.1 years respectively for boys. The time difference between menarche and PWV did not differ between the maturity groups and amounted to about 0.6 +/- 0.05 years (SD = 0.9). For boys a similar lack of difference between maturity groups was obtained concerning the time difference between secondary sex characteristics; stage 4 (SSC IV) and PWV. Mean height and weight for girls and boys differed between the maturity groups at PHV but not at PWV, menarche or SCC IV.
Swedish population reference standards for height, weight and body mass index (BMI) attained at 6 to 16 years (girls) or 19 years (boys) are presented. Data were obtained from two independent nationwide samples of Swedish children; one (740 children) born in 1955, the other (2907 children) born in 1967. The weights of the children born in 1955 were adjusted to equal those born in 1967; heights did not differ. These reference standards refer therefore to Swedish children born at around 1970. The observations were fitted by the power transformation, or L, M, S method of Cole and Green. Weights and BMIs were thus normalized and valid SD scores for individuals obtained. Centile charts are given for clinical use. The means of the present, nationwide standards were 1-2 cm and 1-2 kg greater than those of the Solna-based standards currently in use.
In March 1980 a cross-sectional study of the pubertal developmental of a sample of Stockholm schoolchildren was conducted. Breast development (B1-B5), pubic hair (PH1-PH5) and axillary hair (AH1-AH3) were rated in 138 girls, and genitalia development (G1-G5), pubic hair (PH1-PH5) and axillary hair (AH1-AH3) were rated in 116 boys according to the Tanner method. The girls' and the boys' ratings were done by one female and one male medically qualified expert respectively. When relating social class to age of pubertal stage no significant differences were found. Median ages for entry to successive pubertal stages as well as centiles were calculated by logistic regression. Girls were somewhat earlier in their breast and pubic hair development than Stockholm girls investigated in earlier studies; however, somewhat later in their development of axillary hair. The boys entered G2 earlier than boys studied in 1970 but entered G5 at exactly the same age, 15.1 years. Boys entered PH2 somewhat later than 1970 boys, but again reached PH5 at exactly the same age, 15.5 years. The present study is based on a more recent and somewhat larger sample of children drawn from a wider area of Stockholm than the earlier studies. It is further suggested that these values be used in the proposed new height and weight reference values for youth in Sweden.
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