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Objective Anaemia is common in healthcare and may indicate undiagnosed cancer. Despite this, evidence regarding risk estimates informing clinical decision-making remains limited, particularly regarding haemoglobin dynamics and the role of mean corpuscularvolume (MCV). We aimed to quantify the 18-month risks of incident cancer (IC) and all-cause mortality (ACM)following incident anaemia (IA), and to examine how MCV modifies these risks.

Methods and analysis Population-based, age- and sex-matched cohort study. The study used the Stockholm Early Detection of Cancer Study (STEADY-CAN), covering almost all adults residing in Stockholm County, Sweden, during 2011–2021. STEADY-CAN links laboratory tests with national registers, capturing healthcare use, diagnoses, cancer outcomes and prescribed medications.

We included 190 057 adults with IA and 190 057 age- and sex-matched non-anaemic controls from the STEADY-CAN cohort. Eligible individuals were ≥18 years old, cancer-free, had ≥2 Hb measurements during 2011–2020 and a concurrent MCV value at the IA date. IA was defined as the first Hb value from 2012 onwards below 130 g/L in men or120 g/L in women after prior normal values.

Sex-stratified adjusted piecewise competing-risks multi-state Cox regression models were used, with separate HRs for IA during 0–3, 3–6, 6–12 and 12–18 months of follow-up. The main outcome measures were IC and ACM during the 18-month follow- up.

Results IC occurred in 6.2% of male and 2.8% of female IA cases, compared with 2.4% and 1.1% of controls. Corresponding ACM rates were 7.4% and 4.0% in IA cases versus 2.5% and 1.7% in controls. IA implied a 9.17-fold higher IC risk and 8.50-fold higher ACM risk among men during 0–3 months of follow-up, with 8.25- and 6.14-fold higher risks among women (all p<0.001). These risks decreased over time but were still significant for both sexes at 6–12 months of follow-up for IC and 12–18 months of follow-up for ACM. Microcytosis was linked to the highest IC risk, particularly for digestive and haematological cancers, whereas macrocytosis was more strongly associated with ACM.

Conclusions IA is a strong marker of both IC and ACM in routine care. Microcytic anaemia should prompt timely gastrointestinal evaluation, while macrocytic anaemia warrants broader assessments for comorbid conditions and systemic disease. Persistently elevated risks underscore the need for structured safety-netting and continued follow-up after IA, even without a cancer identification. Our findings highlight the value of using anaemia patterns and MCV in early risk stratification.

Background Research indicates that about 40% of all cancer cases within the European Union (EU) are preventable. Public awareness of modifiable risk factors is essential for informed health-related decision-making. Systematic assessments of public awareness are crucial for identifying awareness gaps and guiding targeted public health interventions. This study aimed to examine awareness of cancer risk factors among the Swedish general public, and to examine the attitude towards lifestyle changes for cancer prevention.

Methods This cross-sectional study used a pre-existing data set with a randomly selected sample of 1520 participants (18–84 years old) recruited from a Swedish online survey panel in April 2024. Statistical analyses utilized post-stratification weights to make the results representative for the general Swedish population. Pearson’s χ²-test and weighted adjusted logistic regression were used to test for associations between demographic characteristics, believing that changed lifestyle habits could reduce one’s cancer risk, and awareness of 20 established risk factors for cancer.

Results A majority (63.6%) of the respondents believed that one’s cancer risk could be reduced through changed lifestyle habits. Most were aware of smoking (97.1%), sun exposure (92.4%), hereditary factors (91.0%), sunbeds (90.2%), and air pollution (90.2%), while fewer were aware of alcohol (64.9%), obesity (61.6%), overweight (58.1%), and processed meat (53.3%) as cancer risk factors. A minority of the responders were aware of low levels of physical activity (48.1%), red meat (38.9%), low intake of fruit and vegetables (32.9%), low intake of whole grains (23.7%) and not breast-feeding one’s child (9.3%) as risk factors. For most risk factors, the awareness was significantly higher among college/university educated respondents. 

Conclusions Beside significant awareness gaps among the Swedish general public regarding several established cancer risk factors, this study found an educational gradient, illuminating important differences in cancer prevention awareness. Achieving meaningful improvements in cancer prevention awareness requires coordinated system-level and policy-level actions to reduce the educational gradient and ensure equitable access to information. This could in turn increase people’s ability to make well-informed decisions regarding their lifestyle habits and preventive measures.

Objectives 

To compare overall and cancer-specific survival for clinical (c)T1aN0M0 renal cell carcinoma (RCC) in patients treated with non-surgical management (NSM: surveillance and watchful waiting) or active treatment (surgery and ablative treatments).

Patients and methods

In this nationwide real-world population-based cohort study, data on clinical, demographic, and socioeconomic factors as well as tumour characteristics and cause of death were retrieved from the Renal Cell Carcinoma Database Sweden (RCCBaSe) for 3989 patients diagnosed with cT1aN0M0 RCC, 2011–2020 and treated with either NSM or active treatment. Differences in survival between NSM and active treated patients were analysed using standard and competing-risks Cox regression models.

Results

In total, 3727 (93.4%) patients underwent active treatments, while 262 patients (6.6%) were treated with NSM. Patients in the NSM group were significantly older and had a higher comorbidity burden. During a median follow-up time of 4.1 years, all-cause mortality was significantly higher among the NSM (38.9%) than the actively treated (10.9%) patients (P < 0.001), as was cancer-specific mortality (13.0% vs 3.4%, P < 0.001). Larger tumours, older age, male sex, increased comorbidity, being unmarried or widowed, having lower disposable income, and having clear cell or papillary RCC compared with chromophobe RCC were all independently associated with poorer overall and cancer-specific survival. One of the limitations is that treatment allocation was not randomised.

Conclusion

Non-surgical management of cT1aN0M0 RCC was associated with poorer survival compared with surgery/ablation and should be offered mainly for patients with limited life expectancy and indolent renal tumours.

Purpose

To examine sex differences in health-related quality of life (HRQoL) among patients surgically treated for renal cell carcinoma (RCC) in Sweden, utilizing data from the National Swedish Kidney Cancer Register (NSKCR).

Methods

In this study of 4658 surgically treated RCC patients, data on HRQoL, clinical, demographic, and socioeconomic characteristics were retrieved from the NSKCR for patients undergoing surgical treatment between January 2016, and April 2024. HRQoL was measured using the 14- and 19-item versions of the Functional Assessment of Cancer Therapy – Kidney Symptom Index (FKSI-14/19) instrument six months after surgery. The association between sex and HRQoL was estimated using linear regression. Separate analyses were performed for the FKSI-14 and FKSI-19 total scores and underlying domains.

Results

In total, 3086 (66.3%) men and 1572 (33.7%) women were included. After adjusting for clinical, demographic, and socioeconomic characteristics, male sex was significantly associated with higher HRQoL. Specifically, men had higher scores, indicating fewer symptoms, for physical and mental symptoms according to FKSI-14 (P < 0.001), and for physical (P < 0.001) and emotional (P < 0.001) disease-related symptoms, as well as treatment side effects (P < 0.022), according to FKSI-19. Total HRQoL was significantly higher in men, according to both the FKSI-14 (P < 0.001) and the FKSI-19 (P < 0.001).

Conclusions

HRQoL differed significantly between men and women six months after surgery, with men reporting higher HRQoL, even after accounting for clinical, demographic, and socioeconomic factors. Healthcare professionals should be aware of the risk of lower HRQoL among female patients.

Background: Detection of colorectal cancer (CRC) is mainly achieved by clinical assessment. As new treatments become available for metastatic CRC (MCRC), it is important to accurately identify these patients.

Aim: To develop a predictive model for identifying MCRC in primary health care patients using diagnostic data analysed with machine learning.

Design and setting: A case-control study utilising data on primary health care visits for 146 patients >18 years old diagnosed with MCRC in the Västra Götaland Region, Sweden during 2011, and 577 sex-, age, and primary health care centre-matched controls.

Method: Stochastic gradient boosting was used to construct a model for predicting the presence of MCRC based on diagnostic codes from primary health care consultations during the year before index (diagnosis) date and number of consultations. Variable importance was estimated using the normalised relative influence (NRI) score. Risks of having MCRC were calculated using odds ratios of marginal effects (OR_ME).

Results: The optimal model included 76 variables with non-zero influence, had an area under the curve of 76.5%, a sensitivity of 77.8%, and a specificity of 69.2%. The 10 most important variables had a combined NRI of 61.0%. Number of consultations during the year before index date had the highest NRI at 19.2%, with an OR_ME of 3.3.

Conclusion: A machine learning method based on primary health care consultation frequency and diagnoses may be used to identify important variables for predicting presence of MCRC. Both primary health care consultations and associated diagnostic codes need to be taken into consideration.

Improving accuracy and timeliness for osteoporosis diagnosis could help prevent fragility fractures, morbidity, and mortality for older individuals. Osteoporosis is an often silent health condition, especially as regards vertebral fractures, and WHO issued a call to action for primary care to lead efforts in screening, assessing, and managing diseases such as osteoporosis. We used a machine learning method, Stochastic Gradient Boosting (SGB), to identify what diagnoses in a primary care setting predict a new osteoporosis diagnosis, using a sex- and age-matched case–control design. Cases of new osteoporosis (ICD-10 code: M80, M81, M82) were identified across all outpatient care settings during 2012–2019. We included individuals aged ≥ 40 years old, stratified by sex and age-groups 40–65 years and > 65 years old. Controls were sampled from outpatients that did not have osteoporosis at any time during 2010–2019. Using the SGB model, we ranked the most important diagnoses related to newly diagnosed osteoporosis, presented as the normalized relative influence (NRI) score with a corresponding odds ratio of marginal effects (ORME) of being newly diagnosed with osteoporosis. A train-test approach was used to develop the model, with the performance evaluated using area under the curve (AUC). In total, we included 30,741 patients with osteoporosis aged ≥ 40 years. AUC was high, > 0.899 for all age and sex stratas. The number of visits to primary care in the year prior to the osteoporosis diagnosis contributed with the most predictive information for all age and sex stratas. For all age groups several other factors also showed high NRI and ORME and among them many unspecific diagnoses such as Dorsalgia showed high NRI, (2.6–9.0%) and other painful musculoskeletal disorders. However, our study also showed that the diagnosis of Hypertension had a very high NRI for patients aged > 65 years but not in patients 40–65 years of age. In this AI study, including only diagnoses from patients seen in primary health care centres, we found that the number of consultations in primary care had high predictive information as well unspecific diagnoses including muscle and skeletal pain predicted high risk for osteoporosis in all age groups.

Classification of observations into one of several distinct categories is a common task in applied statistics, traditionally performed using parametric statistical models such as logistic regression. These parametric models are, however, often outperformed in terms of prediction accuracy by black box supervised learning models (BBSLMs). A drawback of BBSLMs is the lack of easy-to-interpret feature effect measures similar to the odds ratio (OR) for logistic regression models. The present paper derives two novel feature effect measures based on partial dependence plots for binary classification using BBSLMs: the relative risk of marginal effects (RRME) and the odds ratio of marginal effects (ORME). The performance and interpretation of these new measures are illustrated in an application studying the risk of death within 48 hours of admission among individuals admitted to hospital with a myocardial infarction. The BBSLMs are shown to have better predictive ability than the logistic regression models, with the RRME:s and ORME:s of death for the main risk factor anterior infarct both being 1.8, comparable to the OR of 1.9 for the logistic regression model. The RRMEs and ORMEs are also shown to be more robust in terms of being applicable also for observations with missing values for some features.

Adliga ätten Örnströms, nummer 991, ursprung har fram tills nu varit höljt i dunkel. I denna artikel utreds dess härstamning på fädernet i tre generationer, tillbaka till slutet av 1500-talet. Författarna visar att ätten har sitt ursprung i Arboga, där såväl fadern som farfadern till den 1681 adlade kaptenen vid Närkes och Värmlands regemente Olof Johansson var borgmästare under 1600-talet. Artikeln redovisar också nya rön om Olof Johanssons släktskap med ett flertal andra adliga ätter.

Uppgifterna i den genealogiska litteraturen om Hans Christoffer vonRohr, nr 807, den yngste av tre bröder som 1672 naturaliserades ochintroducerades på Riddarhuset, är motsägelsefulla och uppvisarmånga besynnerligheter. Särskilt de många äktenskapen och barnen,där han skall ha varit gift hela sju gånger, varav sex av äktenskapenskall ha följt på varandra i tät följd under en 20-årsperiod, är iögonfallande.Syftet med föreliggande artikel är att källkritiskt utreda dennakomplicerade härva och bedöma trovärdigheten av de olika uppgifterna,för att fastställa vilka uppgifter som kan anses vara tillförlitligaoch vilka uppgifter som bör strykas ur den genealogiska litteraturen.För detta syfte görs en källkritisk genomgång av uppgifterna om vonRohr och hans uppgivna hustrur och barn i den genealogiska litteraturen,härleder ursprunget till dessa och undersöker i vilken mån de harstöd i samtida primärkällor eller tvärtom strider mot vad som meddelasav dessa. Föreliggande artikel visar att von Rohr endast var gift tregånger, och att grundorsaken till de många besynnerligheterna i denvon Rohrska genealogin står att finna i Åkersteins genealogier, där direktpåhittade namn, födelse-, vigsel- och dödsdatum för såväl vonRohr själv som hans hustrur och barn har vilselett senare tiders genealoger,vilka i sin tur har fått ta till olika typer av ad hoc-lösningar,såsom att stoppa in okända hustrur i de genealogiska tabellerna, för attfå de många motsägelsefulla uppgifterna att gå ihop. Vi redovisar härvidäven nya uppgifter om von Rohrs tredje hustrus ursprung samt tidigareej redovisade barn.