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06/24/2004 23:12
Kristen
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06/24/2004 23:12
Kristen
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Cancer deaths more prevalent in people with DC
An interesting (and depressing) study was conducted over a 15 year period showing cancer deaths to be statistically significant in people with stage 2 or greater DC. It was published in a medical journal in the UK. (see below) I would assume that the presence of DC already indicates that your immune system is on the fritz (I'm not a doctor and "on the fritz" is not a medical term ;-) Kristen
Increased total mortality and cancer mortality in men with Dupuytren's disease: a 15-year follow-up study. Gudmundsson Kristjan G; Arngrimsson Reynir; Sigfusson Nikulas; Jonsson Thorbjorn The Health Care Centre, Fludabakka 6, 540, Blonduos, Iceland. kristgud@HNLfi.is Journal of clinical epidemiology (England) Jan 2002, 55 (1) p5-10, ISSN 0895-4356 Journal Code: 8801383 Document type: Journal Article Languages: ENGLISH Main Citation Owner: NLM Record type: Completed Subfile: INDEX MEDICUS The aim of the present study was to evaluate the mortality rate and causes of death of individuals with Dupuytren's disease. In 1981/82, as part of The Reykjavik Study, a general health survey, 1297 males were examined for clinical signs of Dupuytren's disease. Based on the clinical evaluation the participants were classified into three groups: (1) those with no signs of Dupuytren's disease were referred to as the reference cohort; (2) those with palpable nodules in the palmar fascia were classified as having stage 1; and (3) those who had contracted fingers or had been operated on due to contractures were classified as having stage 2 of Dupuytren's disease. In 1997, after a 15- year follow-up period, the mortality rate and causes of death were investigated in relation to the clinical findings from 1981/82. Information about causes of death were obtained from the National Icelandic Death Registry and the Icelandic Cancer Registry. During the follow-up period, 21.5% (225/1048) of the reference cohort were deceased compared to 29.9% (55/184) of those with stage 1 and 47.7% (31/65) of those with stage 2 of Dupuytren's disease. When adjusted for age, smoking habits and other possible confounders, individuals with stage 2 of the disease showed increased total mortality [hazard ratio (HR) = 1.6; 95% CI 1.1-2.4]. Cancer deaths were increased (HR = 1.9; CI 1.0-3.6). In contrast, participants with stage 1 of Dupuytren's disease did not show increased mortality. A moderate but non-significant increase in cancer incidence was observed among individuals with stage 2 of Dupuytren's disease (HR = 1.5; 95% CI 0.9-2.4, P = 0.15). The study showed increased total mortality of individuals with Dupuytren's disease stage 2, where 42% of the excess in mortality could be attributed to cancer deaths. Tags: Human; Male; Support, Non-U.S. Gov't Descriptors: *Cause of Death; *Dupuytren's Contracture--mortality--MO; *Neoplasms--mortality--MO; Aged; Confounding Factors (Epidemiology); Dupuytren's Contracture--complications--CO; Dupuytren's Contracture --epidemiology--EP; Follow-Up Studies; Iceland--epidemiology--EP; Middle Aged; Neoplasms--complications--CO; Prevalence; Registries; Risk Factors; Smoking--adverse effects--AE
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11/02/2004 23:01
Patsy
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11/02/2004 23:01
Patsy
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early death
I find this very upsetting. I plan to have at least an annual cancer exam due to this article.
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11/03/2004 23:48
RHONDAnot registered
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11/03/2004 23:48
RHONDAnot registered
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CAUSE AND CONCERN~sq~S.
LET'S SEE, I DONT SMOKE, DONT HAVE DIABETES, DONT HAVE CANCER,I DON'T THINK I HAVE ALZIEMERS!!(?)AND ONLY DRINK EVERY NOW AND THEN, I'M AT A STAGE 4 AND A HALF SAYS MY THERAPIST FOR MY HAND, (OF STAGES 1-4,,,, 4 BEING THE WORST), OH AND NO SWEEDISH IN THE FAMILY. SOO, WHAT MIGHT HAVE CAUSED MY D.C.? AND IM 40 SOMETHING.
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12/01/2004 23:53
Michael Lusknot registered
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12/01/2004 23:53
Michael Lusknot registered
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Dupuytren~sq~s and mortality
Kristen,
I read that Journal of Clinical Epidemiology article too. It does make depressing reading for people with stage 2 DD (with contracture). It concludes that men with stage 2 DD in late middle age are over 50% more likely to die in the next 15 years than those with stage 1 (palpable nodules, no contracture) or without any sign of DD. It also concludes that 42% of the increase in mortality is due to cancer. Stage 2-ers are almost twice as likely to die of cancer as non-DD or stage 1 men - although, curiously, the incidence of cancer is not statistically higher than the norm, meaning perhaps that cancer when it occurs is more aggressive in DD sufferers.
But a couple of things puzzle me:
1) It seems if DD had that marked an effect on mortality, it would have been discovered long ago. People who live in the Grampian Region of Scotland (population ~525,000, Viking or Celtic ancestry, take your pick) have an unusually high rate of DD, yet overall mortality and mortality from cancer is at about the British average.
2) If cancer accounts for 42% of the increased mortality, what accounts for the remaining 58%?
3) Why is the increase in cancer so uniformly spread throughout the types of cancer?
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12/06/2004 23:28
mary hnot registered
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12/06/2004 23:28
mary hnot registered
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mortality studies
just curious about life expectancy research...any correlation between shortened life expectancy in females with DC ? studies quoted referred to amles i believe.
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12/11/2004 23:54
Michael Lusknot registered
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12/11/2004 23:54
Michael Lusknot registered
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mortality studies
I've been ploughing through the Uppsala study mentioned by Sean. I'm probably missing some subtleties, but to this poor befuddled layman, it seems to contain some internal inconsistencies; and it comes to very different conclusions re cancer risk than the Journal of Clinical Epidemiology (Reykjavik) study. (In the following examples, remarks in parentheses are mine:
On page 32, it says: 'Cancer was the second most common cause of death (in those who had undergone surgery for Dups), with a significantly increased overall mortality of 20%'
On page 36, in a section entitled ‘Cancer and free oxygen radicals’ and refering to the results of the Reykjavik study, it says: ‘After adjustment for age, smoking habits, body mass index, fasting blood glucose, and manual or learned labour, individuals with clinical signs of DC showed an increased cancer mortality ratio of 1.9. (implying an increased cancer mortality of 90%, if I understand it correctly).
So are ‘increased overall mortality’ and ‘increased mortality ratio’ different concepts, or are the results of the two studies that drastically different?
The Reykjavik result is most worrisome, both because it implies a much larger cancer mortality risk, and because it adjusted for confounding factors like smoking. On the other hand, the Uppsala study had a much larger sample size (16,517) than the Reykjavik study (1,297). Uppsala also adjusted for diabetes.
Another apparent inconsistency:
On page 30, when discussing how increased overall mortality was related to the age of the patients when they had their surgeries, it says: ‘We observed a significant increase in overall mortality for both genders in all age groups except in patients under 20…, in women between 30 and 39…, and among patients over 70 at the time of surgery. In the next sentence it says: ‘…in women the (mortality) risk was more than doubled if they underwent surgery bfore the age of 50.’ How can both these things be true?
More befuddlement to come...
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12/11/2004 23:59
Sean
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12/11/2004 23:59
Sean
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life expectancy
Michael, I agree with you that there is still the impression that there could be correlating factors between DC and cancer. I thought (page 36) that their "explanation for the pattern of different cancers in patients with DC could be dietary factors, especially antioxidants. Oxidative stress has been associated with DC, as well as with the development of cardiovascular disease and diabetes. In our study of cancer incidence in patients operated for DC, we observed that gastric and colorectal cancers occurred more frequently than expected, as did cancers of the breast and prostate."
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12/12/2004 23:59
Michael Lusknot registered
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12/12/2004 23:59
Michael Lusknot registered
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Dups & mortality
Sean,
Although the Uppsala study shows a significant increase in mortality for stage 2 DD-ers, it's certainly a lot more hopeful than the Iceland study. It concludes that the increased risk of mortality might be due to dietary factors and other lifestyle choices that also tend to trigger DD, meaning it's controllable. I for one am going to pay a lot more attention to antioxidants in my diet!
At this point, I don't see how the two studies can be entirely reconciled, but I guess the size of the sample populations (~16K vs 1267) gives the Uppsala study more credence.
Best Regards, Michael
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