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Risk of cancer of unknown primary among immigrants to Sweden

Shu, Xiaochena; Sundquist, Kristinaa; Sundquist, Jana,b; Hemminki, Karia,c

European Journal of Cancer Prevention: January 2012 - Volume 21 - Issue 1 - p 10–14
doi: 10.1097/CEJ.0b013e3283498ded
Research Papers: Epidemiology

Incidence of cancer of unknown primary (CUP) varies globally, and environmental factors are suspected to be related to its development. Immigrant studies offer insights into disease etiology, but no studies have been published on CUP. We investigated CUP risk in immigrants to Sweden to search for etiological clues. The nationwide Swedish Family Cancer Database was used to calculate standardized incidence ratios for CUP in the first-generation immigrants compared with native Swedes from 1958 to 2008. A total of 2340 patients with CUP were identified among immigrants during a follow-up of 23 million person-years compared with 30 507 patients with CUP identified in native Swedes who were followed for 260 million person-years, showing an overall standardized incidence ratio of 0.88 (95% confidence interval: 0.85–0.93). The median age at immigration was 28 years for men and 27 for women. Significantly lower CUP risks, ranging from 0.18 to 0.89, were mainly observed among Finnish, German, and Asian immigrants. The decreased risks tended to be lower for women compared with men. Danes of both sexes had an increased risk. The increased or decreased CUP risks observed in this novel study suggested that early life environmental risk factors or genetic factors influence the development of CUP. The risk patterns were modified by sex. The observed differences may give clues about incidence rates in countries of origin for which incidence data are lacking.

aCenter for Primary Health Care Research, Lund University, 205 02 Malmö, Sweden

bStanford Prevention Research Center, Stanford University School of Medicine, California, USA

cDivision of Molecular Genetic Epidemiology, German Cancer Research Center, Im Neuenheimer Feld 580, D-69120 Heidelberg, Germany

Correspondence to Xiaochen Shu, MD, Center for Primary Health Care Research, CRC, building 28, floor 11, entrance 72, Malmö University Hospital, S-205 02 Malmö, Sweden Tel: +46 40 391334; fax: +46 40 391370; e-mail:

Received April 19, 2011

Accepted May 28, 2011

© 2012 Lippincott Williams & Wilkins, Inc.