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About me

I am a biostatistician and epidemiologist with research interests in cancer epidemiology and reproductive epidemiology. Since coming to Karolinska Institutet in 1999, I have developed research in numerous epidemiological projects, with a strong focus on cancer and perinatal outcomes. In 2016, I defended my thesis “Pregnancy and breast cancer: Risk patterns, tumour characteristics and prognosis”. I have a methodological interest in register-based research, epidemiological designs and survival analysis. I am also involved in developing policy and guidelines concerning research data documentation and regulations at Karolinska Institutet.

Since 2017, I am affiliated (20%) with the Cancer Registry of Norway, where I lead a project on breast cancer survival by clinical subtype and stage.

I have collaborations with clinical researchers at Karolinska University Hospital.


  • 2016, PhD (Medical Sciences), Karolinska Institutet.
  • 1999, MSc (Mathematical statistics), Stockholm University.

Research description

Research on cancer and pregnancy
My primary research interest is cancer in relation to pregnancy and reproductive history, with a special focus on pregnancy-associated cancer, i.e. cancer diagnosed during or within one or two years after a pregnancy. The research questions I am addressing concern the increasing incidence trend, risk patterns before and after delivery, tumour characteristics and survival. I also study other reproductive factors, such as age at births, number of children, infertility and IVF treatment, in relation to cancer risk and prognosis.

Due to improvements in cancer treatments, the number of young cancer survivors is increasing. It is important to evaluate their possibilities to form families after end of treatment. One of my research aims is therefor to study reproductive potential and fertility after cancer, both by clinical factors and by previous reproductive history.


Research on breast cancer survival
My second research interest is breast cancer among women. I am specifically studying how survival has improved over time, and how survival depends on patient and tumour factors. One of my projects relates to identifying predictors for long-term survival, given that breast cancer patients have an increased relapse risk many years after diagnosis. I am also interested in clinical subtypes of breast cancer (as defined by ER, PR and HER2 status) and survival.

Since 2017, I am affiliated  (20%) with the Cancer Registry in Norway on a project on breast cancer survival. I am also using Swedish Breast Cancer Quality Registry data to address these questions.


Methods for register-based epidemiology
As a statistician and epidemiologist, I am particularly interested in finding the best way to utilize register data to estimate disease risks in the population, for example by clever study designs and statistical methods for register-based research.

In my research I utilize the large Swedish population-based health registers available for research. These unique data sources can be used to answer many questions in way that is impossible in many other countries. In some of my research projects, I develop new methodology and study designs to be able to answer our questions.


Research documentation and Data management

The quality of research is highly dependent on the quality of the underlying data. I have worked effortlessly for many years to improve the procedures for research documentation and data management within research projects at KI. This includes everything from standardized variable lists and codes, commented and structure statistical programming, version control to documentation of research projects and ethical approvals.

I have been leading the development of research documentation guidelines in our department, as well as teaching hands-on techniques for research documentation to epidemiologists, clinicians and researchers at KI and elsewhere. I am regularly an invited speaker on this topic.

A video of my lecture 2018-11-22 at the KI Library Workshop is available in the menu to the right. Slides for this presentation are available on request



Teaching portfolio

I have been involved in teaching and course organising of:

• Survival analysis (biostat III), within the Doctoral Programme in Epidemiology

• Epidemiology II, within the Doctoral Programme in Epidemiology

• Competing risks and multistate models

• Epidemiological designs in a statistical framework

• Workshops on epidemiological designs and cancer survival analysis

• Good Data Management Practice in Epidemiology

• Guidelines for Data Management in Clinical Research



Breast cancer-specific survival by clinical subtype after 7 years follow-up of young and elderly women in a nationwide cohort
Johansson Alv, Trewin Cb, Hjerkind Kv, Ellingjord-dale M, Johannesen Tb, Ursin G
International journal of cancer 2019;144(6):1251-1261

Causes of sick leave, disability pension, and death following a breast cancer diagnosis in women of working age
Plym A, Johansson Alv, Bower H, Voss M, Holmberg L, Fredriksson I, et al
Breast (Edinburgh, Scotland) 2019;45():48-55

Diagnostic pathways and management in women with pregnancy-associated breast cancer (PABC): no evidence of treatment delays following a first healthcare contact
Johansson Alv, Weibull Ce, Fredriksson I, Lambe M
Breast cancer research and treatment 2019;174(2):489-503

Life-course socioeconomic differences and social mobility in preventable and non-preventable mortality: a study of Swedish twins
Ericsson M, Pedersen Nl, Johansson Alv, Fors S, Dahl Aslan Ak
International journal of epidemiology 2019;():-

The risk of breast and gynecological cancer in women with a diagnosis of infertility: a nationwide population-based study
Lundberg Fe, Iliadou An, Rodriguez-wallberg K, Gemzell-danielsson K, Johansson Alv
European journal of epidemiology 2019;34(5):499-507

A prospective investigation of perceived stress, infertility-related stress, and cortisol levels in women undergoing in vitro fertilization: influence on embryo quality and clinical pregnancy rate
Cesta Ce, Johansson Alv, Hreinsson J, Rodriguez-wallberg Ka, Olofsson Ji, Holte J, et al
Acta obstetricia et gynecologica Scandinavica 2018;97(3):258-268

Contemporarily Treated Patients With Hodgkin Lymphoma Have Childbearing Potential in Line With Matched Comparators
Weibull Ce, Johansson Alv, Eloranta S, Smedby Ke, Björkholm M, Lambert Pc, et al
Journal of clinical oncology : official journal of the American Society of Clinical Oncology 2018;36(26):2718-2725

Tumor characteristics and prognosis in women with pregnancy-associated breast cancer
Johansson Alv, Andersson Tm, Hsieh Cc, Jirström K, Cnattingius S, Fredriksson I, et al
International journal of cancer 2018;142(7):1343-1354

Volumetric Mammographic Density, Age-Related Decline, and Breast Cancer Risk Factors in a National Breast Cancer Screening Program
Hjerkind Kv, Ellingjord-dale M, Johansson Alv, Aase Hs, Hoff Sr, Hofvind S, et al
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 2018;27(9):1065-1074

Association Between Maternal Smoking During Pregnancy and Severe Mental Illness in Offspring
Quinn Pd, Rickert Me, Weibull Ce, Johansson Alv, Lichtenstein P, Almqvist C, et al
JAMA psychiatry 2017;74(6):589-596

Association Between Proton Pump Inhibitor Use and Risk of Progression of Chronic Kidney Disease
Klatte Dcf, Gasparini A, Xu H, De Deco P, Trevisan M, Johansson Alv, et al
Gastroenterology 2017;153(3):702-710

Association Between Sleep Characteristics and Incident Dementia Accounting for Baseline Cognitive Status: A Prospective Population-Based Study
Bokenberger K, Ström P, Dahl Aslan Ak, Johansson Al, Gatz M, Pedersen Nl, et al
The journals of gerontology. Series A, Biological sciences and medical sciences 2017;72(1):134-139

Ovarian stimulation and risk of breast cancer in Swedish women
Lundberg Fe, Iliadou An, Rodriguez-wallberg K, Bergh C, Gemzell-danielsson K, Johansson Alv
Fertility and sterility 2017;108(1):137-144

Sex differences in cancer risk and survival: A Swedish cohort study
Radkiewicz C, Johansson Alv, Dickman Pw, Lambe M, Edgren G
European journal of cancer (Oxford, England : 1990) 2017;84():130-140

Time-dependent risk of depression, anxiety, and stress-related disorders in patients with invasive and in situ breast cancer
Yang H, Brand Js, Fang F, Chiesa F, Johansson Al, Hall P, et al
International journal of cancer 2017;140(4):841-852

Association of infertility and fertility treatment with mammographic density in a large screening-based cohort of women: a cross-sectional study
Lundberg Fe, Johansson Al, Rodriguez-wallberg K, Brand Js, Czene K, Hall P, et al
Breast cancer research : BCR 2016;18(1):36-

Chemotherapy, Genetic Susceptibility, and Risk of Venous Thromboembolism in Breast Cancer Patients
Brand Js, Hedayati E, Humphreys K, Ludvigsson Jf, Johansson Al, Bergh J, et al
Clinical cancer research : an official journal of the American Association for Cancer Research 2016;22(21):5249-5255

Infection-related hospitalizations in breast cancer patients: Risk and impact on prognosis
Brand Js, Colzani E, Johansson Alv, Giesecke J, Clements M, Bergh J, et al
The Journal of infection 2016;72(6):650-658

Pregnancy and the Risk of Relapse in Patients Diagnosed With Hodgkin Lymphoma
Weibull Ce, Eloranta S, Smedby Ke, Björkholm M, Kristinsson Sy, Johansson Al, et al
Journal of clinical oncology : official journal of the American Society of Clinical Oncology 2016;34(4):337-44

Risk of hospitalisation and death due to bone fractures after breast cancer: a registry-based cohort study
Colzani E, Clements M, Johansson Al, Liljegren A, He W, Brand J, et al
British journal of cancer 2016;115(11):1400-1407

Socioeconomic status in relation to Parkinson's disease risk and mortality: A population-based prospective study
Yang F, Johansson Al, Pedersen Nl, Fang F, Gatz M, Wirdefeldt K
Medicine 2016;95(30):e4337-

What is the impact of chronic systemic inflammation such as rheumatoid arthritis on mortality following cancer?
Simard Jf, Ekberg S, Johansson Al, Askling J
Annals of the rheumatic diseases 2016;75(5):862-6

Cancer during pregnancy and the postpartum period: A population-based study
Andersson Tm, Johansson Al, Fredriksson I, Lambe M
Cancer 2015;121(12):2072-7

Family history and risk of pregnancy-associated breast cancer (PABC)
Johansson Al, Andersson Tm, Hsieh Cc, Cnattingius S, Dickman Pw, Lambe M
Breast cancer research and treatment 2015;151(1):209-17

Long-term HPV type-specific risks for ASCUS and LSIL: a 14-year follow-up of a randomized primary HPV screening trial
Elfström Km, Smelov V, Johansson Al, Eklund C, Naucler P, Arnheim-dahlström L, et al
International journal of cancer 2015;136(2):350-9

Long-term HPV type-specific risks of high-grade cervical intraepithelial lesions: a 14-year follow-up of a randomized primary HPV screening trial
Smelov V, Elfström Km, Johansson Al, Eklund C, Naucler P, Arnheim-dahlström L, et al
International journal of cancer 2015;136(5):1171-80

Evidence for modest familial co-aggregation between dementia and parkinsonism
Feldman Al, Wirdefeldt K, Johansson Al, Gatz M, Pedersen Nl
European journal of epidemiology 2014;29(1):49-56

Hydatidiform mole and subsequent pregnancy outcome: a population-based cohort study
Joneborg U, Eloranta S, Johansson Al, Marions L, Weibull Ce, Lambe M
American journal of obstetrics and gynecology 2014;211(6):681.e1-7

Long term duration of protective effect for HPV negative women: follow-up of primary HPV screening randomised controlled trial
Elfström Km, Smelov V, Johansson Al, Eklund C, Nauclér P, Arnheim-dahlström L, et al
BMJ (Clinical research ed.) 2014;348():g130-

Mortality in women with pregnancy-associated malignant melanoma
Johansson Al, Andersson Tm, Plym A, Ullenhag Gj, Møller H, Lambe M
Journal of the American Academy of Dermatology 2014;71(6):1093-101

Time-dependent risk of developing distant metastasis in breast cancer patients according to treatment, age and tumour characteristics
Colzani E, Johansson Al, Liljegren A, Foukakis T, Clements M, Adolfsson J, et al
British journal of cancer 2014;110(5):1378-84

Childbearing and the risk of bladder cancer: a nationwide population-based cohort study
Weibull Ce, Eloranta S, Altman D, Johansson Al, Lambe M
European urology 2013;63(4):733-8

Stage at diagnosis and mortality in women with pregnancy-associated breast cancer (PABC)
Johansson Al, Andersson Tm, Hsieh Cc, Jirström K, Dickman P, Cnattingius S, et al
Breast cancer research and treatment 2013;139(1):183-92

[Structuring and documenting research projects]
Eloranta S, Johansson Al, Kristinsson Sy, Andersson Tm
Lakartidningen 2013;110(8):416-9

Accuracy and Sensitivity of Parkinsonian Disorder Diagnoses in Two Swedish National Health Registers
Feldman Al, Johansson Alv, Gatz M, Flensburg M, Petzinger Gm, Widner H, et al
NEUROEPIDEMIOLOGY 2012;38(3):186-93

Analysis of 1:1 Matched Cohort Studies and Twin Studies, with Binary Exposures and Binary Outcomes
Sjolander A, Johansson Alv, Lundholm C, Altman D, Almqvist C, Pawitan Y
STATISTICAL SCIENCE 2012;27(3):395-411

Estrogen Receptor Status in Relation to Risk of Contralateral Breast Cancer-A Population-Based Cohort Study
Sandberg Mec, Hall P, Hartman M, Johansson Alv, Eloranta S, Ploner A, et al
PLOS ONE 2012;7(10):e46535-

Vaginal hysterectomy and risk of pelvic organ prolapse and stress urinary incontinence surgery
Forsgren C, Lundholm C, Johansson Alv, Cnattingius S, Zetterstrom J, Altman D

Hysterectomy and risk of cardiovascular disease: a population-based cohort study
Ingelsson E, Lundholm C, Johansson Alv, Altman D
EUROPEAN HEART JOURNAL 2011;32(6):745-50

Increased Mortality in Women with Breast Cancer Detected during Pregnancy and Different Periods Postpartum
Johansson Alv, Andersson Tml, Hsieh Cc, Cnattingius S, Lambe M

Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden
Dhejne C, Lichtenstein P, Boman M, Johansson Alv, Langstrom N, Landen M
PLOS ONE 2011;6(2):e16885-

Occupational exposure in Parkinsonian disorders: A 43-year prospective cohort study in men
Feldman Al, Johansson Alv, Nise G, Gatz M, Pedersen Nl, Wirdefeldt K

Prognosis of Patients With Breast Cancer: Causes of Death and Effects of Time Since Diagnosis, Age, and Tumor Characteristics
Colzani E, Liljegren A, Johansson Alv, Adolfsson J, Hellborg H, Hall Pfl, et al

Reporting and incidence trends of hydatidiform mole in Sweden 1973-2004
Salehi S, Eloranta S, Johansson Alv, Bergstrom M, Lambe M
ACTA ONCOLOGICA 2011;50(3):367-72

Influence of hysterectomy on fistula formation in women with diverticulitis
Altman D, Forsgren C, Hjern F, Lundholm C, Cnattingius S, Johansson Alv

Risk of renal cell carcinoma after hysterectomy
Altman D, Yin L, Johansson A, Lundholm C, Grönberg H
Archives of internal medicine 2010;170(22):2011-6

Can Association Between Preterm Birth and Autism be Explained by Maternal or Neonatal Morbidity?
Buchmayer S, Johansson S, Johansson A, Hultman Cm, Sparen P, Cnattingius S
PEDIATRICS 2009;124(5):e817-25

Hysterectomy for Benign Indications and Risk of Pelvic Organ Fistula Disease
Forsgren C, Lundholm C, Johansson Alv, Cnattingius S, Altman D

Hysterectomy on benign indications in Sweden 1987-2003: A nationwide trend analysis
Lundholm C, Forsgren C, Johansson Alv, Cnattingius S, Altman D

Increasing Incidence of Pregnancy-Associated Breast Cancer in Sweden
Andersson Tml, Johansson Alv, Hsieh Cc, Cnattingius S, Lambe M

Mastitis and the Risk of Breast Cancer
Lambe M, Johansson Alv, Altman D, Eloranta S
EPIDEMIOLOGY 2009;20(5):747-51

Maternal Smoking and Infant Mortality Does Quitting Smoking Reduce the Risk of Infant Death?
Johansson Alv, Dickman Pw, Kramer Ms, Cnattingius S
EPIDEMIOLOGY 2009;20(4):590-7

Serum calcium and the risk of prostate cancer
Halthur C, Johansson Alv, Almquist M, Malm J, Gronberg H, Manjer J, et al
CANCER CAUSES & CONTROL 2009;20(7):1205-14

Cancer and mortality among users and nonusers of snus
Roosaar A, Johansson Alv, Sandborgh-englund G, Axell T, Nyren O

Placental weight and risk of invasive epithelial ovarian cancer with an early age of onset
Cnattingius S, Eloranta S, Adami Ho, Axelsson O, Dickman Pw, Hsieh Cc, et al

A long-term follow-up study on the natural course of oral leukoplakia in a Swedish population-based sample
Roosaar A, Yin L, Johansson Alv, Sandborgh-englund G, Nyren O, Axell T

Airborne occupational exposures and risk of oesophageal and cardia adenocarcinoma
Jansson C, Plato N, Johansson Alv, Nyren O, Lagergren J

A long-term follow-up study on the natural course of snus-induced lesions among Swedish snus users
Roosaar A, Johansson Alv, Sandborgh-englund G, Nyren O, Axell T

Environmental tobacco smoke and risk of spontaneous abortion
George L, Granath F, Johansson Alv, Anneren G, Cnattingius S
EPIDEMIOLOGY 2006;17(5):500-5

Risks of repeated miscarriage
George L, Granath F, Johansson Alv, Olander B, Cnattingius S

Self-reported nicotine exposure and plasma levels of cotinine in early and late pregnancy
George L, Granath F, Johansson Alv, Cnattingius S

Accommodation of additional non-randomly sampled cases in a study of Helicobacter pylori infection in families
Kivi M, Johansson Alv, Salim A, Tindberg Y, Reilly M
STATISTICS IN MEDICINE 2005;24(24):4045-54

Endogenous and exogenous hormone exposure and risk of cognitive impairment in Swedish twins: a preliminary study
Rasgon Nl, Magnusson C, Johansson Alv, Pedersen Nl, Elman S, Gatz M

Helicobacter pylori status in family members as risk factors for infection in children
Kivi M, Johansson Alv, Reilly M, Tindberg Y

Occupational exposures and risk of esophageal and gastric cardia cancers among male Swedish construction workers
Jansson C, Johansson Alv, Bergdahl Ia, Dickman Pw, Plato N, Adami J, et al
CANCER CAUSES & CONTROL 2005;16(6):755-64

Socioeconomic factors and risk of esophageal adenocarcinoma: A nationwide Swedish case-control study
Jansson C, Johansson Alv, Nyren O, Lagergren J

[Health care services during summer--a dilemma?]
Nordenvall C, Edgren G, Gillispie A, Larsson M, Adami J, Johansson A, et al
Lakartidningen 2004;101(4):290-2

Psychosocial working conditions and the risk of esophageal and gastric cardia cancers
Jansson C, Johansson Alv, Jeding K, Dickman Pw, Nyren O, Lagergren J

Reasons for increasing trends in large for gestational age births
Surkan Pj, Hsieh Cc, Johansson Alv, Dickman Pw, Cnattingius S

Birth weight and risk of angina pectoris: Analysis in Swedish twins
Hubinette A, Cnattingius S, Johansson Alv, Henriksson C, Lichtenstein P

Time of birth and risk of intrapartum and early neonatal death
Stephansson O, Dickman Pw, Johansson Alv, Kieler H, Cnattingius S
EPIDEMIOLOGY 2003;14(2):218-22

Plasma foliate levels and risk of spontaneous abortion
George L, Mills Jl, Johansson Alv, Nordmark A, Olander B, Granath F, et al

Maternal weight, pregnancy weight gain, and the risk of antepartum stillbirth
Stephansson O, Dickman Pw, Johansson A, Cnattinghius S

The influence of socioeconomic status on stillbirth risk in Sweden
Stephansson O, Dickman Pw, Johansson Al, Cnattingius S

Maternal hemoglobin concentration during pregnancy and risk of stillbirth
Stephansson O, Dickman Pw, Johansson A, Cnattingius S

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Data Management and research documentation for researchers (2018-11-22)

Slides available on request