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Introduction: The Danish National Patient Register (NPR) was established in 1977, and it is considered to be the finest of its kind internationally. Content: At the onset the register included information on inpatient in somatic wards. The content of the register has gradually been expanded, and since 2007 the register has included information on all patients in Danish hospitals. Validity and coverage: Although the NPR is overall a sound data source, both the content and the definitions of single variables have changed over time. Changes in the organisation and provision of health services may affect both the type and the completeness of registrations. Conclusion: The NPR is a unique data source. Researchers using the data should carefully consider potential fallacies in the data before drawing conclusions.

Background Screening mammography works better in fatty than in dense breast tissue. Computerized assessment of parenchymal texture is a non-subjective method to obtain a refined description of breast tissue, potentially valuable in addition to breast density scoring for the identification of women in need of supplementary imaging. We studied the sensitivity of screening mammography by a combination of radiologist-assessed Breast Imaging Reporting and Data System (BI-RADS) density score and computer-assessed parenchymal texture marker, mammography texture resemblance (MTR), in a population-based screening program. Methods Breast density was coded according to the fourth edition of the BI-RADS density code, and MTR marker was divided into quartiles from 1 to 4. Screening data were followed up for the identification of screen-detected and interval cancers. We calculated sensitivity and specificity with 95% confidence intervals (CI) by BI-RADS density score, MTR marker, and combination hereof. Results Density and texture were strongly correlated, but the combination led to the identification of subgroups with different sensitivity. Sensitivity was high, about 80%, in women with BI-RADS density score 1 and MTR markers 1 or 2. Sensitivity was low, 67%, in women with BI-RADS density score 2 and MTR marker 4. For women with BI-RADS density scores 3 and 4, the already low sensitivity was further decreased for women with MTR marker 4. Specificity was 97–99% in all subgroups. Conclusion Our study showed that women with low density constituted a heterogenous group. Classifying women for extra imaging based on density only might be a too crude approach. Screening sensitivity was systematically high in women with fatty and homogenous breast tissue.

Purpose Hormone replacement therapy (HRT) is used to reduce climacteric symptoms of menopause and prevent osteoporosis; however, it increases risk of breast cancer. Mammographic density (MD) is also a strong risk factor for breast cancer. We conducted this review to investigate the association between HRT use and MD and to assess the effect of different HRT regimens on MD. Methods Two of authors examined articles published between 2002 and 2019 from PubMed, Embase, and OVID using Covidence systematic review platform. Any disagreements were discussed until consensus was reached. The protocol used in this review was created in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Quality of each eligible study was assessed using the Oxford Center for Evidence-Based Medicine (OCEBM) hierarchy. Results Twenty-two studies met the inclusion criteria. Six studies showed that using estrogen plus progestin (E + P) HRT was associated with higher MD than estrogen alone. Four studies reported that continuous estrogen plus progestin (CEP) users had higher MD than sequential estrogen plus progestin (SEP) and estrogen alone users. However, two studies showed that SEP users had slightly higher MD than CEP users and estrogen alone users. Conclusions Epidemiological evidence is rather consistent suggesting that there is a positive association between HRT use and MD with the highest increase in MD among current users, and CEP users. Our results suggest that due to increase in MD and masking effect, current E + P users may require additional screening procedures, shorter screening intervals, or using advanced imaging techniques.

In a fishing community Thyborøn-Harboøre on the Danish West coast, a chemical factory polluted air, sea, and ground with > 100 xenobiotic compounds. We investigated cancer incidence in the community. A historical cohort was identified from the Central Population Register and followed for cancer incidence in the Danish Cancer Register including inhabitants from 1968–1970 at height of pollution, and newcomers in 1990–2006 after pollution control. Two fishing communities without pollution, Holmsland and Hanstholm, were referent cohorts. We calculated rate ratios (RR) and 95% confidence intervals (CI). In 1968–1970, 4914 persons lived in Thyborøn-Harboøre, and 9537 persons in Holmsland-Hanstholm. Thyborøn-Harboøre had a statistically significant excess cancer incidence compared with Holmsland-Hanstholm; RR 1.20 (95% CI 1.11–1.29) deriving from kidney and bladder cancer; stomach and lung cancer in men, and colorectal cancer in women. In 1990–2006, 2933 persons came to live in Thyborøn-Harboøre. Their cancer incidence was the same as for newcomers to Holmsland-Hanstholm; RR 1.07 (95% CI 0.88–1.30). Persons in Thyborøn-Harboøre at height of chemical pollution had a cancer risk 20% above persons living in non-polluted fishing communities with a pattern unlikely to be attributable to life style. The study suggested that chemical pollution may have affected cancer risk.

We studied mortality and hospital contact in people from Thyborøn-Harboøre, an environmentally contaminated fishing community on the Danish West Coast. The population and a comparison group from other fishing communities on the Danish West Coast were identified from historical data in the Central Population Register. All persons were followed up for death and hospital contacts to March 2023. Event rates were compared with Poisson regression; adjusted rate ratios (aRR); and 95% confidence interval (CI). The old cohort included inhabitants in Thyborøn-Harboøre in 1968–1970 before pollution was controlled; 4914 persons/2485 deaths. All-cause mortality, aRR 1.06 (95% CI 1.01–1.11), and cancer mortality, aRR 1.17 (95% CI 1.05–1.30), were elevated; especially for kidney cancer aRR 1.82 (95% CI 1.07–3.12). Hospital contacts were elevated for psychiatric disorders; with an aRR of 4.07 (95% CI 1.41–11.72) for anxiety in men. As there is still considerable concern in the area about possible health consequences from stored chemicals, we included also a new cohort of newborn and immigrants to the area in 1990–2006; 2933 persons/302 deaths. All-cause mortality, aRR 1.26 (1.11–1.43) (men 1.15 and women 1.44), and cancer mortality, aRR 1.47 (95% CI 1.14–1.89) were elevated. Hospital contacts were elevated for ischemic heart disease/heart attack and indicated for autism/obsessive compulsory disorder in boys. In conclusion, mortality data confirmed incidence data of excess kidney cancer in the old cohort. The new cohort had a generally elevated mortality, possibly indicating selective immigration from other parts of Denmark. However, the new cohort is still relatively young, and the mortality pattern needs to be monitored.

Background Internationally, non-participation in breast screening increased with decreasing level of education indicating importance of information campaigns to enhance awareness of screening. However, in Denmark in the 1990s the association between education and non-participation was U-shaped. We therefore analyzed recent Danish data. Methods Data derived from the Capital Region of Denmark, biennial, organized breast screening program 2008–2020, where women aged 50–69 were personally invited to screening. Non-participation was measured as number of women with no participation out of women eligible for at least three invitations. Sociodemographic determinants were identified by linkage to public registers. Results were reported as age adjusted odds ratios (OR) of non-participation including 95% confidence intervals (CI). Results Among 196,085 women, 86% participated. Using women with low education as baseline, the OR for professional bachelors was 0.64; and for academics 0.75. The strongest determinants of non-participation were being non-married OR 2.03; born outside Denmark OR 2.04; being self-employed OR 1.67; retired OR 3.12; on public support OR 3.66; or having co-morbidity OR 1.56. Conclusion The U-shaped association between education and non-participation in breast screening prevailed. The data further indicated that screening participation was low in women with pertinent health and social problems.

PurposeObesity increases the risk of several cancers, but the influence of bariatric surgery on the risk of individual obesity-related cancers is unclear. This study aimed to assess the impact of bariatric surgery on cancer risk in a multi-national setting.Materials and MethodsThis cohort study included all adults with an obesity diagnosis identified from national patient registries in all Nordic countries (Denmark, Finland, Iceland, Norway and Sweden) from 1980 to 2012. Cancer risk in bariatric surgery patients was compared with non-operated patients with obesity. Multivariable Cox regression provided adjusted hazard ratios (HRs) with 95% confidence intervals (CIs). Age, sex, calendar year, country, length of follow-up, diabetes, chronic obstructive pulmonary disease and alcohol-related diseases were evaluated as confounders.ResultsAmong 482,572 participants with obesity, 49,096 underwent bariatric surgery. Bariatric surgery was followed by a decreased overall cancer risk in women (HR 0.86, 95% CI 0.80–0.92), but not in men (HR 0.98, 95% CI 0.95–1.01). The risk reduction was observed only within the first five post-operative years. Among specific tumours, HRs decreased for breast cancer (HR 0.81, 95% CI 0.69–0.95), endometrial cancer (HR 0.69, 95% CI 0.56–0.84) and non-Hodgkin lymphoma (HR 0.64, 95% CI 0.42–0.97) in female bariatric surgery patients, while the risk of kidney cancer increased in both sexes (HR 1.44, 95% CI 1.13–1.84).ConclusionBariatric surgery may decrease overall cancer risk in women within the first five years after surgery. This decrease may be explained by a decreased risk of breast and endometrial cancer and non-Hodgkin lymphoma in women.

During the past 30 years, a mortality gap developed between Lolland-Falster (the rural-provincial southeastern part) and the rest of Denmark. A main driver was selective in-migration of Danes with a high risk of death, especially of working-ages. In the present study, we determined the role of economic status in this selective in-migration. We used individual-level data from the Central Population Register and data on income source; self- or publicly supported. The study population included people aged 30–64 and living in Denmark at any time between 1992 and 2018. Mortality rate ratios (MRR) were calculated using Poisson regression for three time-periods: 1992–1999, 2000–2009 and 2010–2018. Two in five in-migrants to Lolland-Falster were people on public support. In 2010–2018, they had an MRR of 8.71 (95% confidence interval (CI): 8.05–9.42) compared with self-supported people, and an MRR of 1.49 (95% CI: 1.38–1.61) compared with publicly supported people elsewhere in Denmark. In-migration of working-aged people on public support was a main contributor to the excess mortality in Lolland-Falster as compared with the rest of Denmark. To understand urban–rural differences in health, population movements and national income patterns are important to take into account.

In women aged ≥ 30 years, Human Papillomavirus testing will replace cytology for primary cervical screening. We compared Hybrid Capture 2 (HC2), cobas, CLART, and APTIMA HPV assays with cytology on 2869 SurePath samples from women undergoing routine screening at 30-65 years in Copenhagen, Denmark. Women with cytological abnormalities were managed according to routine recommendations, with 92% completeness. Those with cytology-normal/HPV-positive samples (on any of the four assays) were invited for repeated cytology and HPV testing in 1.5 year, and 58% had additional testing. HPV testing detected more ≥ CIN3 than cytology (HC2: 35, cobas, CLART: 37, APTIMA: 34, cytology: 31), although statistically the differences were not significant. Cobas and CLART detected significantly more ≥ CIN2 than cytology (cobas, CLART: 49, cytology: 39). The proportion of women with false-positive test results (positive test results without ≥ CIN3) varied between 3.3% with cytology and 14.9% with cobas. All HPV assays led to significantly more false-positive tests, whereas compared to HC2 cobas and CLART were associated with a significantly higher and APTIMA with a significantly lower proportion. Detection of CIN1 was particularly increased for the three DNA assays. With APTIMA combined with cytological triage, about 20% more women were referred for colposcopy than with cytology screening. With the three DNA assays, the increase was ≥ 50%. The number of women with repeated testing was twice as high with APTIMA and almost five times as high with cobas compared to cytology. To our knowledge, Horizon was the only study set in routine practice that compared more than two HPV assays in the same women while also ascertaining the histological status of women with normal cytology/HPV-positive test results. HPV-based screening of Danish women aged 30-65 detected more high-grade CIN but decreased the screening specificity, and increased the demand for additional testing.

Danish women-who were HPV-vaccinated as girls-are now reaching an age where they are invited to cervical cancer screening. Because of their expected lower cervical cancer risk, we must reassess our screening strategies. We analyzed Danish HPV-vaccinated women's outcomes after the first screening test at age 23. Our study was embedded in Danish routine cytology-based screening. We conducted an observational study and included women born in 1994, offered the 4-valent HPV vaccine at age 14, and subsequently invited to screening at age 23. Cervical cytology was used for diagnostics and clinical management. Residual material was HPV tested with Cobas® 4800/6800. The most severe histology diagnosis within 795 days of screening was found through linkage with the Danish National Pathology Register. We calculated the number of women undergoing follow-up (repeated testing and/or colposcopy) per detected cervical intraepithelial neoplasia (CIN2+). A total of 6021 women were screened; 92% were HPV-vaccinated; 12% had abnormal cytology; 35% were high-risk HPV-positive, including 0.9% HPV16/18 positive, and 20% had follow-up. In women that were cytology-abnormal and HPV-positive (Cyt+/HPV+), 610 (98.5%) had been followed up, and 138 CIN2+ cases were diagnosed, resulting in 4.4 (95% CI 3.9-5.2) women undergoing follow-up per detected CIN2+. In contrast to recommendations, 182 (12.2%) cytology-normal and HPV-positive (Cyt-/HPV+) women were followed up within 795 days, and 8 CIN2+ cases were found, resulting in 22.8 (95% CI 13.3-59.3) women undergoing follow-up per detected CIN2+. Overall, HPV prevalence was high in HPV-vaccinated women, but HPV16/18 had largely disappeared. In the large group of cytology-normal and HPV-positive women, 23 had been followed up per detected CIN2+ case. Our data indicated that primary HPV screening of young HPV-vaccinated women would require very effective triage methods to avoid an excessive follow-up burden. Trial registration number: NCT0304955.