Objective: To enhance the precision of the risk estimate for breast cancer in hyperprolactinemia patients by collecting more data and pooling our results with available data from former studies in a meta-analysis. Design: Population-based cohort study and meta-analysis of the literature. Methods: Using nationwide registries, we identified all patients with a first-time diagnosis of hyperprolactinemia during 1994-2012 including those with a new breast cancer diagnoses after the start of follow-up. We calculated standardised incidence ratios (SIRs) as a measure of relative risk (RR) using national cancer incidence rates. We performed a meta-analysis, combining data from our study with data in the existing literature. Results: We identified 2457 patients with hyperprolactinemia and 20 breast cancer cases during 19 411 person-years of follow-up, yielding a SIR of 0.99 (95% CI 0.60-1.52). Data from two additional cohort studies were retrieved and analyzed. When the three risk estimates were pooled, the combined RR was 1.04 (95% CI 0.75-1.43). Conclusions: We found no increased risk of breast cancer among patients with hyperprolactinemia.
Background Data on long-term risk of cancer after a postmenopausal bleeding diagnosis are sparse. Methods We used Danish medical registries to conduct a population-based cohort study of women with a first hospital-diagnosed postmenopausal bleeding during 1995–2013. We computed the absolute risk of cancer and the standardised incidence ratio (SIR) comparing the observed cancer incidence with that expected in the general population. Results Among 43,756 women with postmenopausal bleeding, the absolute 1- and 5-year risk of endometrial cancer were 4.66% and 5.18%, respectively. The SIR of endometrial cancer was elevated during 0–3 months (SIR = 330.36 (95% CI: 315.43–345.81)), 3–12 months (SIR = 11.39 (95% CI: 9.79–13.17)), 1–5 years (SIR = 2.55 (95% CI: 2.19–2.94)) and >5 years of follow-up (SIR = 1.63 (95% CI: 1.40–1.90)). All selected gynaecological and urological, gastrointestinal and haematological cancers had elevated 0–3 months SIRs. Beyond 1 year of follow-up the SIRs of ovarian and bladder cancer remained elevated with a 1–5-year SIR of 2.15 (95% CI: 1.71–2.65) and 1.45 (95% CI: 1.14–1.80), respectively. Conclusions In the Danish population, women with a first hospital-diagnosed postmenopausal bleeding have an increased 0–3 months risk of gynaecological, urological, gastrointestinal and haematological cancers. The SIR of endometrial, ovarian and bladder cancer remained elevated for several years.
Objective To examine the risk of urogenital, colorectal, and neurological cancers after a first diagnosis of acute urinary retention. Design Nationwide population based cohort study. Setting All hospitals in Denmark. Participants 75 983 patients aged 50 years or older with a first hospital admission for acute urinary retention during 1995-2017. Main outcome measures Absolute risk of urogenital, colorectal, and neurological cancer and excess risk of these cancers among patients with acute urinary retention compared with the general population. Results The absolute risk of prostate cancer after a first diagnosis of acute urinary retention was 5.1% (n=3198) at three months, 6.7% (n=4233) at one year, and 8.5% (n=5217) at five years. Within three months of follow-up, 218 excess cases of prostate cancer per 1000 person years were detected. An additional 21 excess cases per 1000 person years were detected during three to less than 12 months of follow-up, but beyond 12 months the excess risk was negligible. Within three months of follow-up the excess risk for urinary tract cancer was 56 per 1000 person years, for genital cancer in women was 24 per 1000 person years, for colorectal cancer was 12 per 1000 person years, and for neurological cancer was 2 per 1000 person years. For most of the studied cancers, the excess risk was confined to within three months of follow-up, but the risk of prostate and urinary tract cancer remained increased during three to less than 12 months of follow-up. In women, an excess risk of invasive bladder cancer persisted for several years. Conclusions Acute urinary retention might be a clinical marker for occult urogenital, colorectal, and neurological cancers. Occult cancer should possibly be considered in patients aged 50 years or older presenting with acute urinary retention and no obvious underlying cause.
Globally non-muscle invasive bladder cancer (NMIBC) is a high-incidence disease. There is a large heterogeneity within NMIBC regarding recurrence-and progression risks, and large-scale studies of treatment patterns and prognoses in an everyday setting could result in NMIBC-subgroup treatment optimization, benefiting both patients and the economy. The Danish national registries provide such an opportunity if the registered procedure codes are valid. Therefore, the aim of the study was to validate the International Classification of Diseases, 10th Edition (ICD-10) codes of NMIBC treatment used in the Danish National Patient Registry (DNPR). Patients and Methods: From the DNPR, we randomly selected 200 NMIBC treatment courses identified by the dates of the course and the codes of transurethral resection of the bladder ((TURB), n = 125), photodynamic diagnosis ((PDD), n = 25), bladder instillation with Bacillus Calmette vaccine ((BCG), n = 25), or bladder instillation with chemotherapy/Mitomycin C ((MMC), n = 25). We used medical record reviews as the reference standard and estimated positive predictive values (PPVs) of all procedure codes and negative predictive values (NPVs) of PDD-and the perioperative single-shot MMC codes. Results: We identified the medical records in 150 (75%) of the 200 treatment courses (149 individual patients).
Objective To examine trends in incidence of acute urinary retention, subsequent benign prostatic hyperplasia‐related treatment and mortality in the era of medical therapy for benign prostatic hyperplasia. Additionally, to compare mortality with the general population. Materials and Methods We conducted a Danish nationwide registry‐based study including 70,775 men aged 45 years or older with a first hospitalization for acute urinary retention during 1997–2017. We computed annual standardized incidence rates, subsequent 1‐year cumulative incidence of benign prostatic hyperplasia‐related surgical and medical treatment, and standardized 3‐month and 1‐year mortality rates. Finally, we compared standardized all‐cause and cause‐specific mortality ratios with the general population. Results The standardized incidence rate of acute urinary retention per 1000 person‐years increased transiently from 2.34 to 3.42 during 1997–2004, but gradually declined to 2.95 in 2017. The 1‐year cumulative incidence of benign prostatic hyperplasia‐related surgery declined from 31.2% to 19.8% and 20.5% to 7.7% after spontaneous and precipitated acute urinary retention, respectively. During 1997–2017, the standardized 1‐year mortality declined from 22.2% to 17.2%. Compared with the general population, mortality was 4–5 times higher after 3 months and 2–3 times higher after 1 year of acute urinary retention. The cause‐specific standardized mortality ratios were particularly high for deaths attributable to malignancies, urogenital disease, certain infections, chronic pulmonary disease, and diabetes. Conclusion During 1997–2017, we observed a transient increase in the incidence of acute urinary retention. The subsequent use of benign prostatic hyperplasia‐related surgery declined considerably and mortality continued to be high, mainly because of deaths from malignancies, urogenital disease, infections, and preexisting comorbidity.
Objectives To assess the risk of benign prostatic hyperplasia (BPH)‐related surgery and acute urinary retention (AUR) in men treated with 5‐alpha‐reductase inhibitor (5‐ARI) versus alpha‐blocker monotherapy in routine clinical care over 15 years of follow‐up. Methods Using population‐based Danish Health registries, we identified all new‐users of 5‐ARI or alpha‐blocker monotherapy in Denmark, 1997–2017. We defined an index date 180 days after the date of first prescription and included men who redeemed at least one additional prescription before the index date. We used multiple imputation to replace missing prostate‐specific antigen values. We performed propensity score‐weighted Cox regression to estimate weighted hazard ratios (wHRs) and cumulative incidence function to estimate weighted cumulative risks of BPH‐related surgery and AUR in intention to treat (ITT) and per protocol (PP) analyses. Results We included 18,421 and 95,984 men treated with 5‐ARI and alpha‐blocker monotherapy, respectively. Overall, treatment with 5‐ARI monotherapy was associated with a reduced risk of BPH‐related surgery (ITT wHR = 0.73 (95% confidence interval [CI]: 0.68–0.78), PP wHR = 0.77 (95% CI: 0.70–0.84) and AUR (ITT wHR = 0.73 (95% CI: 0.67–0.78), PP wHR = 0.75 (95% CI: 0.66–0.84). The 15‐year risk of BPH‐related surgery in men treated with 5‐ARI versus alpha‐blocker monotherapy was 14.8% (95% CI: 14.1%–15.5%) versus 19.1% (95% CI: 18.7%–19.5%) in the ITT analysis and 13.8% (95% CI: 12.6%–14.9%) versus 17.5% (95% CI: 16.9%–18.0%) in the PP analysis. The 15‐year risk of AUR in men treated with 5‐ARI versus alpha‐blocker was 13.0% (95% CI: 12.3%–13.6%) versus 16.6% (95% CI: 16.3%–17.0%) in the ITT analysis and 12.6% (95%: 11.3%–14.0%) versus 16.9% (95% CI: 16.3%–17.6%) in the PP analysis. Conclusion Treatment with 5‐ARI versus alpha‐blocker monotherapy in routine clinical care was associated with a reduced risk of BPH‐related surgery and AUR for up to 15 years of follow‐up. After 15 years of follow‐up, the relative risk reduction was 21%–25% and the absolute risk reduction was 4%.
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