Time trends in the clinical management of cervical intraepithelial neoplasia grade 2: A Danish register-based study.

INTRODUCTION: Active surveillance for cervical intraepithelial neoplasia grade 2 (CIN2) has been implemented recently in many countries, including the Nordic countries. In Denmark, the only eligibility criterion for active surveillance for CIN2 is that the woman should be of reproductive age. With this study, we aimed to evaluate clinical and socioeconomic characteristics in women with CIN2 managed by active surveillance or large loop excision of the transformation zone (LLETZ) and to evaluate temporal changes in the clinical management of CIN2. MATERIAL AND METHODS: We conducted a Danish nationwide study using data from healthcare registries. All female residents aged 18-40 years, diagnosed with incident CIN2 from January 1, 1998, to February 29, 2020, were included. We collected data on age, index cytology result, year of CIN2 diagnosis, region of residence, civil status, HPV vaccination status, and socioeconomic position indicators. The variables were tabulated overall and by management group (active surveillance vs. LLETZ). To evaluate time trends, we used joinpoint regression to calculate the annual percentage change (APC), including 95% confidence intervals (CI). RESULTS: Of the 27 536 women with CIN2 included, 12 500 (45.4%) underwent active surveillance, and 15 036 (54.6%) underwent a LLETZ. Women undergoing active surveillance were younger, more often HPV-vaccinated, and more likely to have a normal/low-grade index cytology result than women undergoing LLETZ. Socioeconomic position indicators did not differ. Over time, the proportion of women undergoing active surveillance increased from 21.7% in 2004 to 73.6% in 2019 (APC 9.7, 95% CI 8.1-11.4). The proportion of women undergoing active surveillance aged <30 declined over time (APC -2.2, 95% CI -2.9 to -1.5). The proportion of women with normal/low-grade index cytology increased slightly to 51.6% in 2019 (APC 0.8, 95% CI 0.4-1.3). CONCLUSIONS: The use of active surveillance for CIN2 has increased over the past two decades in Denmark. Observed differences in characteristics between women undergoing active surveillance versus LLETZ are likely related to indications for clinical management.

Cycling reduces blood glucose excursions after an oral glucose tolerance test in pregnant women: a randomized crossover trial.

The aim of this study was to evaluate the effect of an acute bout of cycling immediately after oral glucose intake on glucose metabolism in pregnant women at risk for gestational diabetes mellitus (GDM). Fifteen pregnant women with BMI ≥ 27 kg/m2 were enrolled in a randomized crossover controlled study and underwent two oral glucose tolerance tests (OGTTs) ingesting 75 g of glucose followed by either 20 min of stationary cycling at moderate intensity (65%-75% maximal heart rate) or rest. Using continuous glucose monitors, glucose was measured up to 48 h after the OGTT. Glucose, insulin, and C-peptide were determined at baseline and after 1 and 2 h. One hour after glucose intake, mean blood glucose was significantly lower after cycling compared with rest (p = 0.002). Similarly, mean glucose peak level was significantly lower after cycling compared with after rest (p = 0.039). Lower levels of insulin and C-peptide were observed after 1 h (p < 0.01). Differences in glucose measurements after 2 h and up to 48 h were not statistically different. We found that 20 min of cycling at moderate intensity after glucose intake reduced blood glucose excursions in pregnant women at risk for GDM. ClinicalTrials.gov Identifier: NCT03644238. Novelty Bullets In pregnant women, we found that cycling after glucose intake resulted in significantly lower glucose levels compared with rest. The exercise intervention studied is feasible for pregnant women and could be readily used to reduce glucose excursions.

[Genital herpes simplex virus infection in pregnancy].

In this review, we discuss genital herpes - a common sexually transmitted infection, which can be transmitted to the baby during birth. Neonatal herpes is a rare but serious infection. In 2019, the Danish Society of Obstetrics and Gynecology revised the guideline for management of genital herpes in pregnancy. Recommendations include antiviral therapy from gestational week 36 in case of primary- or recurrent infection in current pregnancy. Delivery by cesarean section is recommended in case of primary infection in the third trimester. Women with recurrent herpes can deliver vaginally, as risk of neonatal infection is low.

Descriptive characteristics of colon and rectal cancer recurrence in a Danish population-based study.

BACKGROUND: Recurrence is a common outcome among patients that have undergone an intended curative resection for colorectal cancer. However, data on factors that influence colorectal cancer recurrence are sparse. We report descriptive characteristics of both colon and rectal cancer recurrence in an unselected population. MATERIAL AND METHODS: We identified 21,152 patients with colorectal cancer diagnosed between May 2001 and December 2011 and registered with the Danish Colorectal Cancer Group. Recurrences were identified in 3198 colon and 1838 rectal cancer patients during follow-up. We calculated the frequency, proportion, and incidence rates of colon and rectal cancer recurrence within descriptive categories, and the cumulative five- and ten-year incidences of recurrence, treating death as a competing risk. We used a Cox proportional hazard model to calculate hazard ratios (HR) and 95% confidence intervals (CI). RESULTS: Recurrence risk was highest in the first three years of follow-up. Patients <55 years old at initial diagnosis (incidence rate for colon: 7.2 per 100 person-years; 95% CI: 6.5-7.9; rectum: 8.1 per 100 person-years; 95% CI: 7.2-9.0) and patients diagnosed with stage III cancer (colon HR: 5.70; 95% CI: 4.61-7.06; rectal HR: 7.02; 95% CI: 5.58-8.82) had increased risk of recurrence. Patients diagnosed with stage III cancer from 2009 to 2011 had a lower incidence of recurrence than those diagnosed with stage III cancer in the years before. Cumulative incidences of colon and rectal cancer recurrence were similar for both cancer types among each descriptive category. CONCLUSIONS: In this population, increases in colorectal cancer recurrence risk were associated with younger age and increasing stage at diagnosis. Cumulative incidence of recurrence did not differ by cancer type. Descriptive characteristics of colon and rectal cancer recurrence may help to inform patient-physician decision-making, and could be used to determine adjuvant therapies or tailor surveillance strategies so that recurrence may be identified early, particularly within the first 3 years of follow-up.

Preadmission glucocorticoid use and anastomotic leakage after colon and rectal cancer resections: a Danish cohort study.

OBJECTIVE: To examine whether preadmission glucocorticoid use increases the risk of anastomotic leakage after colon and rectal cancer resections. DESIGN: A population-based cohort study. SETTING: Denmark (2001-2011). PARTICIPANTS: We identified patients who had undergone a primary anastomosis after a colorectal cancer resection by linking medical registries. Participants who filled their most recent glucocorticoid prescription ≤90, 91-365 and >365 days before their surgery date were categorised as current, recent and former users, respectively. MAIN OUTCOME MEASURES: We calculated 30-day absolute risk of anastomotic leakage and computed ORs using logistic regression models with adjustment for potential confounders. RESULTS: Of the 18,190 patients with colon cancer, anastomotic leakage occurred in 1184 (6.5%). Glucocorticoid use overall was not associated with an increased risk of leakage (6.4% vs 6.9% among never-users; OR 1.05; 95% CI 0.89 to 1.23). Categories of oral, inhaled or intestinal-acting glucocorticoids did not greatly affect risk of leakage. Anastomotic leakage occurred in 695 (13.2%) of 5284 patients with rectal cancer. Glucocorticoid use overall slightly increased risk of leakage (14.6% vs 12.8% among never-users; OR 1.36, 95% CI 1.08 to 1.72). Results did not differ significantly within glucocorticoid categories. CONCLUSIONS: Preadmission glucocorticoids modestly increased the risk of anastomotic leakage mainly after rectal cancer resection. However, absolute risk differences were small and the clinical impact of glucocorticoid use may therefore be limited.

Conization as a marker of persistent cervical human papillomavirus (HPV) infection and risk of gastrointestinal cancer: a Danish 34-year nationwide cohort study.

PURPOSE: Persistent cervical infection with human papillomavirus (HPV) may be a marker of poor immune function and thus associated with an increased cancer risk. HPV infection is implicated in all cases of cervical cancer, but except for anal and esophageal cancers, the association between persistent HPV infection and gastrointestinal cancer has not been investigated. METHODS: We performed a nationwide population-based cohort study of 83,008 women undergoing cervical conization between 1978 and 2011, using cervical conization as a marker of chronic HPV infection. We computed standardized incidence ratios (SIRs) as a measure of the relative risk of each cancer comparing women undergoing conization with that expected in the general population. We also calculated absolute risks. RESULTS: During follow-up, 988 GI cancers occurred versus 880 expected among 83,008 women followed for a median of 14.9 years, corresponding to a SIR of 1.1 (95 % CI 1.1-1.2). Risks were increased for anal (SIR 2.9; 95 % CI 2.3-3.5) and esophageal (SIR 1.5; 95 % CI 1.1-2.0) cancers, with suggested increased risks of cancers of the gallbladder and biliary tract (SIR 1.3; 95 % CI 0.90-1.8), pancreas (SIR 1.2; 95 % CI 0.97-1.4), and liver (SIR 1.1; 95 % CI 0.79-1.6). The SIRs decreased with increasing follow-up time. The risks of gastric, small intestinal, colon, or rectal cancers were not elevated. Overall, the absolute cancer risk was 0.18 % (95 % CI 0.15-0.21) after 5 years. CONCLUSIONS: The relative risks of several gastrointestinal cancers were raised among women who underwent cervical conization for persistent HPV infection, but the absolute risks were low.

Comorbidity and survival of Danish patients with colon and rectal cancer from 2000-2011: a population-based cohort study.

OBJECTIVE: To evaluate recent trends in the prevalence and impact of comorbidity on colorectal cancer (CRC) survival in the Central Region of Denmark. MATERIAL AND METHODS: Using the Danish National Registry of Patients, we identified 5,777 and 2,964 patients with a primary colon or rectal cancer, respectively, from 2000 through 2011. We estimated survival according to Charlson Comorbidity Index scores and computed mortality rate ratios (MRRs) using Cox proportional hazard regression analysis, adjusting for age and sex. RESULTS: More than one-third of CRC patients had comorbidity at diagnosis. During the study period, 1-year survival increased substantially in colon cancer patients with Charlson score 0 (72% to 80%) and modestly for Charlson score 3+ patients (43% to 46%). Using colon cancer patients with Charlson score 0 as reference, adjusted 1-year MRRs in patients with Charlson score 3+ were 2.19 (95% confidence interval [CI]: 1.57-3.05) in 2000-2002 and 2.56 (95% CI: 1.96-3.35) in 2009-2011. One-year survival after rectal cancer improved from 81% to 87% in patients with Charlson score 0 and from 56% to 60% in Charlson score 3+. Corresponding MRRs in patients with Charlson 3+ were 2.21 (95% CI: 1.33-3.68) in 2000-2002 and 3.09 (95% CI: 1.91-5.00) in 2009-2011 using Charlson score 0 as reference. Five-year MRRs did not differ substantially from 1-year MRRs. CONCLUSION: Comorbidity was common among CRC patients and was associated with poorer prognosis. We observed improved survival from 2000 to 2011 for all comorbidity levels, with least improvement for colon cancer patients with comorbid conditions.