Amalie Helme Simoni

Objective: Magnetic resonance imaging (MRI) improves prostate cancer detection, but some tumours may be undetectable. This study assessed prostate cancer detection in biopsy-naïve men undergoing first-time prostate MRI. Material and methods: In this nationwide Danish cohort (2018–2022), men aged ≥ 40 years undergoing first-time prostate MRI were classified as MRI-positive if biopsied within 30 days, and MRI-negative if not. This served as a proxy for the radiology report findings. One-year cumulative incidence of prostate cancer diagnosis in the Danish Prostate Cancer Registry, repeated MRI, biopsy and mortality was estimated by MRI-status (positive/negative) and prostate-specific antigen (PSA) level, using the Aalen–Johansen estimator. Occurrence of high-grade cancer was also assessed. Results: Among 10,777 men, 40% were MRI-positive and 60% MRI-negative. The cumulative incidence of prostate cancer was higher in the MRI-positive than the MRI-negative men during 1-year follow-up (63% vs. 5% at PSA levels 2–3.9 µg/L), increasing with higher PSA levels (91% vs. 38% at PSA levels ≥ 20 µg/L). At 1 year, repeated MRI occurred in 21% of MRI-positive men and 9% of MRI-negative men; the subsequent 1-year biopsy incidence was 15% among MRI-negative men. Mortality was comparable between MRI-positive and MRI-negative men (1% vs. 1%). The risk of high-grade prostate cancer at the time of diagnosis was 80% in MRI-positive and 74% in the MRI-negative men. Conclusions: Among biopsy-naïve men undergoing first-time prostate MRI, MRI-positive status strongly predicts prostate cancer, even in men with low PSA. In MRI-negative men with PSA < 4.0 µg/L, prostate cancer risk remains low within the 2-year follow-up.

The Danish National Patient Registry (DNPR) and the Danish Cancer Registry (DCR) are central to registry-based cancer research. This systematic review evaluates studies assessing the quality of cancer-related data in these registries under their current data structures. PubMed and Embase were systematically searched on January 24, 2025 (PROSPERO: CRD420251005952). Studies validating cancer-related data in the DNPR or DCR against a gold standard were included. Findings were synthesized narratively and categorized by DNPR data, DCR data, or multi-source algorithms. The literature search generated 915 records, of which 50 were included: 23 validated DNPR data, 9 DCR data, and 18 algorithm performance. The quality of DNPR cancer diagnoses and treatment showed positive predictive values (PPVs) of 57–100%, highest for common malignancies and treatments. The quality of DNPR comorbidities and complications varied substantially (PPVs 0–98%). The PPV of a melanoma diagnosis in the DCR was 97%. The DCR staging completeness varied considerably (34–95%). Algorithms presented PPVs of 60–96% for recurrence, active cancer, and recognized metastases, and 28% for unrecognized metastases. The DNPR and DCR provide high-quality data for many cancer diagnoses, treatments, and outcomes, supporting their use in register-based research. While some data elements, including data on complications, exhibit lower quality, algorithmic approaches can enhance utility for less robust data. However, several aspects of cancer-related data remain unvalidated.

Background: Research focusing on health care in end-of-life among cancer patients with mental disorders is limited and presents inconsistent findings. Aim: To investigate disparities in health care in end-of-life among patients who died from lung cancer according to pre-existing mental disorders. Design: A Danish nationwide cohort study linking nationwide registries on health care in end-of-life including specialist palliative care (including hospice admissions), ‘drug reimbursement for terminal illness’, high-intensity-treatment during the last 30 days before death and death at hospital, analysed using Poisson regression, adjusted for sociodemographic and clinical factors. Setting/participants: All adult decedents who died of lung cancer in Denmark from 2011 through 2020, including individuals with mental diagnoses prior to their cancer diagnosis. Results: Among 36,323 patients dying from lung cancer, 12% had pre-existing mental disorders. Patients with mental disorders were less likely to receive specialist palliative care (adjusted risk ratio (RR) 0.90; 95% CI: 0.87; 0.94), hospice admissions (RR: 0.86; 95% CI: 0.80; 0.94), chemotherapy (RR: 0.66; 95% CI: 0.57; 0.76), radiotherapy (RR: 0.82; 95% CI: 0.74; 0.92), surgery (RR: 0.47; 95% CI: 0.22; 1.00), hospital admissions (RR: 0.96; 95% CI: 0.92; 0.99) and to die in a hospital (RR: 0.88; 95% CI: 0.85; 0.91), compared to patients without mental disorders. No disparities were observed in receiving drug reimbursement, admissions to intensive care units or emergency care. Conclusion: Pre-existing mental disorders were associated with a lower probability of specialist palliative care, but also some high-intensity-treatments in end-of-life. These patients may be deprived of optimal palliative care but also appeared less subjected to possible overtreatment in end-of-life compared to patients without mental disorders.

Background The Danish clinical quality registries monitor and improve the quality of care, using quality indicators and defined development targets referred to as ‘standards’. This study aims to investigate the fulfilment of standards in the Danish clinical quality registries in cancer care and screening. Methods Data was included from annual reports in the 27 Danish clinical quality registries in cancer care and screening. The most recent report from each registry was downloaded the 13 December 2023. Indicators were included if: evaluating care or screening over 12 months, presenting a well-defined standard with a desired direction and presenting the proportion and number of individuals for which the standard was fulfilled. Data were extracted on national and regional levels for the last 3 years, and fulfilment of standards was presented as the proportion of indicators that fulfilled the standard within each unit of comparison. Results In total, 216 quality indicators were included. At the national and regional level, standards were fulfilled for 75% and 71%, respectively. Fulfilment within the registries varied from 5% to 100% on national and 12% to 99% on regional level. Standards were more often fulfilled for result (than process indicators) and for established (than supplemental indicators). Altogether, 43% of the standards were fulfilled across all regions delivering data for the specific indicator. Conclusions The approach to defining standards for clinical quality indicators as conservative minimum or ambitious development targets varied in the Danish clinical quality registries in cancer care and screening. This deviating behaviour seriously restrains possibilities for comparing clinical quality across cancers despite the robust infrastructure of the quality registries, limiting the possibilities for overview and prioritising resources and attention to the most urgent cancers.

Background: Higher incidence of acute coronary syndrome (ACS), among those with lower income, has been recognized in the most recent decades. Still, there is a paucity of data on temporal changes. This study aims to investigate 20-year time trends in income-related disparity in the incidence of ACS in Denmark. Methods: This Population-based repeated cross-sectional study included all patients with first-time ACS, aged ≥20 years, registered in the Danish National Patient Registry 1998–2017. Aggregated sociodemographic data for the Danish population was accessed from Statistics Denmark. Yearly incidence rates (IR) and incidence rate ratios (IRR), with the highest-income quartile as a reference, were standardized using cell-specific personal equivalent income according to year, sex and age group with 95% confidence intervals. Interaction analysis was executed for differences in IR of ACS between the lowest- and highest-income quartile over time. Results: A total of 220 070 patients hospitalized with ACS from 1998 to 2017 were identified. The yearly standardized ACS IRs decreased in all income quartiles. However, the IR remained higher in the lowest-income quartile compared to the highest for both men [1998: IRR 1.45 (95% confidence interval, CI 1.39–1.52) and 2017: 1.47 (1.40–1.54)] and women [1998: IRR 1.73 (1.64–1.82) and 2017: 1.76 (1.65–1.88)]. Interaction analysis showed that over the period the difference in IR between the lower- and the highest-income quartile decreased with 1–5 ACS cases per 100 000 person-year. Conclusion: Income-related disparity in the incidence of ACS was present in Denmark between 1998 and 2017. Despite a marked overall decrease in the yearly ACS incidence, the extent of income-related disparity remained unchanged.