Danish Medical Journal

Cytology and high-risk human papillomavirus testing to reduce colposcopies in women with postcoital bleeding

INTRODUCTION. Women with postcoital bleeding (PCB) are traditionally referred for colposcopy. A 2022 regional strategy recommends colposcopy only if abnormalities are found in cytology, human papillomavirus testing or by gynaecological examination (GE). This study explores the number of reduced colposcopies using this triad to detect precancerous or cancer lesions and examines the potential for implementing this strategy with general practitioners (GPs). METHODS. Between 1 January 2022 and 15 October 2024, a retrospective cohort study was conducted on women referred with PCB identified using the International Classification of Diseases, tenth version (ICD-10) diagnosis codes "DN930 Bleeding after coitus" and "DN930B Contact bleeding". Data were collected from the hospital's electronic patient files and the Danish Pathology Database. RESULTS. Data from a total of 392 patients were analysed. Among 199 low-risk patients with normal tests, 161 (81%) avoided colposcopy. The combined sensitivity of cytology and hrHPV tests was 97%, detecting 33 of 34 CIN2+ cases. One CIN2+ case was missed by both tests but identified by GE. GP agreed with gynaecologists in 53% of abnormal GE findings, whereas 47% were misclassified as normal GE findings. CONCLUSIONS. Combining cytology, hrHPV testing and GE reduces unnecessary colposcopies in low-risk women with PCB by 81%. The triadic approach successfully identified all CIN2+ cases. Implementing the new strategy with GPs is challenging due to GPs' limited accuracy in identifying abnormal GE findings. FUNDING. None. TRIAL REGISTRATION. Not relevant.

Addressing geriatric oncology in Danish cancer guidelines to meet future challenges

INTRODUCTION. The risk of cancer increases with age. Furthermore, frailty and age-related impairments significantly impact treatment outcomes. With an aging population, it is crucial to ensure a tailored, evidence-based cancer care approach. This study evaluated the extent to which frailty and age-related considerations are incorporated into current Danish national cancer guidelines across six frequent cancer types. METHODS. We systematically reviewed all guidelines from the Danish Multidisciplinary Cancer Groups on lung, breast, colorectal, ovarian, bladder and prostate cancer. Guidelines were screened to identify how they address age, frailty, performance status (PS), comorbidity, functional status, general health status and individualised assessment. Identified comments were graded based on their level of specificity and clinical applicability. RESULTS. All cancer guidelines addressed age and comorbidity. Frailty was explicitly mentioned in four out of six, of which only one guideline provided specific recommendations. PS was frequently included (5/6), and individualised assessments were encouraged in four of six guidelines, but lacked clarity regarding implementation. CONCLUSIONS. Danish national cancer guidelines acknowledge age, PS and comorbidity, but lack specific recommendations for frailty assessment and management. By addressing these gaps, we encourage future guidelines to include recommendations on frailty assessment to help clinical decision-making and improve treatment outcomes for older people with cancer. FUNDING. None. TRIAL REGISTRATION. Not relevant.

Register-based algorithm to detect post-operative complications in patients with ovarian cancer

INTRODUCTION. Epithelial ovarian cancer (OC) is the most fatal gynaecological cancer. The use of extensive surgical procedures implies the potential severity of post-operative complications. In Denmark, registration of complications has changed from manual database registration to data transfer from medical records to the Danish National Patient Registry (NPR). This study examines whether a new complication algorithm based on NPR data may be used to identify 30-day post-operative complications among patients with advanced stage IIIC–IV OC. METHODS. Complications were graded according to Clavien-Dindo (CD). The algorithm was validated in a cohort undergoing surgery at the OUH, between 1 January 2007 and 31 December 2012. The CD grades were sub-grouped into mild (CD 0-2) and severe (CD 3-5) complications for sub-analyses. RESULTS. A total of 330 patients were included. The overall sensitivity (SN) and specificity (SP) of the algorithm (CD 0-5) were 56.4% (95% confidence interval (CI): 48.0-65.0%) and 92.4% (95% CI: 86.5-93.0%), respectively, with an overall kappa coefficient (κ) of 0.43. For severe complications (CD 3-5), the algorithm had an SN of 74.2% (95% CI: 67.4-83.6%) and an SP of 97.4% (95% CI: 95.5-99.4%), with a κ of 0.65. CONCLUSIONS. The algorithm had a moderate SN and a high SP with substantial agreement regarding severe complications. A standardised registration of complications in the NPR will likely improve the algorithm's performance. FUNDING. The Danish Clinical Quality Program DKK 200,000. TRIAL REGISTRATION. Not relevant.