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Jakob H Viuff,1 Ilse Vejborg,2 Walter Schwartz,3 Martin Bak,4 Ellen M Mikkelsen1 1Department of Clinical Epidemiology, Aarhus University Hospital,Aarhus N 8200, Denmark; 2Department of Radiology, University Hospital of Copenhagen Rigshospitalet, Copenhagen 2100, Denmark; 3Department of Radiology, Odense University Hospital, Odense C 5000, Denmark; 4Department of Pathology, Sydvestjysk Sygehus, Esbjerg 6700, DenmarkCorrespondence: Jakob H ViuffVirus, Lifestyle and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, Copenhagen 2100, DenmarkEmail jviuff@cancer.dkPurpose: In this cross-sectional study, we evaluated the association between morbidity and participation in the prevalence round of the Danish national mammography screening program.Patients and Methods: Morbidity was assessed by the Charlson Comorbidity Index (CCI) score (0, 1– 2, and ≥ 3) and by 19 individual diagnoses. We retrieved data on participation from The Danish Quality Database of Mammography Screening and on diagnoses from The Danish National Patient Registry. We estimated prevalence proportion ratios (PR) with 95% confidence intervals (CI).Results: In total, 519,009 (79.8%) women participated in the first national breast cancer screening round. Relative to women with a CCI score of 0, the adjusted PRs were 0.96 (95% CI: 0.95– 0.96) for a CCI score of 1– 2 and 0.80 (95% CI: 0.79– 0.81) for a CCI score of ≥ 3. Compared with no disease, the PRs for a diagnosis of the most prevalent, but less severe diseases, chronic pulmonary disease, cerebrovascular disease, diabetes I and II were 0.93 (95% CI: 0.93– 0.94), 0.96 (95% CI: 0.94– 0.96), and 0.96 (95% CI: 0.95– 0.97), respectively. Among women with low prevalent, but most severe diseases, the PRs were 0.69 (95% CI: 0.60– 0.81) for AIDS and 0.73 (95% CI: 0.70– 0.76) for metastatic solid tumor.Conclusion: Women with a high CCI score or one severe chronic condition are less likely to participate in breast cancer screening compared to women without disease. However, these women account for a small proportion of all non-participating women. Thus, it might be most beneficial to maximize breast cancer screening participation in women with less severe although more common morbidities.Keywords: mass screening, mammography, breast cancer, patient compliance, morbidity and comorbidity

Objective: To study the association between use of fertility drugs and colorectal cancer among women with infertility., Design: Population-based cohort study., Setting: Not applicable., Patient(s): The study cohort was obtained from the Danish Infertility Cohort and consisted of all women with infertility aged 20-45 years living in Denmark during 1995-2017., Intervention(s): Information on the use of specific types of fertility drugs, colorectal cancer diagnoses, covariates, and vital status were obtained from the Danish Infertility Cohort and Danish national registers., Main Outcome Measure(s): Cox proportional hazard models adjusted for potential confounders were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for colorectal cancer overall and rectal and colon cancer separately., Results(s): Among 148,036 women in the final study cohort, 205 women were diagnosed with colorectal cancer. Ever use of clomiphene citrate (CC) was associated with a lower rate of colorectal cancer (unadjusted HR, 0.67; 95% CI, 0.51-0.89; adjusted HR, 0.68; 95% CI, 0.50-0.93). However, the lower rate was only seen among women who first used CC >8 years ago (unadjusted HR, 0.56; 95% CI, 0.41-0.76; adjusted HR, 0.52; 95% CI, 0.36-0.75). No marked associations were found between the use of any of other types of fertility drugs and colorectal cancer. The results for colon and rectal cancer analyzed separately were similar, except for a suggestion of a decreased risk of rectal cancer associated with the use of gonadotropins (adjusted HR, 0.46; 95% CI, 0.20-1.08)., Conclusion(s): Among women with infertility, the use of most types of fertility drugs was not associated with colorectal cancer. However, CC may decrease the risk of colorectal cancer and gonadotropins might decrease the risk of rectal cancer, but we cannot rule out that these findings may be more related to the underlying conditions in these women or are chance findings. Consequently, the results from this study should be investigated further in large epidemiological studies., (Copyright © 2022 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)